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Communication for Anesthesiologists

Communication for Anesthesiologists. Gordon MD 12 Nov 09. Anesthesiologists and Perioperative Communication Kopp, Vincent J. M.D. Shafer, Audrey M.D. Anesthesiology:August 2000 - Volume 93 - Issue 2 - pp 548-555.

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Communication for Anesthesiologists

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  1. Communication for Anesthesiologists Gordon MD 12 Nov 09

  2. Anesthesiologists and Perioperative CommunicationKopp, Vincent J. M.D. Shafer, Audrey M.D.Anesthesiology:August 2000 - Volume 93 - Issue 2 - pp 548-555 • Anesthesiologists, other health professionals, and patients communicate on multiple levelsevery day • Participate in activities involving complex social transactions with medical, legal, ethical, and personal significance • Good communication is as important to protecting professional integrity as it is to patient safety and satisfaction. • It is as important for anesthesiologists to pay attention to the structure and function of professional communication as it is to learn the pharmacokinetics and pharmacodynamics of drugs

  3. Anesthesiologists and Perioperative CommunicationKopp, Vincent J. M.D. Shafer, Audrey M.D.Anesthesiology:August 2000 - Volume 93 - Issue 2 - pp 548-555 Clear, succinct, respectful communication is essential to working in the compressed time frame presented by anesthesia practice Manners, habits, appearances, and interpersonal skills affect the impression the anesthesiologist makes on patients or other colleagues (non-verbal communication) Becoming aware of one's individual patterns of language and behavior is the starting point for improved professional communication

  4. Anesthesiologists and Perioperative CommunicationKopp, Vincent J. M.D. Shafer, Audrey M.D.Anesthesiology:August 2000 - Volume 93 - Issue 2 - pp 548-555 Communication and the Hippocratic Ethic • Patient submissive in need • Physician empowered by knowledge • With this power comes responsibility • Exercise power with tact and respect • To do no harm means to speak and act with restraint

  5. Anesthesiologists and Perioperative CommunicationKopp, Vincent J. M.D. Shafer, Audrey M.D.Anesthesiology:August 2000 - Volume 93 - Issue 2 - pp 548-555 Intraop • Show respect for patient as sensate being • Communication of respect builds trust • Always speak as if the patient will remember • Peds induction: soft, hypnotizing tone plus gentle touch

  6. Anesthesiologists and Perioperative CommunicationKopp, Vincent J. M.D. Shafer, Audrey M.D.Anesthesiology:August 2000 - Volume 93 - Issue 2 - pp 548-555 The “Captain Effect” “It is probable that the tendency of some anesthesiologists not to bother or contradict surgeons, or the reluctance of some nurse anesthetists or residents to call their supervisors, has led to catastrophe…” - Gaba

  7. Anesthesiologists and Perioperative CommunicationKopp, Vincent J. M.D. Shafer, Audrey M.D.Anesthesiology:August 2000 - Volume 93 - Issue 2 - pp 548-555 Breaking Bad News • Face patient and/or family • Be honest and informative • Convey a sense of caring • Say “dead” and “died,” not “expired” or “passed away” • Poor communication skills increase litigious actions • Attention to physical setting • Formal introductions • Genuine reactions to survivors reactions and needs • Keep open channels for communication • Offers of appropriate social and clergy services

  8. Anesthesiologists and Perioperative CommunicationKopp, Vincent J. M.D. Shafer, Audrey M.D.Anesthesiology:August 2000 - Volume 93 - Issue 2 - pp 548-555 Facility with a variety of communication skills signifies highly developed professionalism. Literal meaning of “profession” = “speaking forth”

  9. Assessment of Competency in AnesthesiologyJohn E. Tetzlaff M.D.Anesthesiology:April 2007 - Volume 106 - Issue 4 - pp 812-825 Outcome Project – General Competencies: Interpersonal and Communication Skills Residents must demonstrate interpersonal and communication skills resulting in effective information exchange and teaming with patients, and professional associates

  10. Assessment of Competency in AnesthesiologyJohn E. Tetzlaff M.D.Anesthesiology:April 2007 - Volume 106 - Issue 4 - pp 812-825 Outcome Project – General Competencies: Interpersonal and Communication Skills Residents are expected to • Create and sustain a therapeutic and ethically sound relationship with patients • Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills • Work effectively with others as a member or leader of a healthcare team or other professional group

  11. Assessment of Competency in AnesthesiologyJohn E. Tetzlaff M.D.Anesthesiology:April 2007 - Volume 106 - Issue 4 - pp 812-825 Outcome Project – General Competencies: Interpersonal and Communication Skills Assessment • The Objective Structured Clinical Examination (OSCE) is a reliable means of measuring communication skills • Case presentation a less demanding alternative than OSCE for measuring verbal communication • Mock orals also useful assessment tool • Properly structured peer review

  12. Communication skills for anesthesiologistsAndrew F. Smith MRCVFRCA, Make P. Shelly FRCACAN J ANESTH 1999 / 46: 11 / pp 1082-1088 • Gone are the days when newly-qualified but unpersonable doctors could be directed into anesthesiology on the grounds that this did not entail direct contact with patients • Poor communication is implicated in complaints by patients and medical misadventures, and bedevils professional and personal relationships

  13. CAN J ANESTH 1999 / 46: 11 / pp 1082-1088 Benefits of improved physician-patient communication Patients satisfaction Staff enhance our personal and professional self-esteem and work satisfaction Healthcare organizations enhanced reputation decreased litigation

  14. CAN J ANESTH 1999 / 46: 11 / pp 1082-1088 Tools of the trade: communication skills ESTABLISHING RAPPORT a state of rapport occurs when one person appreciates that another's world may be different but tries to understand that world empathy goes further; it implies entering the other's world, not just appreciating that it is different

  15. Tools of the trade: communication skills ESTABLISHING RAPPORT CAN J ANESTH 1999 / 46: 11 / pp 1082-1088 non-verbal signals convey our attitudes and values to the patient even before a word is spoken where verbal and non-verbal messages concerning interpersonal attitudes are contradictory, observers tend to 'believe' the non-verbal one it has been estimated that non-verbal elements carry most of our meaning, with only 7% of what we communicate contained in the actual words we speak

  16. Tools of the trade: communication skills ESTABLISHING RAPPORT CAN J ANESTH 1999 / 46: 11 / pp 1082-1088 Nonverbal communication Tone and volume of voice, intonation, emphasis, facial expression and gestures Maintaining eye contact Sit beside the patient, at their eye level or at an angle to them Physical closeness and touch Mirroring

  17. Tools of the trade: communication skills ESTABLISHING RAPPORT CAN J ANESTH 1999 / 46: 11 / pp 1082-1088 Listening Develop an attentive frame of mind Focus attention outwards Encouraging “Have I got this right?” Summarizing Silence

  18. CAN J ANESTH 1999 / 46: 11 / pp 1082-1088 Tools of the trade: communication skills Asking Questions To guide or prompt Leading questions Closed questions Open questions

  19. Tools of the trade: communication skills Understanding a different model of the world CAN J ANESTH 1999 / 46: 11 / pp 1082-1088 Acceptance of the patient's viewpoint is an important element in creating rapport It is important to accept what people say as representing how they see the world, even if it comes across as threatening, bizarre or apparently stupid. In the early stages of the conversation, the patient deserves to be listened to without hindrance.

  20. CAN J ANESTH 1999 / 46: 11 / pp 1082-1088 Tools of the trade: communication skills Developing self-awareness Before you can help others, you need to be aware of yourself Whatever your own feelings, it is important not to let them interfere with the job in hand Reaching conclusions about the people we meet based on inadequate evidence can be unhelpful. We need to deal in facts, not assumptions.

  21. CAN J ANESTH 1999 / 46: 11 / pp 1082-1088 Applying the skills: framework and specific tasks Interview: 'a conversation with a purpose' Focusing on the purpose of the interview will help direct it Remembering that even the simplest interview should have a beginning, a middle and an end provides structure

  22. CAN J ANESTH 1999 / 46: 11 / pp 1082-1088 Applying the skills: framework and specific tasks Beginning Physical setting comfortable no interruptions privacy Plan and goals are essential Introduction Purpose How long “What have you learned so far?”

  23. Applying the skills: framework and specific tasks Middle – Getting down to the task at hand CAN J ANESTH 1999 / 46: 11 / pp 1082-1088 Dealing with feelings Fundamental: Acknowledge the feelings One of the main reasons for trying to focus on the patient while listening to them is to help distinguish the patient's problems from the doctor's

  24. CAN J ANESTH 1999 / 46: 11 / pp 1082-1088 Applying the skills: framework and specific tasks Middle – Getting down to the task at hand Dealing with feelings Anger Priority is to stay calm and not become angry Acknowledge the anger 'You are obviously feeling angry about this..’ Uncertainty Anxiety Frequent specific fears related to anesthesia: waking up when should be asleep (awareness) staying 'asleep' when should be awake (death) perception of loss of control one study found that 45% of patients admitted to concerns about the qualifications of their anesthesiologist when asked directly

  25. CAN J ANESTH 1999 / 46: 11 / pp 1082-1088 Applying the skills: framework and specific tasks Middle – Getting down to the task at hand Imparting information ask the patient first what they already know patient should be given time to react and opportunities to ask questions

  26. Applying the skills: framework and specific tasks Middle – Getting down to the task at hand CAN J ANESTH 1999 / 46: 11 / pp 1082-1088 Explaining complex concepts simply Summary of the main points and then more detail can be added as the patient wants Jargon is a major communication barrier Check understanding from time to time

  27. CAN J ANESTH 1999 / 46: 11 / pp 1082-1088 Applying the skills: framework and specific tasks Middle – Getting down to the task at hand Breaking bad news Allow emotions to be expressed Acknowledge any distress Explore concerns “You seem upset. Can you talk about what’s making you feel like that?” Deal with grief

  28. CAN J ANESTH 1999 / 46: 11 / pp 1082-1088 Applying the skills: framework and specific tasks Ending Summarize Check outcome satisfactory “Good bye” Follow up plan Record

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