The Bedside Communication Handbook

The following sections are included:

• PREFACE
• PREFACE
• FOREWORD
• CONTENTS
• CONTRIBUTORS

The term carries with it two components — the professional component describing a doctor who is skilled in his or her craft and a humanistic component that describes the character and nature of the doctor…

The following sections are included:

• INTRODUCTION
• CLINICAL COMMUNICATION IN 4 ESSENTIAL STAGES
• TURN OVER TO EMPATHISE WITH YOUR PATIENTS

The cornerstone of a healthy therapeutic relationship is the presence of trust and rapport between the physician and the patient. Mistrust arises when the patient feels poorly understood. Empathy, which is the ability of a person to understand, share and appropriately respond to the emotions of another is an essential attribute in clinical communication…

In the earlier chapter, Empathy (the 1st ‘E’ ) focused on facilitating expression of affective empathy. This chapter will focus on the 2nd E — Engage which teaches the development of cognitive empathy using a 3-tiered pyramid. It teaches the engagement of patients and their families in an in-depth exploration of the unique values, concerns and expectations that underpin their treatment decisions…

Making decisions regarding treatment requires the patient and/or their carer to reason and weigh the benefit and burden of available therapeutic options. Such decision-making frequently involves value-judgment, and oftentimes takes place under stressful and emotionally-charged circumstances. In this quadrant, the healthcare professional uses a structured approach to empower his/her patient to make a reasonable and informed choice, based upon the values-driven goals of care elicited after engaging with them…

In this final E — Establish, the clinician reviews the salient issues in the conversation, condensing them into a succinct summary for the patient and family to process. By so doing, the clinician further empowers decision-making about treatment by offering the patient and caregivers an opportunity to correct misunderstandings, allowing them to raise any final concerns which they may wish to explore…

The following sections are included:

• IMPORTANCE OF VERBAL COMMUNICATION
• VERBAL COMMUNICATION STRATEGIES
• CONCLUSION
• PRACTICAL TIPS
• REFERENCES

The following sections are included:

• IMPORTANCE OF NON-VERBAL COMMUNICATION
• WHAT IS NON-VERBAL COMMUNICATION?
• TYPES OF NON-VERBAL COMMUNICATION
• SPECIAL CIRCUMSTANCES
• NON-VERBAL COMMUNICATION: A TWO-WAY RELATIONSHIP
• CONCLUSION
• PRACTICAL TIPS
• REFERENCES

The following sections are included:

• EFFECTIVE COMMUNICATION WHEN YOU ARE MASKED, SHIELDED AND GOWNED
• COMMUNICATION STRATEGIES
• CONCLUSION
• PRACTICAL TIPS
• REFERENCES

The following sections are included:

• INTRODUCTION
• INTRODUCING THE ‘SPIKES’ PROTOCOL
• CASE SCENARIO — USING ‘SPIKES’ TO BREAK BAD NEWS
• CONCLUSION
• PRACTICAL TIPS
• REFERENCE

The following sections are included:

• INTRODUCTION
• CASE SCENARIO
• CONCLUSION
• PRACTICAL TIPS

The following sections are included:

• INTRODUCTION
• PREPARATION AND PROGNOSTICATION
• FRAMING THE DISCUSSION AS A NARRATIVE AND RELATIONSHIP
• PRACTICAL TIPS
• ACKNOWLEDGEMENT
• REFERENCES

When a patient experiences a hospital admission and may potentially deteriorate further, conversations are important to align care with a patient’s values as well as with best medical recommendations…

The following sections are included:

• INTRODUCTION
• CASE SCENARIO
• CONCLUSION
• REFERENCES

The following sections are included:

• INTRODUCTION
• INITIATING THE FAMILY CONFERENCE
• ENGAGE THE PATIENT AND FAMILY USING THE 3 “CONS”
• EMPOWER PATIENT AND FAMILY WITH KNOWLEDGE
• EMPATHISE
• ESTABLISH GOALS
• PRACTICAL TIPS
• REFERENCES

The following sections are included:

• INTRODUCTION
• CASE SCENARIO
• APPROACH TO THE CASE:
• PRACTICAL TIPS
• REFERENCES

The following sections are included:

• INTRODUCTION
• PENDLETON’S PATIENT-CENTRED MODEL
• CASE SCENARIO
• PRACTICAL TIPS
• REFERENCES

The following sections are included:

• HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION
• INTRODUCING THE SPIKES PROTOCOL
• CASE SCENARIO TO USE AS AN EXAMPLE TO DEMONSTRATE SPIKES PROTOCOL
• USE DOCTOR/PATIENT NARRATIVE INTERPLAY
• PRACTICAL TIPS
• REFERENCES

Tuberculosis (TB) remains a communicable disease of public health importance in Singapore. As a disease that is transmitted via the airborne route, prevention of TB infection requires stringent infection control and concerted public health strategies. Hence, effective communication with patients diagnosed with TB is of utmost importance. This will ensure the implementation of measures such as directly-observed therapy, inpatient management in isolation rooms (where necessary) and other aspects of management are much easier. Treatment of TB requires a fairly long duration of combination anti-tuberculous therapy (at least 6 months duration). Counselling on treatment adherence and management of expectations of patients who require fairly long periods of follow-up are key aspects of TB care. Last but not least, there are some sociolegal implications of making a diagnosis of TB as well. These include mandatory contact tracing, treatment and legal notification, all of which may inconvenience or otherwise affect patients, making effective communication between care providers and patients critical.

The following sections are included:

• USE OF ANTIBIOTICS
• INTRODUCING THE SPIKES PROTOCOL
• CASE SCENARIO TO USE AS AN EXAMPLE TO DEMONSTRATE SPIKES PROTOCOL
• USE DOCTOR/PATIENT NARRATIVE INTERPLAY
• PRACTICAL TIPS
• REFERENCES

Chronic diseases are by definition illnesses where no cure is available, and where interventions are limited to symptom control, preventing disease progression and promotion of self-care management. In the developed world, chronic illness has become increasingly prominent over the years due to the decrease in death from acute illnesses as a result of improved sanitation, public health awareness and surveillance. Singapore too, is not immune to this increasing burden of chronic illness, where ischaemic heart disease, diabetes mellitus and stroke are the leading causes of disease burden…

This definition of empathy elegantly sums up the elements of good communication between healthcare providers and parents of sick children seeking paediatric treatments for various medical conditions, particularly in children palliative care.

The following sections are included:

• BREAKING COLLUSION
• CASE SCENARIO
• STEPS IN BREAKING COLLUSION
• PRACTICAL TIPS
• REFERENCES

The following sections are included:

• INTRODUCTION
• CASE SCENARIO
• I. PREPARATION BEFORE MEETING THE FAMILIES/ PATIENT(S)
• II. HOLDING A FAMILY MEETING ABOUT WITHDRAWAL OF TREATMENT
• PRACTICAL TIPS
• REFERENCES

The following sections are included:

• INTRODUCTION
• CASE SCENARIO
• (A) EXPRESSING EMPATHY
• (B) ENGAGING IN CONVERSATION
• (C) EMPOWERING DECISION-MAKING
• (D) ESTABLISHING GOALS AND PLANS
• PRACTICAL TIPS

It’s been a long day filled with new patients and near collapses. You’ve skipped lunch. You’re hungry and exhausted. The last thing to do before heading home is to take a patient’s consent for a simple procedure. Easy, right? You explain the procedure, indication, risks and benefits to the patient. No one has refused this procedure before. You hold out the pen with the expectation that the patient will sign without questions. He looks you in the eye and says

The following sections are included:

• INTRODUCTION
• SPIKES PROTOCOL
• CASE SCENARIO
• COMMUNICATION OPPORTUNITY 1
• PRACTICAL TIPS PART 1
• COMMUNICATION OPPORTUNITY 2
• PRACTICAL TIPS PART 2
• COMMUNICATION OPPORTUNITY 3
• OVERALL PRACTICAL TIPS
• SUMMARY
• REFERENCE

Paternalism may be said to live at the heart of traditional medicine; after all, doctors have long operated from the fundamental principle of beneficence (Salus aegroti suprema lex)…

The following sections are included:

• INTRODUCTION
• WHO SHOULD OBTAIN THE CONSENT?
• 3 KEY ELEMENTS OF INFORMED CONSENT
• LEGAL AGE TO GIVE CONSENT
• CONSENT IN EMERGENCIES
• PATIENTS WITHOUT MENTAL CAPACITY
• DELAY OR REFUSAL OF TREATMENT
• LIMITATIONS TO CONSENT
• DOCUMENTING THE CONSENT PROCESS
• SUMMARY
• PRACTICAL TIPS
• ANNEX A: MINISTRY OF HEALTH DIRECTIVE ON CONSENT TAKING PRACTICES
• ANNEX B: MENTAL CAPACITY ACT
• ANNEX C: MEDICAL NEGLIGENCE FLOWCHART — BOLAM TEST VS MODIFIED MONTGOMERY TEST
• REFERENCES

Even when expected, the death of a loved one is still hard to accept. One that is unexpected adds an unimaginable dimension of misery for the vast majority of people. What is potentially worse is being told that the deceased may need to undergo a post-mortem examination of the body as required by law, particularly when the cause of death is unclear or when death has occurred in suspicious circumstances…

It is highly unlikely, if not impossible, to be actively practicing medicine without ever committing an error (i.e., an unintended act of commission or omission) at some point in one’s career. The outcome varies across a spectrum of severity, from the patient suffering no morbidity at all, to severe disability and at the very worst, death as a result of the error. It is now widely accepted that open disclosure mitigates the fallout that follows, even in cases where no harm has demonstrably occurred…

The following sections are included:

• INTRODUCTION
• OVERCOMING RESISTANCE TO CHANGE
• PRACTICAL MEANS OF CARING FOR ONESELF
• CONCLUSION
• PRACTICAL TIPS
• REFERENCES

The following sections are included:

• INTRODUCTION
• DIALOGUE
• COPING ADAPTIVELY
• CONCLUSION
• PRACTICAL TIPS
• REFERENCES

The following sections are included:

• INTRODUCTION
• WHAT IS A COMPLAINT?
• WHY ARE COMPLAINTS IMPORTANT?
• WHY ARE COMPLAINTS MORE PREVALENT?
• WHAT DO PATIENTS COMPLAIN ABOUT THEIR DOCTORS?
• WHAT TYPES OF COMMUNICATION ERRORS MADE BY DOCTORS HAVE BEEN IDENTIFIED THROUGH COMPLAINTS?
• EXTERNAL FACTORS CONTRIBUTING TO POOR DOCTOR-PATIENT COMMUNICATION
• CONCLUSION
• PRACTICAL TIPS
• REFERENCES

Medicolegal trouble is not something that can be avoided. If you practice long enough as a doctor, trouble may come. It is akin to road traffic accidents. You can be very careful all the time, but unforeseen circumstances beyond your control can occur. If you fear medicolegal trouble, it may become impossible to work because you may end up constantly second guessing yourself.

The following sections are included:

• INTRODUCTION
• RESOLVING CONFLICT USING THE 4 ‘E’ FRAMEWORK
• PRACTICAL TIPS
• REFERENCES

The following sections are included:

• INTRODUCTION
• EMPATHISE
• ENGAGE
• EMPOWER
• ESTABLISH
• CONCLUSION
• PRACTICAL TIPS
• REFERENCES

Healthcare delivery is becoming increasingly team-based and dependent on interprofessional collaboration. This is an important development with some studies suggesting that interprofessional collaboration could improve healthcare outcomes. Interprofessional collaboration is often defined as the involvement of varied healthcare workers working together with relevant parties to improve patient outcomes and experience. Collaborations may occur amongst different professionals within a single organisation or across a range of organisations…

The following sections are included:

• INTRODUCTION
• CHALLENGES OF COMMUNICATING IN THE ED
• RECOMMENDATIONS FOR COMMUNICATING IN THE ED
• PRACTICAL TIPS
• CONCLUSION
• REFERENCES