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Patient Communication

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Patient Communication The Dance We Do Brian E. Wood, D.O. Associate Professor and Chair, Department of Neuropsychiatry and Behavioral Sciences – PowerPoint PPT presentation

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Title: Patient Communication


1
Patient CommunicationThe Dance We Do
  • Brian E. Wood, D.O.
  • Associate Professor and Chair,
  • Department of Neuropsychiatry and Behavioral
    Sciences
  • Edward Via Virginia College of Osteopathic
    Medicine
  • brwood6_at_vcom.vt.edu

2
Communication
  • a process by which information is exchanged
    between individuals through a common system of
    symbols, signs, or behavior
  • exchange of information
  • personal rapport

Meriam-Webster Online Dictionary
3
Why Communicate?
  • To include someone in interaction
  • To impart to someone something you want them to
    understand.
  • To attempt to understand something about others.
  • Innate human drive to seek others.
  • Fascination with the existence of other life
  • Personification in fantasy/literature, etc.

4
(No Transcript)
5
Biology of Communication
  • Very complex interplay of physiological functions
    controlled by the

6
The Missing Link
  • Brain functioning and communication are directly
    linked.
  • The brain, when working properly, uses many
    complex mechanisms of communication to connect
    with other organisms.
  • One of the predominant mechanisms is language but
    there are others.
  • Posture, physical presence
  • Gestures and mannerisms
  • Appearance and expression

7
Mental Status Exam
  • Observation of brain functioning is the goal
  • Complications/limitations
  • Attempting to derive information about brain
    functioning through observation of behavior and
    responses to tasks, etc.
  • Looking at brain functioning through overlay of
    learned responses, behavior, dynamics, etc.
  • Examination remains science with art
  • Not unlike any other medical examination (ex.
    Auscultation)

8
Characteristics of Patient Communication
  • Mental Status (functioning of the CNS) is
    integrally involved
  • There are two parties
  • You
  • The patient
  • There is a constant two way street
  • Communication to and from the patient
  • There is a dynamic interplay

9
Language
  • Language encompasses many complex processes.
  • Not just speech
  • Expressive language
  • Written
  • Verbal
  • Prosidy
  • Receptive language
  • Written
  • Verbal
  • Prosidy

10
Non-verbal communication
  • Patient appearance
  • Anxious ?
  • Distracted?
  • Does the non-verbal communication conflict with
    verbal ?
  • Often when patients have barriers to verbal
    communication (ambivalence, social barriers,
    etc.), we see mixed messages from verbal and
    non-verbal sources.

11
Eliciting Information
  • Eliciting information from only verbal sources
  • Content or fact oriented
  • Very limited scope to patient communication
  • Close ended factual information gathering
  • Eliciting information from multiple sources
  • Much more complete view of patient status
  • Content (static) plus Process (dynamic)
    information
  • Open ended

12
Patient Interview Design
Information In
  • Should incorporate ways of getting both content
    and process information.
  • Open ended questions for sensitivity.
  • Close ended questions for specificity.

Open Ended Process
Close Ended Content
Information Out
13
Patient Interview
  • Content
  • Factual (ex.)
  • History of illnesses
  • Current living arrangements
  • Close ended
  • Provided directly or indirectly.
  • Process
  • Interaction based (ex.)
  • Rapoirte
  • Openess to examiner
  • Open ended
  • Based on observation of patient and environmental
    interactions.

14
Effects of CNS Abnormalities
  • Can abnormalities in brain functioning affect
    content of information? What brain functions
    might be involved?
  • Fairly direct relationships.
  • Can abnormalities in brain functioning affect
    process information? Which brain functions?
  • Much more complex issues
  • May be subtle but very significant

15
Mental Status Abnormalities and their Effects
  • Process
  • Inability to establish relationship with
    examiner.
  • Inability to filter extraneous environmental cues
  • Inability to understand (capacity)
  • Content
  • Factual errors
  • Distortion of information (ex. Negativistic
    thinking)

16
Factual Errors and Distortions
  • May introduce error into elements of history and
    thus diagnostic decisions.
  • May be dependent on multiple factors including
    patient functioning and environment.
  • Usually requires corroborating source of
    information.

17
Inability to Interact with Examiner.
  • May result in complete inability to acquire
    reliable factual information.
  • Be aware of your interactions and how the patient
    is interpreting them.
  • May require treatment of the patient and/or
    adjustment of examiner technique in order to
    engage patient in therapeutic interaction.

18
Capacity
  • Ability to engage in some sort of cognitive
    process
  • Many different types or areas of capacity
  • Capacity to understand
  • Capacity to manage affairs
  • Capacity to give informed consent
  • Not an all or nothing phenomenon
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