Patient Communicati

on

“The Dance We Do”

Brian E. Wood, D.O.Associate Professor and Chair,

Department of Neuropsychiatry and Behavioral SciencesEdward Via Virginia College of Osteopathic Medicine

brwood6@vcom.vt.edu

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

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.

Biology of Communication

Very complex interplay of physiological functions controlled by the:

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

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)

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

Language

• Language encompasses many complex processes.• Not just speech• Expressive language

– Written– Verbal– Prosidy

• Receptive language– Written– Verbal – Prosidy

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.

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

Patient Interview Design

• Should incorporate ways of getting both content and process information.

• Open ended questions for sensitivity.

• Close ended questions for specificity.

Information In

Information Out

Open EndedProcess

Close EndedContent

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.

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

Mental Status Abnormalities and their Effects

• Content– Factual errors– Distortion of

information (ex. Negativistic thinking)

• Process– Inability to establish

relationship with examiner.

– Inability to filter extraneous environmental cues

– Inability to understand (capacity)

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.

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.

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”