Clinical Communication Thieves

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Clinical Communication Thieves

13 Sep, 3:30 PM

[Music] good evening everyone this is dr rishali and i welcome you on behalf of netflix for this session so for today's session that's clinical communication thieves we have with us dr trishna nani who's working as a general practitioner in the southeast region of england he is a member of the royal college of general practitioners and faculty at brighton and sussex medical school he is a passionate medical educator with an interest in listening centered clinical communications he is serving as a chair for international listening associations health care team he is the co-founder of glocal academy which has been instrumental in delivering custom made listening centered clinical communication skill training programs to health care professionals and organizations in india and uk he enjoys long distance running and walking he hates cooking but loves eating food so we are thrilled to have you sir back as always we know this is going to be an amazing session so i'll hand it right over to you thank you vishali for the introduction so people it's been a while i think from here onwards we'll be doing one session a month um so hence there has been some delay from the last session so there are a couple of raised hands rishali can you ask them accept them up please so today's session is on clinical communication thieves i wonder why i said teams like thieves rob our valuable things there are certain thieves that are operating in the plane side that are robbing our capacity to communicate with others the thieves that are robbing our capacity to listen to the others the thieves that are robbing our capacity to explain things clearly to patients families and colleagues to shall we accept all the best hands for the better i have accepted everyone's request all of you must have got the audio video pop-up okay those who are on stage can you say hello for me please hello hello hello hi is that sarah yeah okay thank you sarah who who else is on stage so can you say hello who are on stage please so that i know can you say your name yeah hello i'm dr nadine hi nadeem thank you for yeah i can't see the name so hence yeah okay can you think of any thieves that are robbing your capacity to communicate with your patients what factors are blocking your capacity to communicate with patients either sometime in a language problem is there okay yeah because they interact in urban and rural patient so very difficult to yeah what you call it difficult to uh resemble the symptoms and local language just phrases and doesn't understand about patient okay yeah you understand what i'm saying there oh yeah if you if it is convenient for you you can speak in your local life yes no no no i i have no difficulties but uh wise is very not clear okay that's okay so people today we're going to talk about all those thieves that are robbing our capacity the themes that may not be visible to us but very clearly visible to the people in front of us and around us those thieves are very clever they exist in the way we sit in the way we behave in the things that we do in the words which we use in the phrases which we use in the way we handle emotions so they are very clever they're hiding in our play inside so today it's all about how to capture them how to capture them and how to negate them because we have to we have to find a way of catching those thieves and putting them away so the concept which we're going to use today is called negation negation concept is from krishnamurti some of you may have heard or read or listened to him amazing person considered as one of the greatest thinkers of 20th century it's from the book awakening intelligence so negation what does it mean he says through negation through negation that thing which alone is the positive comes into being so what is he's saying is we've got to consciously work at negating removing the barriers the blocks that are inhibiting our capacity to do things so if you apply that to our session today through negation which is by negating the listening blocks listening which alone is the positive will come into being so what are the blocks for listening we we need to identify those blocks only then we would be able to get them we would be able to find strategies in addressing them so we got a lot of work to do in our clinical practice so that's the concept which we're going to come come come back again and again throughout the session negation if you have any questions so far you can type up or those who are on stage you can unmute and ask okay like with all the sessions please listen with curiosity participate in the dialogue ask questions post comments if there is something that you want further explanation if you want me to expand on certain things please let me know so these are the five principles that we have been campaigning about the five fundamental principles we call them as i will principles i will is an acronym for intentional presence which is be present with an intention to pay attention so my request for you today is of course you blocked your time it's nine o'clock in india you want to learn something you want to become a better communicator so be here with us participate in the dialogue so intentionally present in this conversation welcome so all the clinical practice welcome means welcoming patients to share their narrative by giving them time and space welcome also implies that we're going to respect each other of the points or perspectives that we share this evening introduction whenever you are introducing to a a new patient always include your name role and purpose hi i'm dr melini i'm a clinician how can i help you today i would like to take i would like to have a conversation with you i would like to perform this test today so make your intention very clear listening intelligence uh i'll talk more about it in a moment which is uh in in in brief it's our ability to read the situation closely and adapt our listening style to the needs and interests of other people and situation so for example the way you listen to the lectures is different to the way you listen to the patient and the way you listen to the team in a multi-disciplinary team meeting or when you are conducting a meeting is different so listening style varies according to the role and the context of course as nadeem was saying earlier on language does matter we need to find effective ways of communicating with people whether it is in english local language or whatever we need to really nadim has recognized that there are some challenges that's the first step if you recognize what are the challenges are then we can put some steps into place they can implement certain strategies so well done nadeem for recognizing them so today it's all about okay what is the thief that is preventing you from being here what is the obstacle you you want to be here you want to pay attention here but something may be really knocking on your conscious radar say for example nadeem a thought may be knocking on him saying that oh my god did i get enough likes on that facebook message or did did people respond to my instagram message or photo or did oh my god what is he going to say to my whatsapp message so a thought might be sitting at the back of his mind nadeem being a gentleman he is saying that go away don't disturb me i'm here i'm listening to dr manily talk about it so he's actively he may be blocking it i know he's laughing maybe something is knocking on his conscious radar at this moment or if he's if he's married his wife may be saying okay when are you coming to cook dinner or wash dishes i don't know you marry nothing okay similarly we'll go through this different thieves and what safeguards we can put in place to to address the challenges okay so what is a safeguard the definition of safeguard is a precautionary measure to ward off impending danger a precautionary measure to ward off impending danger or damage i'm sure you all have different passcodes isn't it for your mobile yeah you have passcode to get into mobile you have passcode to get into whatsapp message and the passcodes it could be number name or these days it's facial recognition once in a while when i'm working or when i'm in the kitchen my daughter comes along and says daddy smile and she puts my camera my phone in front of my face and it unlocks and she goes away and gets the app she wants so not that effective isn't it facial recognition it's very sensitive and similarly for your house you may have house alarms security systems so what safeguards do you have or do you have in place to avoid distractions right now how are you managing to pay attention to this how are you really paying attention to what i'm saying how are you paying attention to what i'm listening what safeguards have you put in place did you turn off your notifications or did you put your mobile on silent or did you close the door what what what have you done all that do you want to come on stage type some safeguards that you caught in place now as we speak in the comments so that you can get a flavor of how you're all implementing it already so who else is on stage the person is really observing very keenly with the hand on his left temple i don't know his name and i can't hear him what's your name we can't hear you we can't hear you it's a shame still we can't hear you um no still we can't hear you uh so please post some safeguards in your comments because it's very important that we learn from each other so why is it important to pay attention or use all our energy to pay attention this explains very beautifully saying when you are with the patient what do we want we want the humane connection we want rapport we want trust to get established with the patient isn't it so they don't it doesn't happen automatically does it it won't so kate and tempest in her book she says i can't summon connection down from the either which means space and expect it to land in my life but i can do everything in my power to create a welcoming environment for it when it does decide to show up this is the same for self-awareness i can't expect deep revelations about the content of my character or my life's trajectory or why i tend to do x when challenged by y to just pop up by when i'm trying audience i have to put in great deal of work to notice my own behavior and even more if i'm hoping to transform it it's a craft so when you are with a patient yes you are needed in different places you got many other responsibilities and rules and things to do however the patient is sharing their story or describing their symptoms it is our responsibility to do everything that we can in our power to be with them to be present so the main these days the main distraction or obstacle is tends to be social media phone or multitasking so how are you managing it what safeguards have you got in place are you in control of them or are you struggling so nadeem what do you do what do you do with your phone when you are with you in the clinic airplane mode and deal with the patient in a consensus yeah oh very good airflow airplane mode very effective yeah others yeah what are you doing what step what are you putting in place so the two things that i do is turn off notifications and put it away out of sight out of mind yeah we would like to hear from because uh because my thinking is that patients trust me for healing therapeutics and other people without concentration i don't make the trust between us and patient okay that's why i make airplane mode in one to two hours yeah very good and the other thing that i have started to uh put in place is this they've got is also working effectively to negate the distractions is during my clinic time i am neither starting a conversation on social media whatsapp nor participating in a conversation that has been initiated by somebody else so if you initiate a conversation or if you participate in a conversation you're distracted yeah our request is don't initiate a conversation when you are in the clinical setting unless it is emergency or urgency then seek permission from the patient or from the family or from your seniors that you need to attend to certain things so refrain as much as you can from participating in an ongoing conversation on whatsapp or other social media like snapchat or what is the current one now signal is the latest app so please it's very important that we we save our energy we focus our attention on the patients why because the more you let go of those barriers the more you have control on those barriers the better your performance will be the better you listen the better they share their stories i don't bring my regular phone into my consulting room oh well done that's a great strategy so he has got maybe work and personal phone it it works yeah the same very interesting silent mode with data off okay well done people for already acting on it is it working all your strategies working all your safeguards working is the question i'm sure they are i'm sure you're able to stay so patient is coming with a lot of pain so we should try to listen the patient carefully sir oh very good expectations uh with a lot of pins so we should try to listen them very carefully sir and if we keep our phone off or on airplane mode it will be very good sir so i have seen that uh many doctors keep us keep their mobiles on whenever patient or tail system his or her symptoms to doctors doctors up pick up the phone and talk so there requires a lot of distraction and if you don't listen carefully to the patient you can't come to the diagnosis either the provisional or definitive so i think the first more end when you are attending the patient and must listen uh carefully to the patient sir because they are our gods patients are our gods yes what's your name say my name is our doctor sarakumar pathetic i have completed my mbbs from uh medical college kolkata very good hi thank you for making hi sir hi sir hi hello thank you for making that point clear so one thing i want to tell you sir sir i rarely use the mobile phone i rarely use the mobile even in my home sir actually in 24 hours i uh i just use two to three times and whenever i was attending the patient during my internship i had always kept my phone switched off because i don't use social media mass i don't use my mobile much there unless it is very much required but when i was attending the patient sir i had always kept my phone on the airplane more sir and whenever i uh finished my duty either it was of 12 hour or 24 hour whenever i was not attending the patient at that time i kept my mobile on just answer even i am not touching my mobiles there because i rarely use the mobile and while attending a patient every doctor should must must listen carefully to the patients because a lot of time patient is a lot of pain and we even can't imagine their pains and we are here to remove their pain so that's why we are sitting here sir so i think we must be careful and we must be serious towards our patient sir even patient has no pain yeah he or she is looking very normal he still he has come to you so you should be very careful very serious towards passion sir very good sarah you made my job very easy this evening people implement what sauron is saying let's try in cutting down our mobile usage let's be uh professional i'm sure like i've seen in the comments you're all working towards that and some of you have already put in strategies in place hats off to you saro and hats off to all of them who are working on it look at this poem people it's very powerful it's very powerful uh and it and we need to really reflect on it very uh carefully and cautiously because this is me this is you this is us in this 21st century we are relying a lot on mobile and we are engaging and conversing with people on social media platforms more than the people around us it is and i think we're all somehow to certain extent uh victims i can call off it i'm obsessed with my phone and all the people who live in it i have never been so connected to others and so disconnected from myself you know so very important people ask this question you are here because you want to become a better clinical communicator better clinician better professional so so we need to work on the things that are coming in your way in becoming that okay so if this is you ask yourself okay how can i limit how can i reduce or how can i avoid and stay focused on the on the person on the patient in front of me on the family on my team okay so it's very important i hope between me and sauron we made the point clear let's move on okay so this statement when when we read this statement oh yes i do that i want to do it somehow you feel like okay i can do it it's easy however from my experience i'm sure from some of you may also agree with me from your experience that to practice listening the way judy says can be very challenging it's a wonderful gift to be listened to even a new experience for some people you may assume that you do listen but good listening is a much rarer quality than we might like to think in essence it's so simple so simple all you have to do is listen but to listen without interference without drifting judging comparing criticizing labeling planning interpreting are maybe not so easy so you are listening to me however what efforts are you putting in place to avoid that interference to avoid drifting off to somewhere else to avoid judging me or other people or comparing with what i'm saying with with what you know already so how are you listening to me what steps are you putting in place right now and what steps and what strategies what safeguards have you put in place to make sure that you listen well to the patients and families and communities so kajal and there are a couple more hands if you want to come on stage please come and share your insights we would love to hear so again what are the blocks or barriers that are affecting your listening how can you negate them is the question it is very important to have this slide in your radar all the time because as a professional as a health care professional as a clinician working in this dynamic you can call messy emotionally charged healthy care settings you have many roles to play you're not a clinician alone you're not a diagnostician alone you're not a physician or a surgeon alone you are a leader you're a team member you're a researcher you're an educator like me and you're also a critical reflector you're a lifelong learner when you are playing so many roles the way you listen very from role to role because each role has got its own responsibility how conscious are you in shifting your listening style when you are navigating through these different rooms how conscious are you here's the question okay what is the situation and what type of listening or what style of listening does this situation demand does it demand empathetic listening compassionate listening evaluate your listening task oriented listening what type of listening does this situation demand and how flexible am i in shifting my listening style in navigating through these tools be good to start asking these questions when you start asking these questions you like you have come here you take up responsibility your own responsibility in learning more about these listening styles that's listening intelligence and i'm part of as you've heard from roshali part of international listening association where we help people in enhancing their listening competence we help people not only and become better clinicians but also we support them in listening education research and in getting better at listening in two days time we are celebrating international day of listening the theme for this year is listening to heal so watch out we go on to listen international day of listening website there are lots of tips that we have created i'm sharing that they they see we have we have put together lots of tips that will help you in becoming a good communicator so charlie casual keeps on raising your hand can you accept that hand please yeah i'm accepted my request for you is when you when we talk about listening first thing that comes to our mind is okay i got to pay attention i got to be receptive to what the other person is saying i need to ask questions i need to formulate the diagnosis it's a process that's what comes to our mind most of the time that maybe that's what you've been taught however it's also helpful to see listening as a being mode state of being right now what is your listening mode if you ask that question you might say okay right now my listening mode is receptive to what doctor my daily is sharing okay i'm taking in okay i'm not going to interrupt him i'm going to receptive and by being receptive i'm going to really try to understand okay and if there is anything that i'm not sure about i'm going to post a comment or come on stage and ask him so that's the listening mode listening mode is right now you're not only being receptive to what i'm sharing with you you're also reflecting on your clinical categories on your communication style so it's all happening hand in hand at the moment i hope okay so vishali is going to play a video it's a very powerful video it has one best short film award at cans canes festival many years ago very powerful it highlights the concept of perspective taking beautifully so please listen to watch this you might [Music] oh [Music] [Music] uh [Music] one [Music] [Music] oh [Music] [Music] oh [Music] [Music] [Music] hmm [Music] oh [Music] okay so i would like to hear people your thoughts uh honor your right so what are your thoughts what's your insights people please share it's a very powerful video it's got multi-layered meanings the more you watch it the more you learn from it how does it help us in clinical practice you know so you might have seen that the dog was very angry that she bird is stealing the insects you know understandably he defended yeah then the the boss he didn't like the dog's behavior initially but when he realized that it was holding off the bird he appreciated it suffers yeah and it's only it's only when the dog a puppy when he it observed that it is taking the insects to feed only when it observe that learn that it's doing it for to feed then it welcomed okay take away all the insects and in written the bird bought lots of fish you know so yes we are faced with our worst thief it's very difficult to capture and put it away at the time and when in working in time constrained high pressure and increased workloads we tend to sometimes rush to conclusions and diagnosis or make judgments hastily or too often okay it's when we take a step back and take a perspective or learn to understand what the other person might be going through and why did they say the things they said or did what they did or what is the real story behind that cry or emotion or what is the real meaning behind those words we tend to establish connection then everything will fall into place was it not um they had no doubt that it has got the best feature the shot which it will have about isn't it so watch it again later on it's called joy story and it emphasizes and it really explains the concept of effective listening beautifully okay if you can parachute the learnings from that video into our clinical practice and consciously put those things into practice by asking questions to know the real meaning to understand the real story and as you might have heard this phrase try to learn to walk in the patient's shoes for a mile as they say yeah connections happen and we make the correct diagnosis adherence to treatment increases patients will fall come for follow-up and they will understand and recall information better yes good comments ginny so i also want you to see which of these apply to you if none of them apply to you kudos well done keep at it if any of these apply to you that's when we need to talk about okay if i talk most in a conversation how can i not or reduce my talking how can i encourage others to use the space effectively how can i really be patient and ask open questions so that they share the conversation if in a team if you are making decisions all the time then maybe it's time to reflect on it and see how can you involve your team members in the shade decision making process any comments people i think this works better if one one or two of you share your insights maybe it's time to get nirisha on to stage or share your insights go ahead sorrow sir i want i want to tell that uh active listening is must and apart from that i think a doctor should give a sufficient time to the patient sir many doctors give sufficient time but sometimes doctor doctors are in a hurry they just they just attain the patient very faster and they don't listen properly so i think apart from affirmative listening active listening way should give sufficient time to the patients there and if patient is telling his or her symptoms we should ask or we should question them this and this how that and that i think so that will be quite good for both doctor and patients giving active listening and giving sufficient time to patient there see people in theory we know all these statements that are giving time active listening and empathic lessons these are all very important and we all want to do our best in clinical practice we want all of us want to do our best in um in in helping patients but there are certain things that really put pressure on us you know the time the number of patients the complexities of the patient reduced to work truth however rather than really letting them control our emotions and our ways of being we need to think or work out ways of addressing them you know yes we want more time you may get more time but not yet so we need to make the best of the time that you have yes we need more doctors in india more health care professionals in india but however that's more of an organizational institutional political and national debate you know until more resources are poured into addressing that problem how can we all work together in taking care of our mental and physical health and doing the best with what we have so i think we need to maybe change the narrative a bit okay this is what i have how can i best do as a team as an individual okay and um and and hence these statements are very important any comments anybody so you do you find yourself thinking about what comes next when the patient is sharing their narrative instead of paying attention if you do don't feel bad we all do it as i've said in the other sessions mind loves to wander it's our responsibility to recognize that and request it back to pay attention so self-awareness is very important reflection is very important your flexibility is very important so that's what today's session is all about i'm going to share some eight to ten things towards the end and you can take them away and put them into practice straight away okay so so these are the things some of the thieves that are hiding in in the way we come across in the words which we use okay if you are using the word but lakin ask yourself okay is but necessary is laking necessary here khani in telugu is it necessary here you need to ask most of the time it there is no role for it once you say but you mean that oh i don't care about you i want to force my point ask you know uh some people who are who are doing course with me like nirisha um they go on they undertake a challenge that for 24 hours they intentionally do not use but and should so they're consciously avoiding using buttons you can take up the challenge if you the moment your you yes shoot is needed you know you've got to tell people what to do but however when are you using that shirt is it towards the end when it is needed or in between no you should do that why should why did you do that you shouldn't have done that you know you which means that you are advising to to too soon too quickly you are being dismissive so watch out when you're using whenever you use the word should pause for one second and two seconds and say okay is it the right time for me to use the word shoot or do i have to wait that's all we need to do if we say okay this is the right time i've collected all the information we had good data gathering and examination so this is the time fine but if you say oh okay no no no i haven't explored the problem yet okay let me park it aside i'll come back to shoot later on that's that's the way you improve your listening style and if somebody is talking to you and if the other person is if you are talking to somebody and if the other person keeps on saying i know i know i know how does it make you feel what you know everything i haven't even told you you know so that may be have it you don't mean to say uh follow me you know you didn't mean it it's just a habit it's just a word but the other person is perceiving but what is this fellow he's saying i know i know i know for everything i haven't shared everything with me so if i know is the listening response that you tend to use put it away please put it away get rid of it you know put two two-part authentication or some security system in place you know that so that it doesn't come in and rob your listening capacity yes muhammad well done for realizing that it's difficult guess what you are a professional being a professional is never easy it's always difficult however we have signed up to face the challenges to make the impossible things possible mohammed do not say it is difficult and not do anything acknowledge that it's difficult and do something about it may i know why it is difficult nadeem so the other thing is emotions oh my god where shall i start about emotions each of these two clinicians you think is communicating or listening better which of these two clinicians i'm sorry i'm sorry to hear that while maintaining good eye contact animated i'm sorry to hear that and the forward lean make somebody shared some sad news i'm sorry to hear that or the same thing i'm sorry to hear that but you're looking away at the computer and typing you say the same thing but your body language is different which which clinician is listening better here so that's the thing which you need to observe yourself number one yeah you you everybody knows that number one is it however are you number one or are you number two remember people the thing which you need to remember is the context you are working in a time constrained busy heavy workload less workforce situations some of these things you don't mean or you know maybe you're not aware that you're doing it if you are doing it i please adapt them please change them because the person sitting in front of you might perceive you differently you may be doing what the clinician number two is doing because it's got 50 100 200 patients to get through okay however the actions his body language is sending out wrong message that oh he doesn't care about me or that person doesn't care about me this doctor doesn't care about me this dentist doesn't care about me this physiotherapist doesn't care about me this nurse doesn't care so it is affecting so all the time you have spent up until that point may be waste because the patient has perceived that you don't care can you see the challenges so you need to be very conscious of what you say how you say how you be all these matter you've got three minutes five minutes i don't know how much time you have make that count by being mindful of what are you saying how you're saying and how you're being okay okay let's take this poll and go ahead vishali the question is coming first so the most difficult part of managing emotion in a professional setting what is it for you what is the most difficult part of managing an emotion in a professional setting which of these four options apply to you one or all inadequate time to address what comes up so i don't uh bring it up fear that i might make things worse don't know the right votes to say so there is yeah it's it's a fair divide you can so what shall we do about it because there is no time you're not going to bring up the emotion and address it you may if you are doing it be mindful that actually they say addressing emotion in the right way at the right time saves time that's the research that has been showing again and again that addressing emotion effectively saves time how because the patient perceives that you're listening you care so they share the right information if you don't address the cues that they are showing and emotions that they are showing they're going to repeat the same things again and again with varying tone because they've acknowledged or they have they've appreciated that you haven't addressed that emotion which they want you to it so they are repeating the same thing in different ways or in the same way so addressing the emotion does save time and by addressing the emotion they share their real concerns so you can you address the real concept and they trust you rapport comes into place whatever management you then design or whatever treatment you then give they're going to adhere to those management to that management or treatment if you give amoxicillin for 10 days or seven days they will take for seven days or ten days because they perceive that you've listened you cared and you you meant and you and they felt like they've been heard valued and understood if you don't address the emotion they feel like they're not heard understood or valued and so they whatever treatment you give they may hesitate to follow it through if they don't get better at two or three days they go and see a different doctor so the treasure is building in the system and if you address the emotion if they feel like they've been listened to guess what whom they're going to come and see you when they come and see you you're going to spend less time because you've already established the rapport you're not going to try hard to rebuild the connection or establish the rapture and guess if the same patient is coming to you again and again for a year 10 years you establish such a beautiful longitudinal relationship along with him his friends come his family comes his colleagues come so you get to know not only one person but the family and the community and the neighborhood it's beautiful isn't it all because you are addressing the emotion if you feel like you you don't you're not addressing emotion because you don't know what to say how to say you don't have the right words fine well done for recognizing that that's your challenge do something by attending the courses that we are offering or somebody else is offered there are various courses that are on offer and we did a full lasting last time that we do offer small group of six to 12 students or doctors to have deeper conversations in-depth conversations about addressing these skills marisha i can see her i'm sure there are others in this session marisha has just finished her her time her journey with us and she has already she said that she's already finding it helpful in the way she'll come on stage later on and share her insights so people awareness once you know what are the things that are really robbing your capacity the thieves then you can do something about it you can do something to negate them there are lots of strategies and you need to find the ones that work for you for your work in your workplace that match your values that match your personality okay it's not one size there is no one size fit all approach look at this poem when i have lost my temper which can happen many times because health care settings are emotionally charged when i have lost my temper i have lost my reason too i'm never proud of anything which i do when i have talked in anger and my cheeks were flaming red i have also added something which i wish i hadn't said i'm sure you you can connect with that it has happened at some point in your personal and professional life in anger i have never done a kindly deed or wise but many things for which i felt i should apologize in looking back across my life and all i have lost or made i can't recall a single time when fury ever paid so i struggle to be patient but i have reached a wiser age i do not want to do a thing or speak a word in rage i have learned my sad experience that when some temper flies i never do a worthy thing a decent deed or otherwise so john edmund is saying that i so i struggle to be patient for i have reached a wiser age i do not want to do a thing or speak a word in rage to do that we need to learn about emotional intelligence and we need to be emotionally competent so emotional competence and listening intelligence are the things that we need and hidden within this poem is also about self-awareness so what are you what are your struggles what are your challenges what are you good at what are you not so good at how can you really continue doing the good things and refine or work and get better at the things that you're not good at so nadeem earlier said language is a challenge indeed it is a challenge so when you hand on your heart hands on your heart when you write prescriptions when you say prescriptions how much do effort do we take in explaining things how do you write the prescription what are the things that you assume or take things for granted when you do that prescription people we might feel like writing a prescription is one activity however it is not as this person rima rudd explains you know when you begin to list out the component task of what we sometimes think of as a single activity that is writing prescription you begin to appreciate the sophisticated literally literacy skills involved taking medicine involves multiple tasks if you give a prescription to a patient he has to first go and get it cached or filled in then bring the medication home then he need to know where to store in the fridge outside the fridge or where to store and the language which is on the medicines the box or prescription is it english local language can he read can anybody in that family read you know the label okay fine he's he's been through he somehow managed all those two steps is it all no many people are on many medication poliformlessly does he know that this does not interact with the others have you made it clear to that person can he take this along with the other medication or not to mix or if not to mix which one he should take first you know all this is going through his mind how can we differentiate between one or the other can you see people so we are writing when we write prescription can we also consider these things who is the person to whom i'm writing the prescription to what are his literacy skills is he an educated person non-educated person what's the culture is if he is a vegetarian strict vegetarian some medicines have got some gelatin or other things that are considered as meat products do they know are they going to take you know some are culturally inappropriate so hence as professionals we need to really think through all these things and put systems in place it may be challenging for you to do but we need effective systems as well you might say oh it's all good for you to talk about these things yes i'm talking as a famous indie dialogue at least you need to talk once we start talking we can as a team if i can do it you can do it if you can do it your colleague can do it if you and your colleague can do it of course your junior can do it can you see when we as a group of people on this session today we have got responsibility to design better system because who is the patient it's me i am the patient you are the patient we are all patients you know when you go to the doctor we expect him to say okay can you what medications are you taking can you make sure that you don't mix with that one or can you take this first wait for another and take the other okay because we all want the best for the patient we all want the people to get better and carry on with their lives you know lead a happy life people don't come and see us when they're happy and everything is going fine do they no they come to us in suffering so that you treat the suffering you address the suffering so that you they have a happy life maybe that's why they consider us as god equivalent you know all as i said you know you have to read and comprehend the directions if you say take it an empty stomach what is empty stomach you know what do they know anyway so this is an example i'll let it there for 30 seconds for you all read it so it's a beautiful narrative that's the source helen osborne uh he is she's done amazing work or doing amazing work on health literacy uh she has written a book called healthy literacy from a to z she's also got a podcast called what is the name health literacy out loud podcast so people are doing many things so can we do similar things where we are working you know okay i hope you got the gist of it you got the meaning of it so i earlier i promise that i'll give you certain things that you can practice just now this is it step number question number one right now you can ask yourself where is my presence most needed in this session or on whatsapp or instagram or at home in the kitchen or watch the tv you decide where is my presence most needed when you are in a clinical setting in an opd or when you are taking history most of the time your presence is needed with the patient not away from the patient unless there is a emergency in your family or your friend if there is a really present need so most of the time your presence is needed with the patient yeah okay so introduction is very important so ask yourself oh i did introduce to saurov just now but did i include my name role and purpose if not let me go back and re introduce it again okay am i attending to this patient's narrative with an open mind or i've already made up a mind of or am i rigid am i close to what the other person is saying okay so was the dog attending to the bird with an open mind no it was defending the insects isn't it so later on it shifted the mind to open mind so welcome welcome he is my body language welcoming and attentive you know you said you all want to be clinician number one so yes ask yourself what is my body language now if it is not then it's very easy you know what to do you know shift it when you're having a conversation if you are talking too much you're not facilitating so ask yourself am i facilitating the conversation by making space for the patient to share by encouraging them to talk or am i really taking control if it is a dance floor are you dancing by yourself or are you letting others dance as well you know if we don't like the people who occupy all the dance floor do we no transfer is for everybody to dance and enjoy together and most importantly people you need to ask if you have just discussed a serious news or if you just finished an emotional conversation you need to ask yourself am i ready to listen to the next question if not process the emotion get rid of the emotion have a break deep breathing exercise take it have a tea whatever do whatever you know however ask yourself am i ready to listen is the atmosphere conducive to listening what is the pace of the interaction is it going too fast like a ping pong table tennis like professional tennis player or do you need to slow down the pace because not every patient has got literacy ability or every patient can understand the language which you are because you are catering especially in india i really celebrate to admire you because every patient is from a different background with different literacy skills and with different emotion you so ask yourself what pace should i be here i know what i want to say yeah you know because you've read medical books back to friend front to back million times you know what to say but the question is not whether you know what you say or not question is am i saying it in the language that the other person understands if i don't know the language the other person is sitting in can i call an interpreter or can you call your colleague can somebody come and explain things clearly to them because you don't want the patient to leave the consulting room not understanding the information do you don't we don't okay so checklist people use this checklist you can take a photo or we can email you this checklist get started here if you are in your medical training or if you just started your clinical practice get started with this checklist eventually design your own put it on your table you know carry it with you it works get started this will negate most of the thieves that are robbing your capacity communicate i promise you know two doctors students across the india all using this checklist not only in india but also in uk we are encouraging people to use this very powerful okay that's the end of the session so it is our responsibility to identify what are the thieves that are robbing our capacity once you know what those thieves are you've got to consciously intentionally do something that is negate them by asking the checklist if you like and use the checklist as a safeguard so that that thief will not come and rob you again yeah okay good fantastic so that's the end of the session as always if you would like to share what i have learned or what i have experienced or what i've become aware of or what is your closing commitment from today what is that you're going to go and do without owning the responsibility okay today i'm going to ask this question where is my presence most needed all the time it may be as simple as that so people type in the comment or share by coming on stage we'll spend five minutes thank you sir anybody else want to join sarah on stage and share your insights please come along i think it helps definitely shinmuga priya do you want to come on stage and say a word or two on by answering that question yes and all the doctors can also type out their questions uh in the comment section uh we'll make sure that we get them answered also like sir said if you want to come on stage and join dr saurabh you can click on raise and and i will just accept your request go on people put something in what you're going to do which thing if you want to capture and put it away anybody want to come on stage we've got three four minutes left so nadim and sauro have been brilliant thank you both we need some fresh voices on stage so um i hope you appreciated my intentions behind this session um to recap we all want to be better communicators we all want to do the best for the patient however the few things that we need to get rid of um and we need my intention was rather than listing all the things i want you to be conscious and work on the things that are really coming between you in the way between you and the patient if it is the time and workforce if they are challenging keeps to put them away but we'll start with yourself you know with your attention with your listening questions and the way you are phrasing your sentences the way you are controlling your emotions and how you are conducting yourself in clinic room body language start by using the checklist i promise you that your patients will adore you and like you respect you and they want to keep coming back to you so like always um thank you richarli thank you the team uh the back office and thank you netflix for continuing uh uh with this journey and encouraging speakers like us to come forward and share whatever we know you know i think together we've got a lot of work to do so thank you audience participants i hope it has given you some food for thought and from tomorrow you're going to be more conscious of what you say or not say or how you be you know so be mindful be curious be conscious reflect and self-awareness is very important okay so shall we take the leave and know one point and um rishali and the vedic team netflix they are putting together a group for clinical communication skills courses it's a small group interactive sessions so if you are interested reach out to vishali or netflix they will highlight or give you the details of the course all the best you can definitely get in touch with us through our support number and we'll get back to you regarding it thank you so much thank you thank you as always very enlightening session thank you good night thank you thank you to all our doctors thank you so much for attending


Clinicians must be able to communicate effectively and compassionately with patients and relatives in order to achieve patient-centered consultation. The effects of poor communication in healthcare can have extremely serious consequences. There are many barriers or obstacles that are hiding in the plain sight and may limit our capacity to communicate effectively. Watch this super interactive session LIVE on MEDFLIX as Dr. Krishna Naineni explains about these blocks and shares how to put safeguards in place!


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