COMMUNICATION
Dr Nesif Al-Hemiary
MBChB – FIBMS(Psych.)
International Associate of the Royal College of
Psychiatrists(UK.)
Definition
Communication is commonly defined as
"the imparting or interchange of thoughts,
opinions, or information by speech, writing,
or signs".
 Although there is such a thing as one-way
communication, communication can be
perceived better as a two-way process in
which there is an exchange and progression
of thoughts, feelings or ideas (energy)
towards a mutually accepted goal or
direction (information).

Communication are a process whereby
information is enclosed in a package and is
discreted and imparted by sender to a receiver
via a channel/medium. The receiver then
decodes the message and gives the sender a
feedback.
 Communication requires that all parties have
an area of communicative commonality.
 Communication is thus a process by which we
assign and convey meaning in an attempt to
create shared understanding.
 This process requires a vast repertoire of skills
in intrapersonal and interpersonal processing,
listening, observing, speaking, questioning,
analyzing, and evaluating.

Types of communication






There are three major parts in human face to
face communication which are body language,
voice tonality, and words.
According to the research:
55% of impact is determined by body language—
postures, gestures, and eye contact,
38% by the tone of voice, and
7% by the content or the words used in the
communication process .
Although the exact percentage of influence may
differ from variables such as the listener and the
speaker, communication as a whole strives for the
same goal and thus, in some cases, can be
universal.
Verbal communication
Human spoken and written languages can be
described as a system of symbols (sometimes
known as lexemes) and the grammars (rules)
by which the symbols are manipulated.
 The word "language" is also used to refer to
common properties of languages. Language
learning is normal in human childhood.
 Most human languages use patterns of sound
or gesture for symbols which enable
communication with others around them.
 There are thousands of human languages, and
these seem to share certain properties, even
though many shared properties have
exceptions.

Nonverbal communication





is the process of communicating through sending and
receiving wordless messages .
Such messages can be communicated through gesture,
body language or posture; facial expression and eye
contact, object communication such as clothing ,
hairstyles or even architecture.
Nonverbal communication plays a key role in every
person's day to day life, from employment to romantic
engagements.
Speech may also contain nonverbal elements known
as paralanguage, including voice quality, emotion and
speaking style, as well as prosodic features such as
rhythm , intonation and stress.
Likewise, written texts have nonverbal elements such
as handwriting style, spatial arrangement of words, or
the use of emoticons.
Body language




Body language is a term for communication
using body movements or gestures instead of,
or in addition to, sounds, verbal language or
other communication.
It forms part of the category of paralanguage,
which describes all forms of human
communication that are not verbal language.
This includes the most subtle of movements
that many people are not aware of, including
winking and slight movement of the eyebrows.
In addition body language can also
incorporate the use of facial expressions.
Why do we communicate?

To satisfy needs.

To gain information.

To manage relationships.

To derive pleasure and entertainment.

To get self-validation.

To coordinate and manage tasks.

To persuade and gain something from
others.
Patient-Doctor Relationship




The quality of patient-doctor relationship is crucial to the practice of
medicine.
The capacity to develop an effective relationship requires a solid
appreciation of the complexities of human behavior and a rigorous
education in the techniques of talking and listening to people.
To diagnose, manage, and treat an ill person, doctors and
therapists must learn to listen.They need the skills of active
listening, which means listening both to what they and the
patient are saying and to the undercurrents of the unspoken
feelings between them .
A physician who monitors both the content of the interaction (what
the patient and the doctor actually say) and the process (what the
patient or the doctor mean to say) realizes that communication
between two people occurs on several levels at once: what the
person believes about himself or herself; what he or she wants
others to believe about them; and finally who the person really
is.
Rapport





An effective relationship is characterized by good
rapport.
Rapport is the spontaneous, conscious feeling of
harmonious responsiveness that promotes the
development of a constructive therapeutic alliance.
It implies an understanding and trust between
the doctor and the patient.
Frequently, the doctor is the only person to whom
the patients can talk about things that they cannot
tell anyone else. Most patients trust their doctors to
keep secrets, and this confidence must not be
betrayed.
Patients who feel that someone knows them,
understands them, and accepts them find
that a source of strength.
Empathy





Empathy is a way of increasing rapport. It is an
essential characteristic of a doctor but it is not
a universal human capacity.
Although empathy probably cannot be created, it
can be focused and deepened through training,
observation, and self-reflection.
It manifests in clinical work in a variety of
ways. An empathic doctor may anticipate
what is felt before it is spoken and can often
help patients articulate what they are feeling.
Nonverbal cues, such as body posture and
facial expression, are noted.
Patients' reactions to the doctor can be
understood and clarified.
Patients sometimes say, How can you
understand me if you haven't gone through
what I'm going through? however, it is not
necessary to have other people's literal
experiences to understand them.
 The shared experience of being human is
often sufficient.
 Whether in an initial diagnostic setting or in
ongoing therapy, patients draw comfort
from knowing that doctors are not
mystified by their suffering.

Listening skills










Greet your patient.
Introduce your self.
Put your patient at ease (help your patient to
relax).
Smile.
Keep eye to eye contact.
Encourage your patient to talk.
Do not interrupt frequently.
Reflect what you hear from the patient.
summarize and ask if any thing was missed or if
your patient had forget to tell something.
Attend to non-verbal cues.
Open versus close ended questions





Interviewing any patient involves a fine balance between allowing the patient's
story to unfold at will and obtaining the necessary data for diagnosis and
treatment.
Most experts agree that an ideal interview begins with broad, open-ended
questioning, continues by becoming specific, and closes with detailed direct
questioning.
An example of an open-ended question is (Can you tell me more about
that?). A closed-ended question would be (How long have you been taking
the medication?).
Closed-ended questions can be effective in generating specific and quick
responses about a clearly delineated topic.
Closed-ended questions have also been found effective in assessing such
factors as the presence or absence, frequency, severity, and duration of
symptoms
Bio-psycho-social Model of disease





In 1977, George Engel at the University of Rochester, published a
seminal paper that described the bio-psycho-social model of disease,
which stressed an integrated systems approach to human behavior and
disease.
The bio-psycho-social model is derived from general systems theory.
The biological system emphasizes the anatomical, structural, and
molecular substrate of disease and its effects on the patient's biological
functioning;
the psychological system emphasizes the effects of psychodynamic
factors, motivation, and personality on the experience of illness and the
reaction to it;
and the social system emphasizes cultural, environmental, and familial
influences on the expression and the experience of illness.
Engel postulated that each system affects, and is affected by, every other
system.
Models of patient-doctor interaction
Paternalistic model.
 Informative model.
 Interpretive model.
 Deliberative model.

The paternalistic model.
In a paternalistic relationship between the doctor and patient, it
is assumed that the doctor knows best. He or she will
prescribe treatment, and the patient is expected to comply
without questioning. Moreover, the doctor may decide to
withhold information when it is believed to be in the patient's
best interests. In this model, also called the (autocratic model)
the physician asks most of the questions and generally
dominates the interview.
 Circumstances arise in which a paternalistic approach is
desirable : in emergency situations the doctor needs to take
control and make potentially life-saving decisions without long
deliberation. In addition, some patients feel overwhelmed by
their illness and are comforted by a doctor who can take
charge.
 In general, however, the paternalistic approach risks a clash of
values. A paternalistic obstetrician, for example, might insist on
spinal anesthesia for delivery when the patient wants to
experience natural childbirth.

The informative model
The doctor in this model dispenses information. All
available data are freely given, but the choice is left
wholly up to the patient.
 For example, doctors may quote 5-year survival
statistics for various treatments of breast cancer
and expect women to make up their own minds
without suggestion or interference from them.
 This model may be appropriate for certain one-time
consultations where no established relationship
exists and the patient will be returning to the
regular care of a known physician.
 At other times, the informative model places the
patient in an unrealistically autonomous role and
leaves him or her feeling the doctor is cold and
uncaring.

The interpretive model
Doctors who have come to know their patients
better and understand something of the
circumstances of their lives, their families, their
values, and their hopes and aspirations, are better
able to make recommendations that take into
account the unique characteristics of an individual
patient.
 A sense of shared decision-making is established as
the doctor presents and discusses alternatives, with
the patient's participation, to find the one that is
best for that particular person.
 The doctor in this model does not abrogate the
responsibility for making decisions, but is flexible,
and is willing to consider question and alternative
suggestions.

The deliberative model
The physician in this model acts as a
friend or counselor to the patient, not
just by presenting information, but in
actively advocating a particular course of
action.
 The deliberative approach is commonly
used by doctors hoping to modify
injurious behavior, for example, in trying
to get their patients to stop smoking or
lose weight.

Transference and counter-transference

Transference :

is generally defined as the set of expectations, beliefs, and
emotional responses that a patient brings to the patientdoctor relationship. They are based not necessarily on who
the doctor is or how the doctor acts in reality but, rather, on
repeated experiences the patient has had with other
important authority figures throughout life.
Counter-transference:





Just as the patient brings transferential attitudes to the patient-doctor
relationship, doctors themselves often have counter-transferential
reactions to their patients.
Counter-transference can take the form of negative feelings that are
disruptive to the patient-doctor relationship, but it can also encompass
disproportionately positive, idealizing, or even eroticized reactions to
patients.
Just as patients have expectations for physicians (for example,
competence, lack of exploitation, objectivity, comfort, and
relief);physicians often have unconscious or unspoken expectations of
patients.
Most commonly, patients are thought of as good patients if their
expressed severity of symptoms correlates with an overtly diagnosable
biological disorder, if they are compliant with treatment, if they are
emotionally controlled, and if they are grateful.
If those expectations are not met, the patient may be disapproved of
and experienced as unlikable, unworkable, or bad.
THANK
YOU