Interpersonal Skills com

8/4/2019 Interpersonal Skills com

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Interpersonal Skills

Health Psychology


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student doctors

Although student doctors found chemistry and

biology relatively easy dealing with their

patients is not so easy.

Battenburg and Gerritsma (1983) student

doctors found it hard to:

1. hard to initiate conversation

2. decide on diagnosis

3. cope with patients emotions


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Patients

Perhaps patients also find it difficult to talk to

doctors and therefore avoid going to see them.

Patients make 11 Lay consultations forevery one consultation with a doctor

(Scambler and Scambler 1984).


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Pitts (1991)

Pitts (1991) suggests there are three

reasons for going to the doctor:

Persistence of symptoms

Critical incident - e.g. pain gets worse

Expectation of treatment


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Kent and Dalgleish (1996)

Kent and Dalgleish (1996) two types of

patient satisfaction that should be

considered: Cognitive satisfaction how happy the patient is with

the treatment etc.

Emotional satisfaction how happy the patient is with

the doctors level of interest and concern.


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What patients like

People often judge the adequacy of their

care by criteria that are irrelevant to the

technical quality of the care. What peopledo know is whether or not they liked the

practitioner: whether he or she was warm

and friendly or cool and uncommunicative.

(Feletti, Firman, & SansonFisher, 1986;

Scarpaci, 1988; Ware et al., 1978).


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Patients are poor judges

Even more significant, since people are

poor judges of technical quality of care,

they often judge technical quality on thebasis of the manner in which care is

delivered (BenSira, 1976, 1980). For

example, if a physician expresses

uncertainty about the nature of the patient's

condition, patient satisfaction declines


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Mooney, K. M., 2001

Mooney, K. M., 2001, 'Predictors of

patient satisfaction in an outpatient

surgery clinic. Plastic SurgicalNursing, 21, 3, 162-4


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Aim

To investigate which elements of the

patient-practitioner relationship lead to

satisfied patients.


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Participants

An opportunity sample of 345 patients (96

per cent of those asked to participate)

attending an out-patient plastic surgeryclinic.

Informed consent was obtained.


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Procedure

The participants were required to evaluate itemssuch as how long they waited to get anappointment, time spent waiting at the surgery

before the doctor was seen, the explanation givenabout any procedures undergone, the technicalskills (thoroughness, competence andcarefulness) of the practitioner and the

interpersonal skills (courtesy, sensitivity,friendliness etc.) of the practitioner on a 5-pointscale ranging from poor to excellent.


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Results

60 per cent rated their overall level of satisfactionas excellent and 30 per cent as very good. Thequality of interaction with the practitioner

received the highest individual rating, while thoseconcerned with the facilities and access toservices were rated lower. The interpersonalskills of the doctor were found to contribute more

to patient satisfaction than the technical skills ofthe doctor and were considered to be a betterpredictor of patient satisfaction.


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Smucker, D. R., Konrad, T.

R., Curtis, P., Carey, T. S.,1998

, 'Practitioner self-confidence and

patient outcomes in acute back

pain', Archives of Family Medicine,

7, 223-8


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Participants

189 doctors and chiropractors, randomly

selected from licensing databases in North

Carolina, USA, who regularly treatedpatients for lower back pain. Informed

consent was obtained.


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Procedure

The medical practitioners were sent a postalquestionnaire to complete. The questionnairecontained ten items such as, 'I lack the diagnostic

knowledge and tools to treat someone with lowerback pain', 'I know exactly what to do to treatsomeone with lower back pain' and 'I feel verycomfortable treating people with lower back

pain', which assessed their self-confidence (thefirst four items on the scale) and attitudes (thenext four items on the scale) in dealing withpatients with lower back pain.


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Procedure

The last two items dealt with knowledge of theprogression from acute to chronic low back painand patient satisfaction with treatment. The

practitioners had to use a 5-point Likert scale (1= strongly agree, 5 = strongly disagree) to recordtheir level of agreement with each statement. Thescores for the first four items were added together

to generate a self-confidence score for eachpractitioner and those for the next four yielded anattitude score. The last two items were treatedindividually.


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Procedure

The medical practitioners were also asked toprovide contact details of any patients who cameto them for treatment for lower back pain and had

not yet received any treatment. Additionally, allthe patients had to own a telephone and be able tospeak English. A total of 1633 patients wererecruited and informed consent was obtained

from them.T

he patients were telephonedimmediately after their initial visit to theirpractitioner, and again after two, four, eight, 12and 24 weeks or until they had fully recoveredfrom this episode of lower back pain.


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Procedure

The length of time until they had returned to a

level of functioning equal to that before the onset

of the lower back pain was recorded.

The practitioners' self-confidence scores were

then compared with the length of time taken by

the patients to return to the same level of

functioning as prior to the lower back pain.


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Results

179 (95 per cent) of the 189 practitioners sent thequestionnaire returned it, and of these 162 (86per cent - 107 doctors, 55 chiropractors)

completed all ten items. A strong correlation was found between scores

on the first four items (measuring self-confidence) and the next four items (measuring

attitudes) for both doctors and chiropractors. Therelationship between the item dealing withpatient satisfaction and the self-confidence scorewas higher for the chiropractors than the doctors.


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Results

Despite differences in levels of self-confidence

and attitudes among the health practitioners, there

was no significant relationship for either of these

factors with the length of time it took patients to

recover functionality. Thus it is not possible to

use a practitioner's level of self-confidence or

attitude as an indicator of the speed of recovery

from lower back pain.


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Ogden et al (2002)

Ogden et al (2002) explored the impact ofthe way in which uncertainty wasexpressed (behaviourally versus verbally)on doctor's and patient's beliefs aboutpatient confidence. Second the studyexamined the role of the patient's personal

characteristics and knowledge of theirdoctor as a means to address the broadercontext.


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Ogden et al (2002)

Matched questionnaires were completed by

GPs (n=66, response rate=92%) and

patients (n=550, response rate=88%) frompractices in the south-east of England.


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Ogden et al (2002)

The results showed that the majority of

GPs and patients viewed verbal

expressions of uncertainty such as `Let'ssee what happens' as the most potentially

damaging to patient confidence and both

GPs and patients believed that asking a

nurse for advice would have a detrimental

effect.


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Ogden et al (2002)

In contrast, behaviours such as using a

book or computer were seen as benign or

even beneficial activities. When compareddirectly, GPs and patients agreed about

behavioural expressions of uncertainty, but

the patients rated the verbal expressions as

more detrimental to their confidence than

anticipated by the doctors.


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Ogden et al (2002)

In terms of the context, patients who

indicated that both verbal and behavioural

expressions of uncertainty would have themost detrimental impact upon their

confidence were younger, lower class and

had known their GP for less time.


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Barnett (2002)

Barnett (2002) has found that a quarter ofsurgeons are brusque, unsympathetic orimpatient when they break bad news topatients. Family doctors are better atbreaking bad news, but most patients aretold by surgeons (86%). 106 cancer

patients were interviewed. 94 of these hadbeen told by doctors and the rest by familymembers.


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Barnett (2002)

The patients were asked to rate the way the

news was delivered in four categories:

positive, neutral, negative and verynegative. In 26 per cent of the cases,

memories of the moment were negative or

very negative. There were also complaints

about the lack of clear, simple information.

(The Times 01-07-02)


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Doctors are sometimes accused

of not listening

Beckman and Frankel (1984) studied 74

visits to the doctor. In only 23% of thecases did the patient have the opportunityto finish his or her explanation of concerns.

In 69% of the visits, the doctor interrupted,

directing the patient towards a particulardisorder.


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Doctors are sometimes accused

of not listening

Moreover, on average doctors interrupted

after their patients had spoken for only 18seconds.


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Doctors can be trained in Non-

Verbal Communication Birdwhistell (1970) estimated that only 30 to 35%

of the social meaning of a conversation is carriedby words alone.

Non-verbal communication includes features of

speech such as:

y tone of voice,

y inflection,

y

rates of speaking,y duration and pauses.


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non-verbal communication

Other forms of non-verbal communication

are conveyed by gestures, dress, physical

proximity, facial expressions, posture andorientation.


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Argyle (1975) four major uses:

To assist speech, for example in synchronising

conversation or supplementing speech by putting stress

on certain words, or pausing between words or varyingthe tone and speed of speech

As a replacement for speech

To signal attitudes, e.g. trying to look cool

To signal emotional states, i.e. we can tell how a personis really feeling by looking at their facial expression or

posture.


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On the card in front of you is written an emotion.You have to stand up in front of the group andcommunicate this emotion non-verbally, that isyou must not use any words. You can

communicate vocally by altering such things asthe pitch, tone and volume of your voice bycounting from 1 to 5 whilst using any other non-verbal channel. Other members of the group write

down the emotion they think is beingdemonstrated as each member takes his turn.


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Emotional words

Fear, Disbelief, Sadness, Dominance,

Boredom, Disgust, Interest, Shame, Anger,

Surprise, Love, Embarrassment,Admiration, Happiness


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Smiling a lot can make people

happy. Zuckerman et al (1981) divided males and

females into three groups.

1.The first group saw a film of a pleasantscene.

2.The second group were shown a film of a

neutral scene.3.The third group were shown a nasty film.


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Within each group

1.a third were asked to suppress their facial

expressions,

2.a third were asked to exaggerate theirfacial expressions

3.and the other third were not asked to do

anything apart from watching the film.


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Results

The people who exaggerated their facial

expressions showed higher levels of arousal and

reported stronger positive or negative emotional

reactions, compared with the other two groups.

So making patients smile will make them feel

happier about themselves.

Learning to suppress facial expressions at timesof stress could reduce stress.


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Doctors dress.

McKinstry and Wang (1991) Pictures of same

doctor dressed formally or informally.

Pictures of formally dressed doctors rated higher

for the amount of confidence the patients had in

them, and on how happy they would be to see

them.

Older and professional-class patients particularlypreferred the formally dressed doctors.


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Touch

Jourard (1966) considered where it is

acceptable to be touched and by whom.

Doctors need to be careful not to alarm thepatient by touching them in a 'no go' area

without their permission.


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Cultural differences

Jourard (1966) also found cultural

differences in the amount of touching.

Observing people in cafes around the

world he counted the number of times

people touched each other during the

course of one hour. His results were:


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Touch

Place Number of touches

San Juan (Puerto Rico) 180

Paris 110

London 0


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British Nurses

Davitz & Davitz (1985) report that Americanpatients' perceptions of British nurses might beinfluenced by different cultural norms:

y The expression of a range of emotions on the partofAmerican patients, in many situations, oftenmade the British nurses uncomfortable and evenmore reserved. It is interesting to note that a

number of patients whom we interviewed judgedthis discomfort as dislike, insensitive, and hard-boiled. 'They're efficient,' noted one patient, 'butthey're not sympathetic.'


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Whitcher & Fisher (1979)

A second piece of research highlights the statusdifferences involved in touching. Whitcher &Fisher (1979) arranged for nurses to either touch

or not touch patients while providing them withinformation about impending operations. Thenurses in the'touch condition'touched the patientson the hand whilst showing them a booklet

describing the operation, whereas those in the 'notouch' condition did not touch the patients at all.All the nurses were female. The patients wereasked for their views about the hospital and theprospective operation.


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After the operation, the patients' blood pressure

was measured. Female patients touched by nurses

reported lower anxiety, more positive feelings to

the hospital and had lower blood pressure after

the operation than those not touched. On the

other hand, male patients who were touched

reported greater anxiety, more negative feelings

and higher blood pressure after the operation than

those who were not touched.


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Whitcher & Fisher (1979) suggest that one

explanation for these results stems from status

differences. Higher status individuals are at

liberty to touch lower status individuals, but not

vice versa. Thus females perceived the touching

as a sign of caring and warmth; males perceived

it as a threatening gesture, which communicated

the nurses' superior status in the hospital setting.


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questioning

1. the most important part of questioning

is listening

2. determine the reasons for asking thequestions

3. do not ask too many questions


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questions fall into the following

categories

1.closed questions

2.open questions

3.affective questions

4.probing questions

5.leading questions


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closed questions

closed questions are questions which require

very short answers and are useful for anxious or

nervous people so that tension can be reduced.

Asking too many closed questions means that thedoctor has to ask lots of questions to get

information and they spend less time listening to

the patient. As an exercise try asking a friend a

series of closed questions for as long as possible.


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open questions

open questions give the respondents the

opportunity to respond in anyway they

wish.T

here is no correct answer.A

disadvantage is curtailing rambling

irrelevances, though the use of well timed

closed questions can bring a wandering

conversation back to the issue at hand.


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three main types of sequences:

1.Funnelling. Beginning and interview with

an open question and gradually becomingmore specific.

2.Inverse funnelling. Going from specificdetails to general topics.

3.The Tunnel. Asking a series of closedquestions.


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Jesudason (1976)

Jesudason (1976) compared open and closed

questions in finding out what foods were taboo

during lactation (mothers producing milk for

their babies) for Indian women. The sampleconsisted of 1151 women who were asked either

to name the foods that were taboo (open) or were

read out a list of 12 foods and asked whether they

ate each food during lactation (closed).


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Jesudason (1976)

About 53% did not report any food taboos

when given the question in open form.

When these women were read the list of 12foods, 32% considered five or more items

taboo.


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affective questions.

affective questions. These are questions

about the patients feelings and emotions

and help to communicate concern andempathy.


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Probing questions.

These questions are used to get a patient

talking when they are not forthcoming.

Hackney and Cormier (1979) suggests theuse of the "accent" and "minimal" prompt.

The accent is a short re-statement that

echoes and focuses a previous statement.


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Probing questions.

The minimal prompts use a large number

of non-verbal responses such as "uh-huh",

"mmm", "ah", and "yes, I see." Non-verbalbehaviours such as leaning forward would

also act as prompts. A problem with using

too many probing questions is that the

interview can become an interrogation.


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leading questions

1.Conversational lead.

2.Pressurised agreements.

3.Hidden subtleties.


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conversational lead.

1. This type of leading question is used to

anticipate agreement with the patient and

thus convey the impression offriendliness and attentiveness. An

example would be "isn't she a marvellous

cook?".


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pressurised agreements.

This type of question puts pressure on people

to agree with the questioner. For example

"you do, of course, brush your teethevery day?". These types of questions

should be avoided by doctors because it

leads to invalid responses.


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hidden subtleties.

1. This type of question leads the

respondent without their knowledge.

Loftus (1975) interviewed 40 peopleabout headaches and headache products,

ostensibly for market research.


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hidden subtleties.

They were asked either "do you get

headaches frequently, and if so, how

often?"O

r "do you get headachesoccasionally, and if so, how often?"

The average number of headaches in the

"frequently" group was 2.2; Whereas in

the "occasionally" group it was 0.7

headaches a week.


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hidden subtleties.

The subjects were also asked how many

products they had tried for the headaches.

One group was given a choice of one,two, or three; Another the choice of one,

five, or ten. The first groups average was

3.3, the second's 5.2. Similar effects can

be used by substituting "short" with "tall"or "the" with "a".


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Savage and Armstrong (1990)

Savage and Armstrong (1990) found that

patients were more satisfied with a

directed consultation rather than asharing consultation.


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Directed consultation statements made such as

you are suffering from, it is essential that

you take this medication, you should be better

in . days, come and see me in . days.

Sharing consultation what do you think that is

wrong?, Would you like a prescription?, Are

there any other problems?, When would you

like to come and see me again?


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359 randomly selected patients free to choose

their doctor. 200 results used.

2 questionnaires one immediately and one a

week later.

Results overall a high level of satisfaction, but

higher for directed group. Higher for

satisfaction with explanation of doctor and withown understanding of the problem. More likely

to report that they had been greatly helped.


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