Healthcare Communication

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Healthcare Communication

Bruce Hugman BA MA DipEd International Training and Communications Consultant Communications Consultant to the WHO Foundation Collaborating Centre for International Drug Monitoring (the Uppsala Monitoring Centre, Sweden) He lives in Thailand.

(RP)

London • Chicago Pharmaceutical Press

r Contents

Preface xii About the author xiv Acknowledgements xv

Part A: Getting started Introduction 3 Learning from you 4 2 Signposts for the journey through this book 5 3 The basic framework for working with patients

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Part B: The nature and importance of communication

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4 What is effective communication? 15 The basics 15 Interaction 16 The revolution we cannot ignore 18 The essentials in healthcare 18 Different planets 20 5 Why do we communicate? 21 The purposes of communication 21 The social urge 22 What are! we all looking for? 23 Conclusion 24 6 Communications at the heart of healthcare 25 A tough life 25 Asserting the need for change 27 Revision{ discussion and application (1) 29

Part C: Aims and ideals in healthcare 7 Vision at the heart of healthcare 33 Pursuing a vision 33 Coping with limits 35 8 Ethics in healthcare communication 37 The stern face of professional ethics

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Highest level principles 38 Transparency 38 Does the truth hurt? 39 Making choices about communicating the truth 40 The ethics and problems of altruism 42 Take care of the staff 42 Making demands 42 Authority and power in healthcare relationships 43 Revision, discussion and application (2) 45

Part 0: Behind the scenes

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9 Secret life: what drives us in communications? 49 The foundations 49 Interaction 49 The interplay of personal and social factors 50 First impressions 52 Perception 53 Personality and motivation 54 Formative experiences 55 The underlying script 56 The influence of social and organisational values 57 Conclusion 58 10 Beyond words: the power of non-verbal communication 59 Multiple factors beyond words 59· Divergence 61 Monitoring and moderating non-verbal behaviour 63 The physical environment 64 Managing and using non-verbal communication 64 Intelligent observation 65 Echoing and mirroring 66 Touch 66 Revi~ion, discussion and application (3) 69

Part E: Foundation knowledge and skills for effective communication

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11 Core concepts and skills 73 Caring 73 Helping 74 IlIur)1i,nating effects 79 Listening 80 Questioning '82 Active listening, prompting, probing 86 Explanation 87 Checking understanding and seeking feedback Summary 89

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12 Special communication needs and processes Being a patient 91 Self-image 93 Patients and pain 94 Bedside manner and home visiting 96 Sustaining long-term relationships 99 Motivation 99 Disclosure 101 Attachment 102 Revision, discussion and application (4) 105

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Part F: The complexity of humanity

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13 The diversily of patients: disturbances and dysfunctions 109 I The impact and meaning of abuse 109 Anger and angry patients 111 Depression and other mental disorders 117 Patients under stress and in crisis 121 The worried well 123 'Difficult' patients 125 14 Communication and the richness of cultural and ethnic diversity 127 Introductory review of basic issues . 127 Overview of diversily issues and responses to difference 127 Topics 129 Conclusion 141 Revision, discussion and application (5) 143

Part G: Working together 15 The whole team and the whole patient 147 Differential demands 147 The whole organisation addressing the whole person 147 Consultations, tests and procedures 148 ,. Nurses' special role in the care of patients - a model for healthcare 152 The pharmacist's special role in care of patients 155 Physical and rehabilitative therapy 157 The great importance of non-medical personnel 157 16 When time and resources are limited 161 Personal slyle 161 Resource triage 161 Emergency and urgent care 166 Financial and other constraints 167 Rational allocation of resources 168 Revision, discussion and application (6) 171

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r Part H: Tough topics

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17 Patient safety 175 More harm than good? 175 Safety issues relating to medicines 176 Quality, availability and accessibility of drug safety information Patients' expectations of safety 1 80 Pharmacovigilance and error reporting 180 Inappropriate use 181 Adherence 1 81 Medication errors 1 83 Falls and accidents 1 86 Expert patients 1 86 Conclusion 1 87 18 Informed consent 189 Essential and difficult 189 Reaching agreement 190 Conclusion 193 19 Risk communication 195 Risk factors 195 The problem of good information, 196 Risk: knowledge and attitudes 196 Consult Dr Paling 199 What to do 201 Uncertainty 205 Conclusion 206 20 Sex and sexual orientation 209 Sex and sexuality 209 Gay, lesbian and transgender people 211Homosexuality and healthcare 212 Language 214 ConClusion 214 21 ""Dyi,ng and death 217 . Responding to death 217 Being ready 21 8 Dying is a process, not an event 220 Loss and mourning 220 Conclusion 221 ;, Revision, discussion and application (7) 223

Part I: The broader communications picture 22 Effective written and spoken communication Clarity of purpose 227

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Targeting/segmentation 227 Audience 228 Method or channel 229 Feedback 230 Repetition 231 Benefits 231 Style, tone, language and structure 232 Structure and economy 232 Visual impression 233 Emails 233 Telephone 235 Individual and proforma letters 238 Report writing 238 Public speaking and presentations 239 Design 240 Conclusion 242 23 Complaints, apologies and public relations '243 Learning from patient dissatisfaction 243 What to do 244 Complaints policy 245 Public relations (PR) 246 24 Notes on media relations 249 Essential relations 249 The essence 249 Active collaboration 251 Conclusion 252 25 Notes on managing meetings 253 26 The challenges of teaching 259 The good, the bad and the sleepy 259 Ihspiration, engagement and interaction 260 Revision, discussion and application (8) 263 Appendix 7: chapter notes and references 265 Appendix 2: Useful books and websites 285 Appendix 3: The Calgary-Cambridge consultation analysis 297 Index 297

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Index

abbreviations, for medication-related documentation, 185 absent-mindedness, 80 abuse victims, 109-11 domestic violence, 111 legacies of childhood abuse, 109,110 abusive communication, 22 acceptance, 92 access to healthcare, 25, 33 accidents to patients/healthcare professionals, 186 risk statistics, 197 active listening, 86, 165 adherence, 11,27, 181-3 adverse drug reactions, 175,177 information for patients, 178,179,180 pharmacovigilance, 180-1 reporting, 180-1 risk communication, 180 information sources, 196 management, 206 advertorials, 250 age, interpersonal interactions influence, 50 aggression, 66, 115-16 emergency procedures, 117 linked to mental disturbancelintoxication, 116-17 management approaches, 116 preventive organisational strategies, 116 altruism, 37, 38, 42, 43 ambivalence, 103 anger, 66,111-12 destructive, 113 management approaches, 112-13,114 acknowledgement of feelings, .. 114-15 in patients, 113-15 ." with patients, 113 telephone communications, 236 antibiotics, inappropriate prescribing, 181 anticipation of future needs, 12 antisocial personality disorders, 120 anxiety, 124 reduction during team-based care, 150 appointments, cultural issues, 132-3 approval-seeking behaviour" 86 assisted suicide, 220 attachment, 102, 103 attentiveness, 127, 163 listening skills, 81, 82 transcultural communication, 140 audience, 228-9 market research, 229

media communications targeting, 249 reaction, 229 segmentation, 227-8 styles of communication, 232 authoritarian relationships, 18 authority, healthcare professional's role, 43 I automatic answering systems, 236 autonomy, 38,41, 75 cultural issues, 136 hospitalized patients, 96 bathing facilities, cultural issues, 134 bedside manner, 96,97-8 beneficence, 38 benefits, emphasis in communications, 231-2 best interests principle, 37,38,42,43 best practice, 11,27,28 bipolar disorder, 120, 124 bisexual people, 212, 213 body language, 59, 60, 61, 164 boundaries, 43, 67 ' professional, 103---4 breathing techniques, stress management, 122 bullying behaviour, 115 Calgary-Cambridge consultation analysis, 291-5 carIng as core skill, 73---4 nurses' vocational values, 153, 154 patients in crisis, 123 catering priOrIties, 159 catering staff, 159 chairpersons, 253, 254 channels of communication, 229-30 checking understanding, 12, 19 with common language limitations, 132 complaints management, 244 consultation under time limitations, 165 as core skill, 89 informed consent process, 192 telephone communication, 237 child abuse, 111 patient history, 109, 110 childbirth, 28 childhood experiences, 55 children bedside manner, 97 capacity for informed consent, 192 family response to hospitalisation, cultural differences, 135-6 civil partnership, 213

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clarification with common language limitations, 131,132 complaints management, 244 probing questions, 87 teaching skills, 261 class prejudice, 54 cleaning staff, 157-8, 186 clinical pharmacists, 155, 156-7 clinical trial participation, 37 informed consent, 189 closed questions, 82-3, 165 clothing, 59 cultural issues, 134 coercive communication, 22 cognition, cultural issues, 129-30 collaboration, 17, 21, 52 cultural issues, 130 'difficult' patients, 125 problems in healthcare systems, 27 commitment to patient care, 73, 163 community empowerment, 168-9 community outcome preferences, 204 compassion, 127 ideal healthcare practice, 34,35, 163 complaints, 243-6, 247 apologising, 246 liability, 244-5 management procedure, 244-5 persistent complainers, 246 serious, 244 complaints policy, 245 computer-based prescribing systems, 177 concern for people, 127 demonstrating empathy, 78-9 ideal healthcare practice, 34, 35, 163 nursing skills, 153, 154 confidence intervals, 205 confidentiality, cultural issues, 136, 139 conflict resolution, 43 consent see informed consent consent form, 190, 192, 193 contact names/numbers, 12 content of communication, 16,56, 65,227 continuity of care, 12, 151, 152, 166 core skills, 73-89 courtesy cultural issues, 136-7 home visiting, 98-9