Cover
Title Page
Preface
Contributors
CHAPTER 1: Why Clinical Communication Matters
1. Clinical communication – a historical perspective
2. Effect of communication on patient outcomes
3. Training and feedback
4. Communication between professionals
5. Written records
6. A caring environment
7. Conclusions
8. References
9. Further resources
CHAPTER 2: The Consultation
1. Introduction
2. Evidence‐based communication
3. Models of the consultation
4. An example of the importance of the model in practice
5. Conclusions
6. Acknowledgements
7. Reference
8. Further resources
CHAPTER 3: Communication and Personality Type
1. Introduction
2. Jung’s theory of personality type
3. Are doctors’ preferences different?
4. How type differences relate to communication
5. Acknowledgement
6. References
7. Further resources
CHAPTER 4: Shared Decision‐Making
1. Introduction
2. What is shared decision‐making?
3. Shared decision‐making and evidence‐based medicine
4. Communicating information about risk
5. Strategies for encouraging shared decision‐making
6. Steps to shared decision‐making
7. Presenting information to patients
8. Health professionals’ training and development needs
9. References
10. Further resources
CHAPTER 5: Communication in Clinical Teams
1. Introduction
2. Human factors
3. Optimising team communication
4. Conclusions
5. References
6. Further resources
CHAPTER 6: Communication in Medical Records
1. General Medical Council perspective
2. The National Health Service code of practice
3. Medical note‐keeping and mortality data
4. Medical note‐keeping and payment
5. Simple tips for good medical note‐keeping
6. Letters and discharge summaries
7. Legal aspects of medical note‐keeping
8. Multidisciplinary records
9. Medical notes as a handover tool
10. Electronic patient records
11. Personal held records
12. Conclusions
13. References
14. Further resources
CHAPTER 7: Advanced Communication for Specific Situations
1. Paediatric consultations
2. Difficult behaviours: the angry or violent patient
3. Language barriers
4. Exploring safeguarding concerns
5. Young people, risk‐taking behaviours, consent and confidentiality
6. Chronic disease
7. Seldom‐heard groups
8. Conclusions
9. Further resources
CHAPTER 8: Communication and Mental Health
1. Introduction
2. Trust, respect and rapport
3. Brief ordinary effective communication
4. Understanding the context
5. World view, culture and class
6. Identifying and alleviating anxiety
7. Resolving conflict in communication
8. Communication in dementia and delirium
9. Conclusions
10. References
11. Further resources
CHAPTER 9: Communication at the End of Life
1. Introduction
2. Timing of end‐of‐life communication
3. Preparation for end‐of‐life discussions
4. Empowering patients and caregivers
5. Dealing with disparate information needs
6. Discussing palliative care
7. Discussing life expectancy
8. Advance care planning
9. Do not attempt CPR orders
10. Conclusions
11. References
12. Further resources
CHAPTER 10: Teaching Clinical Communication
1. Introduction
2. Engaging students
3. Clinical communication is teachable
4. Planning a curriculum – choosing a model
5. Defining the sessions – what needs to be taught?
6. Tutor groups
7. Feedback
8. Role of simulated patients
9. Marrying process and content
10. Presentation skills
11. Role of this model in experiential inter‐professional learning
12. Conclusions
13. Acknowledgements
14. References
15. Further resources
Recommended Books, Articles and Websites
1. For students and teachers
2. Academic
3. Articles
4. Websites (all accessed January 2017)
Index
End User License Agreement

List of Illustrations

Chapter 01
1. Figure 1.1 Evolution of the doctor–patient relationship.
2. Figure 1.2 Factors influencing patient‐centredness.
3. Figure 1.3 Model of behaviours linked to higher patient satisfaction.
Chapter 02
1. Figure 2.1 A ‘comprehensive’ clinical method.
2. Figure 2.2 The curriculum wheel for clinical communication.
3. Figure 2.3 The Calgary‐Cambridge guide – basic framework.
4. Figure 2.4 The Calgary‐Cambridge Guide – the expanded framework.
5. Figure 2.5 The Calgary‐Cambridge Guide – communication process skills.
Chapter 03
1. Figure 3.1 Jung’s theory of psychological type.
2. Figure 3.2 Personality preferences of medical graduates (n = 313) compared with UK adults (n = 1634). E, extraversion; I, introversion; S, sensing perception; N, intuitive perception; T, thinking judgment; F, feeling judgment; J, judging orientation; P, perceiving orientation; ST, sensing perception with thinking judgment; SF, sensing perception with feeling judgment; NF, intuitive perception with feeling judgment; NT, intuitive perception with thinking judgment.
Chapter 04
1. Figure 4.1 Patient‐reported influences on individual capacity to participate in shared decision‐making (SDM).
2. Figure 4.2 Visual patient decision aid (Cates plot, www.nntonline.net) for use of an anticoagulant in the management of atrial fibrillation (AF).
3. Figure 4.3 Evidence‐based medicine and shared decision‐making.
4. Figure 4.4 A shared decision‐making model for clinical practice.
5. Figure 4.5 Weight changes with different antidepressants – a patient decision aid from Wiser Choices. SSRI, selective serotonin reuptake inhibitor; SNRI, serotonin–norepinephrine reuptake inhibitor; TCA, tricyclic antidepressant.
Chapter 05
1. Figure 5.1 Communication has to be heard, interpreted and translated into action.
2. Figure 5.2 There is good evidence that team briefings and ‘safety huddles’ in a variety of healthcare settings can enhance teamwork and communication. Safety huddles are a recognised tool for frontline staff and caregivers.
3. Figure 5.3 Example handover sheet.
4. Figure 5.4 WHO Surgical Safety Checklist.
Chapter 06
1. Figure 6.1 The UK General Medical Council’s Good Medical Practice (2013) outlines four domains of practice: knowledge, skills and performance; safety and quality; communication, partnership and teamwork; and maintaining trust. The domain of communication, partnership and teamwork is assessed on a regular basis for all doctors with a licence to practice in the UK through various means, e.g. work‐based assessments (for doctors in training), 360° colleague feedback, patient satisfaction surveys and compliments/complaints received.
2. Figure 6.2 Take care when talking in public places.
3. Figure 6.3 The SBARR communication tool.
4. Figure 6.4 Picture archiving communication systems (PACS) are also medical records – do not leave screens open for unauthorised people to view.
Chapter 07
1. Figure 7.1 The triadic consultation. A 9‐year‐old girl is referred by her general practitioner for recurrent bouts of abdominal pain, causing poor school attendance. The girl’s mother suffers from chronic back pain with limited mobility, and her paternal grandfather has just been diagnosed with pancreatic cancer. What is going on in everyone’s mind? Unless the doctor is skilled and vigilant in involving both parties, their agendas and information may remain hidden, and leave one or more parties dissatisfied.
2. Figure 7.2 Angry family consultation: triadic conversation.
3. Figure 7.3 Common categories of abuse that require safeguarding actions.
4. Figure 7.4 The cycle of change.
Chapter 08
1. Figure 8.1 Effective communication in mental health – areas that need to be considered.
2. Figure 8.2 Some factors impacting communication and assessment of mental health.
3. Figure 8.3 Unspoken expectations of different roles.
4. Figure 8.4 Importance of non‐verbal communication. Non‐verbal communication accounts for most of our communication, and also has cultural meaning. The environment in which communication takes place also has an impact on the effectiveness of communication. ‘The most important thing in communication is to hear what is not being said’ (Peter F. Drucker).
5. Figure 8.5 The interaction between dementia and the body, senses and surroundings. An interactive model of dementia. For successful treatment, all these interacting aspects of a person’s function should be considered.
Chapter 09
1. Figure 9.1 NURSE – a mnemonic to help accept, validate and acknowledge emotions and concerns.
2. Figure 9.2 The SPIKES protocol for giving bad news.
3. Figure 9.3 Example ‘question prompt list’ questions – prognosis and end‐of‐life planning.
4. Figure 9.4 The key steps in the advance care planning process.

Pages

This edition first published 2018
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Preface

Good clinical communication is essential for safe patient care. Clinical communication occurs within the patient encounter, but also through information flow within and between clinical teams. Issues around communication account for the majority of complaints about patient care.

The last quarter of a century has seen the establishment of an evidence base for good communication skills and the teaching and assessment of it. We are now better placed to identify and to demonstrate the qualities required for effective communication with the range of patients and professionals encountered in clinical practice. Communication is a core part of curricula within medical schools. Students trained in the early days of these programmes are now practitioners and teachers themselves, meaning the practice and role‐modelling of these skills are gradually increasing.

This book is intended as a reference for healthcare students and practitioners, either as part of a communication skills course or for personal study. Issues around clinical communication relate to skills required within the consultation, for communication within and between teams, in medical records and during handover.

Clinical communication concerns not only establishing rapport with patients and ensuring patient satisfaction with the encounter on a human level – it also means actively listening to patients and understanding their experience and perspective on the anatomical and physiological changes that may constitute pathology and disease. Detailed gathering of hard clinical data reduces the risk of diagnostic error and leads to better treatment and management decisions.

Although this book inevitably reflects our own work in the UK’s National Health Service, we are pleased to have brought together a range of international authors, all of whom are recognised experts in their fields. It has been a pleasure to edit this book and in the process to understand better the development of our own communication with patients, students and colleagues. We hope you enjoy and learn from it.

Nicola Cooper & John Frain
January 2017

Contributors

Magdy Abdalla, MBCHB, FRCSI, DRCOG, FRCGP, MMedSci

GP Teaching Fellow, Division of Medical Sciences and Graduate Entry Medicine
University of Nottingham, Nottingham, UK

Nivedita Aswani, MBChB, MRCPCH

Consultant Paediatrician, Lead for Paediatric Diabetes, Derbyshire Children's Hospital, Derby, UK

Phyllis Butow, BA (Hons), DipEd, MClinPsych, MPH, PhD

Psycho‐Oncology Cooperative Research Group (PoCoG) & Centre for Medical Psychology and Evidence‐based Decision‐making, School of Psychology
Surgical Outcomes Research Centre (SoURCE), Institute of Surgery, University of Sydney, Sydney, Australia

Gillian B. Clack, PhD(Lond)

Former Honorary Senior Lecturer, Division of Medical Education, King’s College London, London, UK

Josephine Clayton, MBBS (Hons), PhD, FRACP, FAChPM

HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Greenwich, Sydney;
Kolling Institute, Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia

Nicola Cooper, MBChB, FAcadMEd, FRCPE, FRACP

Consultant Physician and Honorary Clinical Associate Professor, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK

Vanessa Cox, MBChB, MRCPCH

Consultant Paediatrician, Derbyshire Children’s Hospital, Derby, UK

Alison Cracknell, MBChB, FRCP, PGCert

Consultant Physician, Honorary Clinical Associate Professor and Patient Safety Lead, The Leeds Teaching Hospitals NHS Trust, Leeds, UK

John Frain, MBChB, MSc, FRCGP, DGM, DCH, DRCOG, PGDipCard

Director of Clinical Skills, Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK

Jonathan Silverman, BA, BM. BCh, FRCGP, FAcadMEd

President of the European Association for Communication in Healthcare, Honorary Visiting Senior Fellow, School of Clinical Medicine, University of Cambridge, Cambridge, UK

Lee Smith, BA, PGDip, MA, MA, RMN

Mental Health Nurse Specialist, Derbyshire Healthcare NHS Foundation Trust, Derby, UK

Nigel D.C. Sturrock, BMSc, MBChB, MSc, MD, FRCP

Executive Medical Director, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK

Julia Surridge, MBBS, DRCOG, DCH, MRCPCH, PGCert (Med Ed)

Paediatric Emergency Medicine Consultant, Derbyshire Children’s Hospital, Derby, UK

Adam Walczak, BPsych (Hons), PhD

Youth Cancer Services & Clinical Trials Division, CanTeen Australia, Sydney, Australia

Andy Wearn, MBChB, MMedSc, MRCGP

Director, Clinical Skills Centre, Faculty of Medical & Health Sciences, The University of Auckland, Auckland, New Zealand