76. Communicating Skills With Patients

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76. Communicating Skills With Patients

76. Communicating Skills With Patients



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Foreword by Myriam Deveugele vi
Foreword by Anthony L Suchman viii
Preface to the third edition x
Preface to the second edition xi
About this book xv
About the authors xvi
Acknowledgements xvii
Introduction 1
1 Defi ning what to teach and learn: an overview of the
communication skills curriculum 7
Introduction 7
More effective consultations 8
Improved health outcomes 8
A collaborative partnership 9
Plan of chapter 10
Types of communication skills and how they interrelate 10
The problem of separating content and process skills in
teaching and learning about the medical interview 12
An overall curriculum of doctor–patient communication skills 14
The Calgary–Cambridge Guide 14
The enhanced Calgary–Cambridge Guides 16
The need for a clear overall structure 27
Choosing the process skills to include in the communication
curriculum 29
The research and theoretical basis that validates the inclusion
of each individual skill 30
Underlying goals and principles of communication that
helped in choosing the skills 31
Skills and individuality 32
Relating specifi c issues to core communication skills 33
Summary 34
2 Initiating the session 35
Introduction 35
Problems in communication 35
Objectives 36
Skills 37

iv Contents
‘What’ to teach and learn about the initiation: the evidence for
the skills 38
Preparation 38
Establishing initial rapport 39
Identifying the reason(s) for the consultation 42
Summary 57
3 Gathering information 59
Introduction 59
Problems in communication 59
Objectives 61
The content of information gathering in medical interviews 62
The traditional medical history 62
The disease–illness model 64

An alternative template for the content of the information-
gathering section of the interview 69

The process skills of information gathering 72
Exploration of the patient’s problems 73
Additional skills for understanding the patient’s perspective 88
Putting the process skills of information gathering together 101
The complete versus the focused history in information gathering 103
The effect of clinical reasoning on the process of information
gathering 106
Summary 108
4 Providing structure to the interview 109
Introduction 109
Objectives 110
Skills 111
‘What’ to teach and learn about providing structure: the evidence
for the skills 112
Making organisation overt 112
Attending to fl ow 117
Summary 118
5 Building the relationship 119
Introduction 119
Problems in communication 122
Objectives 123
Skills 124
‘What’ to teach and learn about building the relationship: the
evidence for the skills 125
Using appropriate non- verbal communication 125
Developing rapport 133
Involving the patient 146
Summary 148

6 Explanation and planning 149
Introduction 149
Problems in communication 149
Objectives 155
The content of explanation and planning 156
The process skills of explanation and planning 157
Providing the correct amount and type of information 161
Aiding accurate recall and understanding 171
Achieving a shared understanding – incorporating the
patient’s perspective 177
Planning – shared decision making 188
Options in explanation and planning 207
Summary: explanation and planning is an interactive process 213
7 Closing the session 215
Introduction 215
Objectives 215
The process skills for closing the session 216
‘What’ to teach and learn about endings: the evidence for the skills 217
Summary 221
8 Relating specifi c issues to core communication skills 223
Introduction 223
Specifi c issues 224
Breaking bad news 224
Cultural and social diversity 233
Age- related issues 240
– communicating with older patients 241
– communicating with children and parents 244
The telephone interview 248
Patients with mental illness 251
Medically unexplained symptoms 259
Other communication issues 260
Further reading 261
References 263
Index 295
Author index 302



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