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Are you ready yet?

What do you do before you interact with your next customer, client or patient?

Gaze and body orientation communicate levels of engagement with and disengagement from courses of action. As doctors and patients accomplish regular tasks preparatory to dealing with patients’ chief complaints, doctors use gaze and body orientation to communicate that they are preparing but are not yet ready to deal with those complaints. In response, patients wait for their doctors to solicit their chief complaint. These findings have implications for research on nonverbal communication, interactional asymmetry, and power.

JD Robinson

Picture by Mad African

I am Joe and I get what I want

As I surveyed the new intake of medical students one student found his way to the front of the room.

Are you the associate dean?

When I confirmed he went on:

My name is Joe ( Not his real name- to spare his blushes). You need to know that I get what I want.

Now two years later here was Dr. Joe graduating, resplendent in his academic gown. He has his wish which I hope is for a lifetime of selfless service to people in distress. So when he is called to the patient in bed 9, on the wards tonight and he is told:

I’m Mr. Smith, and you need to know I get what I want. Tell your boss to come to my room at 11am, I’ll be ready for him then and by the way I’m not happy taking those pill, please take them away.

Joe will know he has got his wish.

Picture by KC

What did you think about on the way to work?

What did you think about as you made your way to work? Were you already at work in your head? Ruminating on the past? Worrying about the future? Did you grumble to yourself about the commute? The unreliable public transport? The traffic jam? The ‘idiot’ who cut you off at the junction? Did you read the ‘fake news’? Did you look at Instagram posts or catch up on Facebook? Were you one of those people yelling into your phone on the bus or tram?

Immediately following their regular commute to work, participants completed questionnaires regarding state driver stress and anger during that commute. Then, immediately following completion of that work day, they completed a state version of the Workplace Aggression Scale. As state driver stress increased, the frequency of both expressed hostility and obstructionism increased (independently) during that work day, but only among male employees. In contrast, overt aggression during that work day was greatest among males who were higher in physical aggressiveness as a general trait characteristic. The present study highlights the interactive nature of traffic and workplace environments, in that negative experiences in the traffic environment may spill over for some individuals to influence non driving events

Journal of Applied Social Psychology Dwight A. Hennessy

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Did this person need those pills?

No matter what business you are in you might ask yourself if whatever you just sold to your customer is what they really needed. If you are a doctor that question cuts deeper- did you really identify  that person’s problem or did your prescription just get them out the door?

Inappropriate prescriptions are known to pose health risks for older adults, leading to unnecessary hospitalisations and undue cost. Budnitz et al

Picture by Brent Matthew Lillard

How do you explain?

In any meeting where you are the expert how do you explain technical details? As a doctor how do you explain viral illness? Warts? Heart disease? Cancer? How do you know the other person ‘gets it’? Do you say the same thing every time? Do you use pictures? Sounds? Have you practiced the script as much as you practice other aspects of your art? Why or why not?

Andrew McDonald wrote in the BMJ:

The development of such a language, securely founded in shared meanings, would be a good first step towards better communication between professionals and patients. It would not, of course, deliver the goal of full participation in decision making, but that goal will remain elusive unless we begin by understanding one another.

Picture by Marco Verch

How do you end your meetings?

We know how to start a meeting- we stand up, shake hands, say hello, smile. But what’s the best way to end a meeting? It matters for one reason:

The peak–end rule is a psychological heuristic in which people judge an experience largely based on how they felt at its peak (i.e., its most intense point) and at its end, rather than based on the total sum or average of every moment of the experience. The effect occurs regardless of whether the experience is pleasant or unpleasant. Wikipedia

If you are a doctor this is all the more important because people generally don’t seek a meeting with you because all is well. They may be experiencing all sorts of unpleasant feelings. So how do you end that meeting? How do you know it’s working?

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Why don’t people take medical advice?

Significant proportions of people walk out of doctors’ clinics and disregard or fail to act on the opinion offered.  What practitioners can do to help is to review their communication style. As Bungay Stanier has suggested it can’t be assumed that the first thing the person mentions is what is bothering them the most. Bungay Stanier’s suggested questions will reduce the rush to action. A rush that fails to identify the issue that the patient may feel is a greater priority than hypertension or diabetes.

I summarise the issue in this video:

 

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What is said to people when drugs are prescribed for life?

Every day doctors suggest that one or other of their patients have to take medication for life. Hypertension, diabetes and certain deficiencies are among the many conditions that may benefit from taking medication longterm. On the other hand, many people reject this advice or take the prescribed drugs only sometimes. Ultimately the decision to accept treatment is for the person with the condition to decide. How can the advice be tailored so that the person is making an informed decision?

BACKGROUND: ‘Concordance’ has been proposed as a new approach towards sub-optimal medication use; however, it is not clear how this may be achieved in practice. AIM: To develop a strategy for understanding sub-optimal medication use and seek concordance during primary care consultations. DESIGN: A developmental qualitative study using a modified action research design. SETTING: Three Scottish general practices. METHOD: Patients using treatment sub-optimally and having poor clinical control were offered extended consultations to explore their situation. Their authority to make treatment decisions was made explicit throughout. Clinicians refined a consultation model during ten ‘Balint-style’ meetings that ran in parallel with the analysis. The analysis included all material from the consultations, meetings, and discussion with patients after the intervention. RESULTS: Three practitioners recorded 59 consultations with 24 adult patients. A six-stage process was developed, first to understand and then to discuss existing medication use. Understanding of medication use was best established using a structured exploration of patients’ beliefs about their illness and medication. Four problematic issues were identified: understanding, acceptance, level of personal control, and motivation. Pragmatic interventions were developed that were tailored to the issues identified. Of the 22 subjects usefully engaged in the process, 14 had improved clinical control or medication use three months after intervention ceased. CONCLUSIONS: A sensitive, structured exploration of patients’ beliefs can elucidate useful insights that explain medication use and expose barriers to change. Identifying and discussing these barriers improved management for some. A model to assist such concordant prescribing is presented. Dowell et al BJGP

I summarise the issue in this video:

https://youtu.be/xFQ2kVOMS64

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It’s not the infrastructure it’s you that makes the difference.

CONTEXT:
Communication education has become integral to pre- and post-qualification clinical curricula, but it is not informed by research into how practitioners think that good communication arises.
OBJECTIVES:
This study was conducted to explore how surgeons conceptualise their communication with patients with breast cancer in order to inform the design and delivery of communication curricula.
METHODS:
We carried out 19 interviews with eight breast surgeons. Each interview centred on a specific consultation with a different patient. We analysed the transcripts of the surgeons’ interviews qualitatively using a constant comparative approach.
RESULTS:
All of the surgeons described communication as central to their role. Communication could be learned to some extent, not from formal training, but by selectively incorporating practices they observed in other practitioners and by being mindful in consultations. Surgeons explained that their own values and character shaped how they communicated and what they wanted to achieve, and constrained what could be learned.
CONCLUSIONS:
These surgeons’ understanding of communication is consistent with recent suggestions that communication education: (i) should place practitioners’ goals at its centre, and (ii) might be enhanced by approaches that support ‘mindful’ practice. By contrast, surgeons’ understanding diverged markedly from the current emphasis on ‘communication skills’. Research that explores practitioners’ perspectives might help educators to design communication curricula that engage practitioners by seeking to enhance their own ways of learning about communication.

Mendick et al

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The most valuable lesson learned on my first day as a doctor

Picture by JD Lasica