community medicine

1. Dr. Dalia El-Shafeei

2. “We are born to see, but have to train
ourselves to observe”

3. What
(Definition )
Why
(Importance )
How
(Elements +
Principles)
By what
(Forms)
Why not
(Barriers )

4. WHAT IS COMMUNICATION?
 Communication is sending or receiving ideas,
thoughts or feelings from one person to one or more
persons in such a way that, the person receiving it
understands it in the same way the sender wants
him/her to understand.
 The term ‘communication’, derived from a Latin term
‘communicare’.
• Also known as “people skills” or “soft skills”.
• Ranked in a survey as the most important
requirement for successful job performance.

5. Continuous Dynamic
Transactional Irreversible
Communication

6. SENDER MESSAGE CHANNEL RECEIVER
Context
FEEDBACK
THE COMMUNICATION PROCESS
The person
initiating the
communication,
or broadcasting
the message.
The specific set of
words, gestures and
images that the sender
uses to convey what he
or she wants to say.
The channel
through which
the message
moves.
Receivers (or the
audience for the
message) - from
whom the receiver
often expects a
response.
The response from the
receiver to the sender.

10. Effective communication =
R (receiver’s meaning)
----------------------------------- = 1
S (sender’s meaning)

11. WHY WE STUDY COMMUNICATION SKILLS?
1-History taking: 60% to 80% of diagnosis.
2-Good communication provides information to the
patient:
-more than 50% of patients deviate from the doctors’ advice
or do not follow it at all.
3-Poor quality of communication leads to patient’s
dissatisfaction:
- Doctors interrupt patients very early.
- Patients do not understand what the doctor is saying.
- Advice is too difficult to follow.

12. COMMUNICATION PRINCIPLES
 Listening (not HEARING)
 Probing (encourage)
 Observing (non- verbal)
 Informing (4 Cs = Clear, Correct, Concise, Complete)

13. 1- LISTENING:
Active process (Not hearing), it involves a conscious
effort to listen to words; to the way they are said, to be
aware of the feelings shown and attempts to hide feelings.
You should:
 Focus your attention; avoid barriers.
 Show that you are listening (verbally and nonverbally).
 Understand ideas and pick key words.
 Retain information (memory, notes).
 Reflect or give your feedback.

15. 2- PROBING:
- What clients think/know.
 encourage them to talk: tell them that are really
listening and wanting to hear more.
 ask questions.
 keep Privacy, listen.

16. 3- OBSERVING:
 Nonverbal communication through:
- Facial expressions,
- Voice tone
- Body language.

17. 4- INFORMING
 in a Clear, Correct, Concise, Complete way.
 Consider: Needs, Language, Obstacles.
 Summing-up briefly.
 Check back with the speaker to ensure that the
statement is accurate.

18. “LAG TIME"
The gap between the speed of talking and
the speed of listening
Most individuals speak at the rate of 100-150
words a minute,
while
they listen at the rate of 450-500 words a minute.

19. “LAG TIME" IS TO BE USED TO:
In stead of thinking about what to reply to the person, or
worse still allowing your mind to wonder on unrelated
subjects, "lag time" is to be used to:
- Listen to the words being used
- Observe the body language
- Make note of the repetition of thoughts and words

20. RULES FOR COMMUNICATION
1. Ensure it fits the purpose
2. A.B.C: 3. K.I.S.S 4. Deliver information
in 3 stages:
Accuracy Keep Introduction
Brevity It Main body of content
Clarity Short Summary
Simple

21. Change behavior
Get action
Ensure
understanding
Persuade
Get & give
Information
COMMUNICATION
GOALS

23.  Environmental barriers:
Loud sounds, activities of nearby people, interruptions from
others, physical discomfort
 Physiological barriers:
Deafness, blindness, learning disabilities, illness.
 Language barriers:
Different language, specific terminology
 Personal barriers:
Socioeconomic conditions, values and beliefs, previous
experience, not valuing themselves, not believing that their
health is important.
 Psychological barriers:
Stress, frustration, anger, tiredness, distracted, preoccupied.

24. SENDER MESSAGE CHANNEL RECEIVER
Context
FEEDBACK
THE COMMUNICATION PROCESS OR ELEMENTS
Knowledge
Formulation
Language
Tone
Personality
Ambiguity
Interest
Clearness
Confusion
Objectivity
Noise
Accessibility
Adaptation
Decoding
Physiology
Personality
Preparation
Time
Selection bias
Formulation

25. Body
Language
55%
Words
7%
Tone of
Voice
38%

26. Verbal
Communication

27. VERBAL COMMUNICATION
 Organize Thoughts
 Paint Word Pictures
 Watch Grammar

28. VERBAL COMMUNICATION
clear
 Clarify
 Listen
 Encourage
 Appreciate
 reassure
Don’t
Give orders
Attack
Be aggressive
Be ridiculous.

29. NON-VERBAL COMMUNICATION

30. Non-verbal communication can
Reinforces, Complements,
Contradicts, Regulates, or Replaces a
verbal message.

31. CATEGORIES OF NONVERBAL COMMUNICATION:
 Body movement; way of walking.
 Posture; way of sitting, standing.
 Gesture; movements of hands, legs, arms and feet.
 Facial expressions & eye contact.
 Space; place of sitting, distance.
 Touch; shake hands, patting on the back.
 Time.
 Personal appearance; clothes, hair, jeweler.
 Paralanguage; vocal characteristics (pitch, volume,
rate and quality), vocal interferences (umm, uhh).

33. Smiling .
Eye contact .
How you look .
Shaking hands .
+ve Non-Verbal Communications

35. > 360 cm
120 – 360 cm
45 – 120 cm
15 – 45 cm

36. WHEN YOU INVADE MY SPACE
 Reactions to an invasion of your space
 Feel troubled
 Get defensive
 Become aggressive

41. COUNSELLING
Counselling is a process that uses communication skills to help
client/patient to reach an informed decision/choice
Counselling will provide customized, client-oriented information
and negotiate available alternatives to help take a decision
based on clear information.
Helping a person or a group to develop
self-help and self-care abilities.

42. CONSULTATION & COUNSELING
Consultation:
Process of a dialogue that leads to a
decision
Counseling:
Helping a person or a group of people to
develop self help

43. CONSULTATION
After each consultation session 5 things
must be established:
1) Discover the reasons of patient attendance
2) Define clinical problem (HPT, DM)
3) Address the patient’s problem (details)
4) Explain the problem to the patient
5) Make effective use of the consultation

44. PRINCIPLES FOR GOOD COUNSELLING
 Treat each client well
 Interact actively
 Give the right amount of information
Tailor and personalize the information
 Use and provide memory aids
 Provide the services that satisfy the client’s
expectations. Help clients remember instructions.
 Confidentiality

45. COUNSELING
Preparing a counseling session
Physical setting
Timing
Interpersonal space

46. 1. Physical setting
Privacy: in a quiet, calm & no
interruption
 Proper lightening & temperature.
2. Timing
45-60 minutes

47. 3. Interpersonal space
 4-9 feet
D
 D
P D P P
(√) (√) (×)

48. COUNSELING,
CONSULTATION, COMMUNICATION PROCESS
 Initiating the session
 Gathering Information
 Building Relationship
 Explanation and Planning
 Closing the sessions

51. BUILDING RELATIONSHIP
 Using appropriate non verbal behavior: eye
contact, posture, demonstrate confidence
 Develop rapport: accept patient views, feeling,
provide support, deals sensitively with disturbing
topics
 Involve the patients: explain rationale, ask
permission and explain process during physical
examination

52. EXPLANATION & PLANNING
A- Providing the correct amount and type of
information:
-Assesses patient’s starting point
-Asks patients what other information does you
needs and would be helpful.
-Give explanation at appropriate time

53. EXPLANATION AND PLANNING
b) Aiding recall and understanding:
 -Organizes explanation.
 -Uses explicit categorization.
 -Uses easily understood language.
 -Uses visual methods of conveying information.
 -Checks patient’s understanding.

54. EXPLANATION AND PLANNING
C-Achieving a shared understanding:
 -Provides opportunities to patients to contribute.
 -Picks up verbal and non-verbal cues.
 -Elicits patient’s beliefs, reactions and feelings.

55. EXPLANATION AND PLANNING
D-Planning: shared decision making:
 -Encourage patient to contribute his thoughts.
 -Negotiate acceptable plan.
 -Offers choices.
 -Checks with patients if he accepts plans and if
his concerns have been addressed

56. CLOSING THE SESSIONS
A-Forward planning:
 -Contracts with patients next steps.
 -Explain possible unexpected outcomes.
B-Ensuring appropriate point of closure:
 -Summarizes session briefly and clarifies plan of
care.
 -Final check that patient is satisfied, comfortable
with plan.

57. THE ELEMENTS OF COUNSELLING
G A T H E R
Greet
Ask
Tell
Help
Explain
Return visit

58. GREET
 Give the clients your full attention as soon as you
meet them.
 Be polite, friendly and respectful.
 Introduce your self and offer them seats.
 Ask how you can help?
 Explain what will happen during the visit.
 Conduct counselling privately

59. ASK ABOUT
 Reasons for coming.
 Their experience with the health matter that
concerns them.
 Any information needed to complete client
records.
 Ask Clients about themselves and their families
as appropriate.

60. TELL CLIENT
-To decide what choices and decisions.
-To express their feelings, needs, wants, & any doubts,
concerns or questions.
 Keep questions open, simple and brief.
 Look at your client as you speak.
 Listen actively to what the client says.
 Show your interest and understanding all the time.
 Tell the clients about their condition or Choices
 Help clients understand their possible condition
 Information should be: Simple, correct and relevant

61. HELP CLIENT TO UNDERSTAND
 Help the clients think about the results of each
possible choice.
 Ask if the client wants anything made clearer,
repeat and rephrase information as needed.
 Check whether the client has made a clear
understanding .
 “What have You understood?”
 “What have you decided to do?”
 Wait for the client to answer.

62. EXPLAIN WHAT TO DO
 Give supplies, if appropriate.
 If the service cannot be given at once, tell the
client how, when & where it could be provided.
 Describe possible side effects and what to do
if they occur.
 Ask the client to repeat instructions. make
sure the client remembers & understands.
 If possible give the client printed materials to
take home.
 Explain when to come back and why

63. RETURN VISIT
 Check if the client is using the Treatment
correctly.
 Ask if the client has any Question or anything to
discuss. Consider all concerns seriously.
 Ask if the client is Satisfied, has there been any
problems since last visit???
 Help the client handle any Problems.
 Refer client who need specialized care.

64. CONCLUSION
Your communication skills can make a difference
between being
hired and fired.
*****
Practice makes a man perfect…

65. ROLE MODELING
IS THE “GOLD” STANDARD IN
TEACHING COMMUNICATION SKILLS

66. ROLE PLAY IS THE
“SILVER” STANDARD IN TEACHING
COMMUNICATION SKILLS

67. TAKE HOME MESSAGE
To Be a Good Doctor, we Have
to Be a
GOOD COMUNICATOR