Introduction to Communication & Clinical Skills

Demonstrate an appreciation of communication skills within the consultation

Communication Skills:

• Use of active listening, empathy, and open/closed questioning techniques.

• Verbal and non-verbal communication (eye contact, posture, facial expression).

• Involving the patient in discussions to build rapport.

Be aware of the Calgary-Cambridge Consultation Model

• Calgary-Cambridge Model:

• Initiating the session: Greet patient, introduce yourself, and explain your role.

• Gathering information: Open-ended questions, use of SOCRATES for pain.

• Building the relationship: Empathy, body language, addressing patient’s ideas, concerns, and expectations (ICE).

• Providing structure: Logical flow, signposting, and summarization.

• Closing the session: End with a clear plan and check patient’s understanding.

Explain in detail the first 4 headings of the Calgary-Cambridge consultation model

• Initiating the Session:

  • Build rapport, introduce yourself, explain purpose, and seek consent to continue.

  • Key Question: "Can you tell me why you’re here today?"

  • listen to patient attentively, without interrupting or directing your patient’s response

• Gathering Information:

  • Encourage patient to tell the story of the problem(s) ‘Would you like to tell me more about that?’

  • SOCRATES: For pain, assess Site, Onset, Character, Radiation, Associated Symptoms, Timing, Exacerbating/Relieving factors, Severity.

  • Pick up on cues, expressions and body lanugage.

  • Use appropriate language ‘Have you experienced any degree of dyspnoea?’ vs ‘Have you felt breathless?’

  • Establish dates/sequence of events – e.g. when did certain symptoms start

  • Use both open and closed questions. (Open question: ‘Can you tell me about your cough?’ - Closed question: ‘Does your cough get worse when you exercise?’)

  • Summarise - to ensure you have interpreted what the patient said correctly AND also shows that you have been listening; that you are attentive to the patient

• Providing Structure:

  • Logical order of questions (flow), signposting, and summaries.

  • Example: Signposting "Now that we’ve discussed your symptoms, I’d like to ask about your medical history."

• Building the Relationship:

  • Non-verbal behavior: Eye-contact, facial expression, tone/volume/rate of speech posture, position, movement, confidence.

  • Developing rapport: Use empathy, provide support, acknowledge patient views.

  • Involving the patient.

Learn the formal structure of history taking and how it relates to the consultation model

Initiating the session:

• History Taking Structure:

• Introduction & Consent: Introduce yourself and obtain consent.

• Presenting Complaint: Use open-ended questions ("What brings you in today?").

Gathering Information:

• History of Presenting Complaint (HPC): Use SOCRATES for pain or explore cough, chest pain, or joint pain using similar methods.

• Past Medical History (PMH): Any previous illnesses, hospitalizations, and ongoing treatments.

• Medications & Allergies: Identify prescribed, OTC, and herbal medicines, as well as any allergies.

• Social History: Living conditions, work, lifestyle, smoking, and alcohol use.

• Family History: Inquire about chronic conditions like diabetes or heart disease in immediate family members.

• Systems Review: A quick review of key systems to identify other issues.

• Summary, Differential Diagnosis & Management Plan: Summarize key findings and discuss next steps.

Gathering Information: for pain (SOCRATES)

Gathering Information: for chest pain (SOCRATES)

Gathering Information: for joint pain (SOCRATES)

Gathering Information: for cough (SOCRATES)

Be aware of summarizing your findings, forming a differential diagnosis, and management plan

Summary:

• Recap key points to ensure the patient’s story is accurately understood.

• This shows the patient you are actively listening and allows for clarification.

• Differential Diagnosis:

  • Use the collected information to create a list of possible diagnoses.

  • Rank possible causes from most likely to least likely.

• Management Plan:

  • Discuss treatment options and check patient’s preferences and understanding.

  • Ensure the patient is aware of follow-up steps and what to expect.

Identify the patient’s ideas, concerns, and expectations throughout the consultation

• Ideas: Patient’s own beliefs about their condition.

• Concerns: Fears or worries the patient may have (e.g., "Do I have cancer?").

• Expectations: What the patient expects from the consultation (e.g., tests, treatment, reassurance).

• Why It’s Important:

  • Addressing ICE ensures patient-centered care.

  • Builds trust and helps in creating an effective treatment plan.