1、中医临床技能实训中医临床技能实训 中医国际接诊能力实训中医国际接诊能力实训Communication Skills in English for the Medical PractitionerWhat to be learned?to develop the language skills in Englishto maintain harmony between doctors and their patientsenabling medical practitioners to carry out their duties in English more effectively and
2、with greater confidence.What is communication?voice managementverbal communicationcultural awareness non-verbal communicationactive listeningPFilmStep 1 Receiving the patient(接诊接诊)vLearning outcomesGreet patients and put them at easeIntroduce yourself and your roleAs the opening question and set the
3、 agenda for the interviewPutting yourself in the patients shoes!Establishing initial contactStep 1 Receiving the patientGreeting and putting your patient at easeStep 1 Receiving the patient Greet the patient and obtain the address Introduce yourself and clarify your roleExplain the purpose&agenda of
4、 interviewObtain permission for special circumstanceConveying warmthwelcoming or unwelcoming?Showing a welcoming voiceA welcoming voice is shown through a moderated pitch and speed,and a gentle rise and fall intonation pattern.e.g.Good evening.Ms Finley,isnt it?e.g.Im Dr Cameron.I hope Im not distur
5、bing you.Step 1 Receiving the patientAsking the opening question:So whats the problem?whats up?Step 1 Receiving the patientDifferent types of opening questions 1.Your GP has explained the situation,but I wonder if you could tell me in your own words?2.What would you like to discuss today?3.Am I righ
6、t in thinking youve come for baby Killians routine check-up?4.How are things with the new tables?5.What brings you here today?6.Has there been any improvement since I saw you last?7.How are you feeling today?8.I have your notes from your doctor,but could you tell me whats been happening?9.So,what ha
7、ve you come to see me about today?10.So,how is little Rhana doing?Step 1 Receiving the patientThe Fellow-up questions to ensure the patient to be able to express himself fully v Is there anything else you would like to discuss today/while youre here today?v Is anything else bothering you at the mome
8、nt?v Do you have any other issues youd like to address today?Step 1 Receiving the patientSetting the agenda:vLanguage for setting the agendaShall we/Lets start with the headache?Shall we start by discussing/looking at the headaches?Well come back to the arthritis later/after that.Well talk about the
9、 arthritis later/after that.If thats all right/OK with you?Does that sound all right/OK?Step 1 Receiving the patientEnd of Step 1Step 2 The presenting complaint(主诉主诉)vLearning outcomes Encourage patients to express themselves in their own words Take an accurate history of the presenting complaint As
10、k about the intensity and degree of pain Use techniques such as facilitation,repetition and clarification Doctor-centered approach or Patient-centered approach Step 2 The presenting complaintQuestion types Open questions(what,why,where type question)Closed question(yes,no or a specific piece of info
11、rmation)Step 2 The presenting complaintDoctors are encouraged to avoid the following question types Multiple questions several questions asked at the same time Leading questions those lead the patient towards a particular answer Tag questions tend to guide patients in their response Step 2 The prese
12、nting complaintCategorize the following questions C Closed L Leading M Multiple O Open T Tag v Presenting complain:hay-fever-type symptomsv 1.Does the sneezing start when the dog is in the house?C,Lv 2.Has he been wheezing as well?_v 3.So the symptoms are there all the time,are they?_v 4.Is he getti
13、ng these attacks while hes outside,too?Do they come on suddenly with no warning?What typically happens?_v 5.Did your sons allergy start after you bought the dog?_v 6.And youve already taken him to see your GP about this problem,havent you?_ Step 2 The presenting complaintC L MCC LCC L TRewrite those
14、 sentences v 1.When does the sneezing start/do you start sneezing?v 2.Does he suffer from/Do you have any other symptoms at all?v 3.How often does he experience the symptoms/do you sneeze?v 4.Can you explain what typically happens when your son has/you have an attack?v 5.Tell me how you(sons)allergy
15、 started?v 6.How have you been treating your allergy till now?Step 2 The presenting complaintHow to describe the pain-Metaphor Step 2 The presenting complaintmatch the adjectives with the ailmentsStep 2 The presenting complaintmigraine(偏头痛偏头痛)urinary infectionperiod painchest painheart attackheadach
16、etoothacheindigestionpins and needlestension headacheshooting painburning sensationcrushing sensationgripping painpounding feelingcramping painstabbing paintingling sensationblinding headachethrobbing painAsk the patient if they have ever experienced a migraine,bad toothache or a broken leg and then
17、 ask them to compare the current pain to that.Step 2 The presenting complaintSeven Attributes of a SymptomvLocationvQualityvQuatity/SeverityvTimingvSetting(in which it occurs)vAggravating/alleviatingvAssociated manifestationsStep 2 The presenting complaintClarification(阐述阐述)Facilitation(鼓励鼓励)&Repeti
18、tion(重复重复)v Decide whether each of these is an example of clarification,facilitation or repetition.1 I see7.Right2 Just let me check what you have told me so far8.Yes3 Patient:I was terrifiedDoctor:Terrified?9.Go on4 When you say _,do you mean_?10.Im listening.Please continue.5.Nod of the head(non-v
19、erbal)11.Slight tilt of the head(non-verbal)6.Lean forward(non-verbal)12.Could you explain what you mean by?Step 2 The presenting complaintEnd of Step 2Step 3 Past medical and family history vLearning outcomes Request the patients past medical historyTake effective notes during an interviewwrite an
20、effective patient note The components of the PMH(Past Medical History)Past illnessesChildhood illnesses Immunisations Surgical proceduresAccidents and injuries AllergiesPregnanciesMedicationStep 3 Past medical and family historyThe use of past tenses and prepositions to obtain a Precise medication h
21、istory Step 3 Past medical and family historyStandard medical abbreviations v HTNv Mv bv yov cigv CXRv MRIv Abdv rv h/ov lv fv FHv wv ICU hypertensionmaleblackyear(s)oldcigaretteschest X-raymagnetic resonance imagingabdomenrighthistory ofleftfemalefamily historywhiteIntensive care unitStep 3 Past me
22、dical and family historyWrite an effective patient note Step 3 Past medical and family historyStep 3 Past medical and family historyEnd of Step 3中医临床技能实训中医临床技能实训 中医国际接诊能力实训中医国际接诊能力实训Examining a patientvAt the end of this unit you will be able to:give effective instructions in a patient-friendly mann
23、erLearning outcomes:How do you feel before being examined?How do you feel before being examined?*anxious anxious*Nervous Nervous*overexposed overexposed*humiliated humiliated*embarrassed embarrassed vCommunication SkillsEmbarrassmentNervousnessFear Patient-friendly*Take off your shoes*Lie back*Raise
24、 your underclothes in height*Rest your arms by your side*Relaxv Listen to Consultation in detail and complete the doctors instructions.v 1._ for me,please,Julie.v 2._ to lift your left leg as high as you can.v 3._ off your shoes and your tights.v 4._ your skirt over your knee.v 5._ if it starts to f
25、eel uncomfortable.Using indirect language for instructionIf you could stand upIf you could stand upId just like you to Id just like you to(please,)If you could take(please,)If you could takeWould you mind just liftingWould you mind just liftingI want you to tell meI want you to tell mevWhy do you th
26、ink the doctor tend to use indirect language(modal)for instruction?Direct language:too direct;as a command rather than an instruction;abrupt and impolite.Indirect language:soften the instruction;it come across more as a request;more polite;lessen anxiety and fear.*Take off your shoes*Lie back *raise
27、 your underclothes in height*Rest your arms by your side*Relax*Would you mind doing*Id just like you to doId just like you to do*(please,)If you could do(please,)If you could do*I want you to tell meI want you to tell me if it starts to feel uncomfortable.Role playvAs doctors,how can you give instru
28、ctions in a patient-friendly manner?Indirect language softenerSimple/informalinstructionA.CircumductionB.Adduction C.Pronation D.Inhale E.Exhale Medical terms Simple termsa.Make small circles with(your arm)b.Rotate/turn inwardc.Turn your palm downd.Breathe ine.Breathe out Read the dialogue and under
29、line all the instructions written in a formal style.The first one is done for you.Replace the formal words with following less formal equivalents(sit up,breathe in,nose,breathe out).Presenting complaint:asthma Patient(wheezing heavily)Doctor:Mrs Daniels,can you sit in the upright position for me,ple
30、ase?I can see youre having difficulties today.Im just going to listen to your chest.Patient:Sure.Doctor:Good.Now,I want you to inhale through your nasal passage.Inhale deeply Thats it.Now exhale.And again inhale and exhale.vAs doctors,how can you give instructions in a patient-friendly manner?Indire
31、ct language softenerSimple/informalinstructionRead aloud the following instructions,then decide what effect the word just creates?A:1.I d just like you to lift your leg.2.I d like you to lift your leg.B:1.One more examination left.2.Just one more examination left.C:1.It looks like a minor fracture.2
32、.It just looks like a minor fracture.It is important to use softeners such as“just”to establish and maintain good interpersonal relations in English-speaking cultures.An absence of softeners can convey a lack of warmth and tact.-by Loveday(1982)The following instructions sound a little abrupt,please
33、 soften them:1.I want you to lift your left leg.2.Relax you leg.3.I am going to feel your shoulder for any fractures.4.It looks like a minor fracture.v Watch the video clip,pay attention to the communicational skills the doctor used in physical examination:v Indirect languagev Simple/informal instru
34、ctionv Softenerv Besides,dont forget tov 1._v 2._v 3._ Wash handsCover body of the patient to preserve patient dignityWarm hands or stethoscopePiecing it all togetherRole PlayvPractise the 3 communication skills in the consulting room.(46 students one room)vBase your practice on the case you choose.
35、vComplete the Progress Check for the unit.Table of Progress checkDoctors name:=be professional in this area,x=need more work in this areav Giving instructions using patient-friendly manner by:*using indirect language*using the softener just*using simple or informal language*using appropriate intonation
