CONSULTATION SKILLS

FOUNDATION MODULE
(CSFM)
Prof .Dr. Alaa Al-algawy
2021
 AIMS
1. To enable students to carry out a patient-
centred consultation.

2. To enable students to take a history from a

patient, perform a physical examination .
 Learning Outcomes
1. Knowledge

2. Skills

3. Attitudes
 Knowledge
The student should be able to:
• Explain the importance of effective
communication skills.

• Describe how to enhance the doctor- patient

relationship.

• Apply normal anatomy, physiological and

psychological functioning to the symptoms and
signs found by examination
 Skills
The student should be able to:
• Explore common symptoms and patient’s
medical, family and social histories

• Give information to the patient about his

illness.

• Perform a competent physical examination.

 Attitudes
The student should demonstrate :

• Appropriate professional behaviour.

• A desire to support their peers in learning.

 Three-years schedule outline
First year:
• Semester 2 : Communication skills and introduction to
history and physical examination.

Second year:
• Semester 3 : Musculoskeletal systems.
• Semester 4 : Cardiovascular and Respiratory system

Third year:
• Semester 5: GIT and urogenital system.
• Semester 6 : Nervous system
 COMMUNICATION SKILLS
The room environment should be optimal
(if possible)

• Quiet
• Air-conditioned
• Well illuminated
• One patient at a time
 COMMUNICATION SKILLS
Principles

•Introduce yourself

•Shake hands

•Make patient sit comfortably

 Principles

•Establish a relationship

•use appropriate questioning style

•use clear language, avoiding jargon

 Principles
• listen well

• Don’t interrupt

• clarify patient symptoms

 Principles
• Achieve empathy

• Make sure the patient understood what

you have said

• Provide information in "small packages"

 Some information can be retrieved from the
relatives especially if the patient is a

• Child
• Unable to talk
• Confused or unconscious
• Mentally ill
• Severely ill
 REMEMBER
• Don’t talk to more than one patient at the
same time.

• Offer sweets, candies, or toys to children

• A smiley face is preferable to frowning one

 After introducing yourself, you should begin by
asking the patient an open question, for
example

• "Can you tell me about your illness?“

• " What is bothering you? “

• "What has brought you to the doctor today?"

 Use open questions to encourage the patient to
give you more information about the problem.

"How did it start?";

"What happened next "?

Use prompts as appropriate e.g.

• "I see";

• "I understand";

• "Tell me more about that."

• Types of questions :
• 1-Open questions: as mentioned before >>

• 2-Probing questions : For instance, if the patient’s

presenting problem was pain, they could be asked "Have
you noticed anything which brings on the pain?"

• 3-Closed questions are likely to produce only short

answers - usually yes or no.. For example - if you
suspected a patient may have a malignancy, supporting
evidence may be sought by asking "Have you lost
weight?" The disadvantages of closed questions are that
they provide limited information, falsification is easy and
their inappropriate use frustrates and irritates patients.
•
• 4-Leading questions are best avoided,
because they encourage patients to give
answers they think you might like to hear.
For example saying to a patient with the pain,
have you?"
is a less effective question than
"Has there been any change in your breathing
with the pain "?
• 5-Double-barrelled questions i.e. asking
patients two overlapping questions or asking
questions in quick succession should be
avoided. For example: "Have you noticed a
cough or shortness of breath with the pain?"
The patients reply may apply only to one of
the symptoms whereas the doctor may
assume it applies to
• both.
•
• 6-Difficult questions - A patient may find it difficult or
embarrassing to talk about certain symptoms such as
vaginal discharge or a testicular lump. They may find
questions distressing or even offensive. It may be
necessary to forewarn the patient by prefacing the
questions with a statement. For example,
• "With the symptoms you're experiencing it is very
important that I ask you some questions about your
sexual health," or
• "I can see that you find this embarrassing but I need
to ask you some more questions about the discharge
so that we can work out what is causing it."
• Acknowledging the patient‟s discomfort and showing
empathy may encourage the patient to be more open
with you.
•
 Make the patient notice that you consider
some of his ideas or opinions, but not
always, e.g:

• Nodding your head

• Yes, that’s right.

• Yes, I know.
 Encourage the patient to continue if a significant
statement is made and the patient stops.
Try repeating the last statement made by the
patient, with a questioning tone to your voice

• You are saying….?

• You mean that …?
 you may receive information out of
sequence. Remember key points.
If not sure about information: For
example:

"You said earlier……….”

“ You mentioned before….”
 If you need to write information
down, do so in a way that does not
interfere with your communication
with the patient .
• Clarify any words or terms used by the patient. If
you do not understand what the patient means,
ask them to explain

• What do you mean by “ ….” ?

• Let me understand this…

 Elicit information from patients about
their histories

• medical
• surgical
• family
• psychosocial
• drug
• Summarize and close the interview
• To communicate effectively you must:
• • Listen to, ask for and respect patients’ views
about their health and respond to concerns and
preferences
• • Share with patients, in a way they can
understand, the information they want or need to
know about their condition, its likely progression,
and the treatment options available to them,
including risks and uncertainties
• • Answer questions and keep patients
informed about the progress of their care
• • Make sure that patients are informed about
how information is shared with other
professionals involved in their care.
• Pearls
• You must be alert from the moment you first
see the patient.
• Employ your eyes, ears, nose and hands in a
systematic fashion to collect information from
which you can deduce the diagnosis.
• The ability to appreciate an unusual comment
or minor abnormality can lead you to the correct
diagnosis.
• Always give the patient your whole attention
and never take short cuts.
• At all stages, explain what you are doing,
and why you are doing it.
• You should not use leading questions

• Try not to write and talk to the patient at the

same time.
Thank you