- learn about the conceptual framework Hodges' model. A tool that can help integrate HEALTH and SOCIAL CARE, INFORMATICS and EDUCATION. The model is situated, facilitates person-centredness, integrated - holistic care and reflective practice. A new site using Drupal is an ongoing aim - the creation of a reflective workbench. Email: h2cmng @ yahoo.co.uk Welcome

Sunday, April 17, 2016

Book: Skills for Communicating with Patients

Skills for Communicating with Patients

Part 1 of my studies at Lancaster has been a busy two years. Picking up this book which I used in a research paper, the delivery note was a surprise. The book arrived c/o Radcliffe Health in April 2014. Since then Radcliffe is no more, but the title is available through CRC Press.

An established text given a 3rd edition it is accessible, thorough and well organised. The content presents the Calgary - Cambridge Guides as described on the back cover (PB).

Initiating the session. Gathering information. 
Providing structure to the interview. Building the relationship. Explanation and planning. Closing the session.

(As a non-medic) what I like about this CPD certified book is the clear path through the chapters that explain the Calgary - Cambridge Guides. Other models, frameworks and approaches are described. The Calgary - Cambridge Guides is process-centric as is evident in 'gathering information', but the complexity that arises in achieving competence is included and fully referenced (pp. 263-293) throughout the book. Framing questions in open and closed form is covered, with example dialogue between patient and doctor on many practical points. Person-centredness, uncertainty, motivational interviewing, mental health - psychosis, risk (suicide) are also explained. While person-centredness is not the main focus, 'patient' ... is very well served in the index. There is much here about shared understandings and planning and how to make suggestions and raise options rather directives (concordance, p.193). Although it might be viewed as 'cold', I liked the emphasis on information and inclusion of health literacy.

In a very brief break from my proposal I've brushed off two draft papers I've mentioned before on W2tQ at some point. They relate Hodges' model respectively to:
  • threshold concepts 5,000 words 
  • case formulation 4,000 words
In a way the Calgary - Cambridge Guides is a means to a formulation, but a formulation that is consultation (appointment, session) specific. Perhaps in future we will see developments that are more integrative and consider continuity as a vital part of this critical activity. This is the challenge in communication getting the scalability of communication and communication skills right. Clearly beyond the scope of this book but how much of that communication gets passed-along (communicated!)?

This is however a very complete, readable and informative read. Without expanding the book further: but more on technology-mediated communication (beyond computers in the consultation) must be essential in a 4th edition? I am biased but in dusting off the above papers, more on the challenges within mental health, especially self-harm, body-image, mental capacity, and forensic might highlight troublesome (threshold) concepts. Understandably, the disease-illness model is highlighted (p.65). Living well through self-care, living with chronicity, strengths and recovery perspectives may also deserve mention? Working towards a 'meeting of experts' (p.184) helpfully begins to address such developments. With my project in mind I also looked for 'evaluation'. If "research" had its own place in the index - what would the content be?

It proved helpful having a break from the draft papers I wished I'd picked this text up sooner and that I can look at my research proposal similarly refreshed...

Silverman, J., Kurtz, S., & Draper, J. (2013). Skills for Communicating with Patients, 3rd Edition, CRC Press.

Below I have mapped some of the elements of the Calgary - Cambridge Guides to Hodges' model (disrupting the original).

humanistic ---------------------------------------  mechanistic
1. Initiating the session:
Exploration of the patient's problems
patients's perspective
background information - context
Aiding accurate recall and understanding
Identifying the reasons for the consultation

Providing STRUCTURE:

2. Gathering information:

biomedical perspective

3. Physical examination:

Providing the correct type and amount of information

Building the RELATIONSHIP:
Approp. non-verbal behaviour
Developing rapport
Involving the patient
Achieving a shared understanding: incorporating the patient's illness framework
4. Explanation and planning:

Making organisation overt
Planning: shared decision making
5. Closing the session:
Ensuring appropriate point of closure
Forward planning 

Image source:
CRC Press