Importance of Communication and Counseling Skills in Clinical Settings
Tutorial:
Communication
& Counseling in
Clinical Setting
Dr. Leena Baghdadi
MBBS, Master CliEpi, PhD CliEpi
Assistant Professor & Clinical Epidemiologist | Family
& Community Medicine| College of Medicine | KSU
Dr L Baghdadi March 2019
1
Objectives:
To understand the concepts of communication
and counseling
To learn why are communication& counseling
skills important ?
To learn the theories and stages of counseling
What are the possible barriers ?
Discuss one practical example of counselling
Dr L Baghdadi March 2019
2
Why Communication & Counseling
Skills?
When doctors use consultation & counseling
skills effectively:
Patients’ problems identified more accurately
Patients more satisfied with their care
Patients more likely to comply with treatment
Patients’ distress & vulnerability to anxiety &
depression are lessened
Dr L Baghdadi March 2019
3
Why
Communication
/ Counseling Skills?
When doctors use consultation skills effectively
Doctors’ and patients wellbeing is improved
Few clinical errors are made
Patients are less likely to complain
Reduced likelihood of doctors being sued
Dr L Baghdadi March 2019
4
Communication
Skills
You often need to be bearers of the worst
imaginable news
You have to arrange complex and often
uncertain information into something
understandable
You have to respond to differing needs of a
hugely diverse range of patients and their
families
And
you have to do much of this when you
are busy and under pressure
Dr L Baghdadi March 2019
5
What is Counseling?
It is the skilled and principled use of relationship
to help the patient develop self-knowledge,
emotional acceptance and growth including
personal resources
Counselors who offer warmth and empathy are
more effective
Dr L Baghdadi March 2019
6
It is an opportunity to talk to a person in non-
judgmental and supportive way.
To better understand his/her current problems
To identifies strategies to help problem solve.
Dr L Baghdadi March 2019
7
Aims of counseling
To help people accept and come to terms with their
difficulties and identify ways of coping more effectively and
resourcefully
The counselor listens and asks questions until both counselor
and client understand the way the client sees things
The counselor enables the client to clarify thoughts and
feelings for better understanding of the problem
Dr L Baghdadi March 2019
8
Stages of Counseling
Exploration:
Enabling the patient to explore the problem
himself and then focus on specific concerns
New understanding:
To see both, themselves and their
situation in new perspectives and how to cope more
effectively
Goal setting
Action:
Possible ways to act ; costs/consequences, planning,
implementation and evaluation ; creative thinking, problem
solving and decision making
Dr L Baghdadi March 2019
9
Deficiencies in Communication
&Counseling
Doctors may not obtain enough information
about patients’ perspective
Provide information in inflexible way
Pay little attention in checking how well
patients have understood
Less than half of patients’ psychological
morbidity is recognized
Dr L Baghdadi March 2019
10
Reasons for patients not disclosing
problems
•
Belief that nothing can be done
•
Reluctance to burden the Doctor
•
Desire not to appear pathetic or ungrateful
•
Concern that it is not legitimate to mention them
•
Doctors’ blocking behavior
•
Worry that their fears about what is wrong with
them will be confirmed
•
Lack of confidentiality and trust
Dr L Baghdadi March 2019
11
The Evidence Base
•
54% of patient
’
s problems & concerns not elicited
(Stewart et al, 1979).
•
Doctors frequently interrupted their patients soon
after their opening statement (mean time 18
seconds) so patients subsequently failed to disclose
significant
(Beckman and Frankel, 1984).
•
Failing to discover the patients feelings and
concerns led to dysfunctional consultations and
counselling (Byrne and Long, 1976).
Dr L Baghdadi March 2019
12
What is a failed communication/
Counseling?
No rapport
Using medical jargon
Not exploring the patients agenda
Not eliciting the actual problem
No contingency plan
No summarization
Failing to clarify
Not exploring in socio-cultural & economic context
Dr L Baghdadi March 2019
13
Problems & Limitations in
Communication & Counseling:
Shortage of time
Language barrier – low literacy
Firm misconceptions and myths
Lack of awareness
Not ready to take responsibility for own illness
Socio-cultural, economic barriers
Fatalistic attitude (It’s God’s will)
Dr L Baghdadi March 2019
14
Barriers to Communication/Counseling
in Clinical Practice
Personal Barriers
Lack of training: undergraduate/postgraduate
Undervaluing importance of communication
Focus only on treating diseases
Personal Limitations
Organizational Barriers
Lack of time
Pressure of work
Interruptions
Dr L Baghdadi March 2019
15
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Dr L Baghdadi March 2019
16
Example 1
Dr L Baghdadi March 2019
17
Smoking Cessation Counselling
Domains to be assessed:
A. Professional Behavior
B. Data Gathering
C. Management
Dr L Baghdadi March 2019
18
Professional Behavior
Building Rapport
Showing empathy
Good posture
Appropriate body language
Avoids interruptions
Dr L Baghdadi March 2019
19
Data Gathering
Exploring Smoking History
:
Number if cigarettes
First cigarettes time
Previous attempts to quit
Motivation
Smokers around the patients?
Dr L Baghdadi March 2019
20
Data
Gathering
General Health issues:
Cardiovascular diseases
Chronic cough
Depression
Any suicidal ideations, etc …
Opportunistic Screening:
Blood Pressure, obesity, adolescent issues,
stress, depression etc…
Dr L Baghdadi March 2019
21
Data Gathering
Exploring ICE :
Idea:
want to give up, any options available
around ??
Concern:
fear of lung cancer.
Expectation:
I might get some prescription to
quit smoking
Dr L Baghdadi March 2019
22
Management
Discuss different pharmacological and non-
pharmacological issues
Patient’s ideas regarding medications
Offering choices of Nicotine Replacement
Therapy e.g. patches and gums
Any cost issues to buy this treatment
Agree on quit date
Respect his treatment choice
Involvement of smoking cessation clinics (with
patient agreement)
Follow up in 2 weeks after quit date
Dr L Baghdadi March 2019
23
Competencies to cover
Dr L Baghdadi March 2019
24
Example 2
Dr L Baghdadi March 2019
25
A 20 years old college student visits the health center for
concerns over her increasing weight. You see that her BMI
is greater than 30.
How will you approach this student, within context of the
5A
approach to counselling?
Please use the attached file to answer the question.
https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21394
Dr L Baghdadi March 2019
26
Thank you
Dr L Baghdadi March 2019
27
Dr. Leena Baghdadi, an Assistant Professor and Clinical Epidemiologist, emphasizes the significance of effective communication and counseling skills in clinical practice. The content discusses the objectives of understanding these skills, barriers, and practical examples of counseling. Highlighted benefits include accurate problem identification, patient satisfaction, compliance with treatment, and reduced distress. Counseling is defined as a principled approach to fostering self-awareness and emotional growth. Effective communication and counseling contribute to improved patient care and reduced clinical errors.
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Presentation Transcript
Tutorial: Communication & Counseling in Clinical Setting 1 Dr. Leena Baghdadi MBBS, Master CliEpi, PhD CliEpi Assistant Professor & Clinical Epidemiologist | Family & Community Medicine| College of Medicine | KSU Dr L Baghdadi March 2019
Objectives: 2 To understand the concepts of communication and counseling To learn why are communication& counseling skills important ? To learn the theories and stages of counseling What are the possible barriers ? Discuss one practical example of counselling Dr L Baghdadi March 2019
Why Communication & Counseling Skills? 3 When doctors use consultation & counseling skills effectively: Patients problems identified more accurately Patients more satisfied with their care Patients more likely to comply with treatment Patients distress & vulnerability to anxiety & depression are lessened Dr L Baghdadi March 2019
Why Communication/ Counseling Skills? 4 When doctors use consultation skills effectively Doctors and patients wellbeing is improved Few clinical errors are made Patients are less likely to complain Reduced likelihood of doctors being sued Dr L Baghdadi March 2019
CommunicationSkills 5 You often need to be bearers of the worst imaginable news You have to arrange complex and often uncertain information into something understandable You have to respond to differing needs of a hugely diverse range of patients and their families And you have to do much of this when you are busy and under pressure Dr L Baghdadi March 2019
6 What is Counseling? It is the skilled and principled use of relationship to help the patient develop self-knowledge, emotional acceptance and growth including personal resources Counselors who offer warmth and empathy are more effective Dr L Baghdadi March 2019
7 It is an opportunity to talk to a person in non- judgmental and supportive way. To better understand his/her current problems To identifies strategies to help problem solve. Dr L Baghdadi March 2019
8 Aims of counseling To help people accept and come to terms with their difficulties and identify ways of coping more effectively and resourcefully The counselor listens and asks questions until both counselor and client understand the way the client sees things The counselor enables the client to clarify thoughts and feelings for better understanding of the problem Dr L Baghdadi March 2019
9 Stages of Counseling Exploration: Enabling the patient to explore the problem himself and then focus on specific concerns New understanding: To see both, themselves and their situation in new perspectives and how to cope more effectively Goal setting Action: Possible ways to act ; costs/consequences, planning, implementation and evaluation ; creative thinking, problem solving and decision making Dr L Baghdadi March 2019
Deficiencies in Communication &Counseling 10 Doctors may not obtain enough information about patients perspective Provide information in inflexible way Pay little attention in checking how well patients have understood Less than half of patients psychological morbidity is recognized Dr L Baghdadi March 2019
Reasons for patients not disclosing problems 11 Belief that nothing can be done Reluctance to burden the Doctor Desire not to appear pathetic or ungrateful Concern that it is not legitimate to mention them Doctors blocking behavior Worry that their fears about what is wrong with them will be confirmed Lack of confidentiality and trust Dr L Baghdadi March 2019
The Evidence Base 12 54% of patient s problems & concerns not elicited (Stewart et al, 1979). Doctors frequently interrupted their patients soon after their opening statement (mean time 18 seconds) so patients subsequently failed to disclose significant (Beckman and Frankel, 1984). Failing to discover the patients feelings and concerns led to dysfunctional consultations and counselling (Byrne and Long, 1976). Dr L Baghdadi March 2019
What is a failed communication/ Counseling? 13 No rapport Using medical jargon Not exploring the patients agenda Not eliciting the actual problem No contingency plan No summarization Failing to clarify Not exploring in socio-cultural & economic context Dr L Baghdadi March 2019
Problems & Limitations in Communication & Counseling: 14 Shortage of time Language barrier low literacy Firm misconceptions and myths Lack of awareness Not ready to take responsibility for own illness Socio-cultural, economic barriers Fatalistic attitude (It s God s will) Dr L Baghdadi March 2019
Barriers to Communication/Counseling in Clinical Practice 15 Personal Barriers Lack of training: undergraduate/postgraduate Undervaluing importance of communication Focus only on treating diseases Personal Limitations Organizational Barriers Lack of time Pressure of work Interruptions Dr L Baghdadi March 2019
16 Good communication & counseling is good for doctors good for patients and good for the health service Dr L Baghdadi March 2019
Example 1 17 Dr L Baghdadi March 2019
Smoking Cessation Counselling 18 Domains to be assessed: A. Professional Behavior B. Data Gathering C. Management Dr L Baghdadi March 2019
Professional Behavior 19 Building Rapport Showing empathy Good posture Appropriate body language Avoids interruptions Dr L Baghdadi March 2019
Data Gathering 20 Exploring Smoking History : Number if cigarettes First cigarettes time Previous attempts to quit Motivation Smokers around the patients? Dr L Baghdadi March 2019
Data Gathering 21 General Health issues: Cardiovascular diseases Chronic cough Depression Any suicidal ideations, etc Opportunistic Screening: Blood Pressure, obesity, adolescent issues, stress, depression etc Dr L Baghdadi March 2019
Data Gathering 22 Exploring ICE : Idea: want to give up, any options available around ?? Concern: fear of lung cancer. Expectation: I might get some prescription to quit smoking Dr L Baghdadi March 2019
Management 23 Discuss different pharmacological and non- pharmacological issues Patient s ideas regarding medications Offering choices of Nicotine Replacement Therapy e.g. patches and gums Any cost issues to buy this treatment Agree on quit date Respect his treatment choice Involvement of smoking cessation clinics (with patient agreement) Follow up in 2 weeks after quit date Dr L Baghdadi March 2019
Competencies to cover 24 The OSCE will accomplish the assessment of the students in the following competencies : Patient education Undertaking of population healthcare in health system in Saudi Arabia Orientation to health services/providers in the community Applying bio-psycho-social approach in certain clinical and community encounters Health promotion and disease prevention in the community Role as a health advocate Apply general principles of communication skills Dr L Baghdadi March 2019
Example 2 25 Dr L Baghdadi March 2019
26 A 20 years old college student visits the health center for concerns over her increasing weight. You see that her BMI is greater than 30. How will you approach this student, within context of the 5A approach to counselling? Please use the attached file to answer the question. https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21394 Dr L Baghdadi March 2019
Thank you 27 Dr L Baghdadi March 2019
