An approach to Communication Challenges in Psychiatry

Raed Hawa

Communication

• Why important?• Role as a physician• Professionalism• Satisfaction• Connecting with patients• Minimize complaints

Lost in TranslationPersonal Experience

• “ where you’re from?”• “we don’t beat our wives”• “ I don’t understand what you’re saying”• “what? Repeat that again”• “I had a mickey and a joint or two”

Lost in TranslationExplain This!

•“He is my mother”•“I push the mathematics”

Lost in TranslationAbbreviations and Slang

• ASAP• AWOL• Out of the blue• The blues• Cold turkey• Special K• Under my skin

Communication ER Rounds

• During am rounds, the ER psychiatrist listens to the presentation by the PGY4 resident on call. The case is about a homeless patient who presents with psychotic symptoms. The staff asks for a differential. The resident who is preparing for his STACER provides text book answers with evidence based support for a comprehensive management plan. You, the PGY1, on your ER psychiatry rotation stay quiet throughout the interaction.

• What do you think the staff’s perception of you?

Communication Inpatient Rounds

• It is busy on the inpatient ward. After discussion with your staff you decide that a patient that was admitted the night before is ok for discharge. The SW comes to see you and comments that the patient is not ready for discharge. You get frustrated as there has been pressure on you to free beds for patients in ER. You are too busy to discuss your decision any further.

• What would you do?

Oncall Triage

• It is 3am. You are oncall in the ER, and the nurse calls you to see a “suicidal” patient. As you go in, she is unable to give you any details about why the patient is here and very little of the paperwork has been done including a triage assessment. No collateral has been requested from other hospitals despite a recent stay there.

• What would you do?

Communication Inpatient Evaluation

• At your final ITER during your inpatient rotation, your supervisor mentions for the first time that the nurses have felt that they were not involved in management, discussion and discharge of patients.

• What do you do?

Communication

• Verbal- tone• Non Verbal- Body language• Collaborative teams and hierarchy• Personalities- eg dominator, blocker, attention

seeker, and evader• Topics- sexuality/drug/religious beliefs• Assumptions- families “in the west”

Tips from An Old Age Resident

• Don’t be Late! If you are, call in • Speak up if you don’t understand something• Ask questions during small group classes • Use the resident lunch time to ask senior

residents for advice if you are unsure• Ask for regular feedback – especially midterm

feedback to avoid any surprises