In this post we will be looking at a summary of some key points from an analysis carried out by two senior examiners for the CSA (Drs Sue Rendel and Kamila Hawthorne) working in partnership with an expert in linguistics and discourse analysis (Professor Celia Roberts from Kings). This is the second in the series and it is about mastering communicative flexibility.
Research found that poor performance was associated with a ‘rigid consultation style’. Doctors that sounded like they were reading from a script, or interrogating the patient with a set list of questions didn’t do so well.
Situational awareness is about recognising who is front of you and how they are behaving. But recognition is not enough, you need to show your recognition in what you say and do.
Here are some things to look out for.
Show you are aware of patients with different cultural beliefs whilst avoiding assumptions.
A few questions can help identify cultural issues:
‘Do you have any dietary or fasting requirements’
‘Are there any religious or spiritual practices that are important in your care’
‘Do you use any traditional remedies?’
‘What language are you most comfortable with?’
Show your assessment of health literacy.
1. 👂Listen to the language used to get a steer on the patient's level of understanding.
2. Show your awareness of their level of understanding by adjusting your language accordingly.
For example, you might pick up on the words the patient uses.
Consider using phrases that expect questions from patients, to help overcome patient reluctance to admit a need for clarification.
‘What questions do you have about your diagnosis or next steps?’
‘Would you like me to explain that in a different way?’
‘Would written instructions help?’
Different generations have different communication preferences. Find out how patients want to communicate. It can be dangerous to assume that the young are tech able and the old tech incompetent.
Modify your speech pattern and vocab to suit your audience
Don’t assume, ask.
Ask patients with communication difficulties how you can communicate best. Some patients want you to speak slowly or loudly or write things down, but others are offended if you do so, so it is best to ask patient preference.
‘I understand you have some hearing problems, what is the best way for me to communicate’
Adapt your questions to maintain a logical flow
Don’t plough ahead with a fixed question list ignoring the patients response. Research found that passing candidates ‘embedded their questions in the patients previous response’ i.e. Your next question should include a response to the patient.
That is enough for this week. Why not listen back to your consults. Do you employ these practices? See if you can try out more of these in your everyday practice and recordings.
Author
N. Boeckx
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