Difficult Conversations in Medicine by Elisabeth Macdonald

By Elisabeth Macdonald

In all branches of medication, powerful communique among future health care pros and sufferers, households and carers is vital to make sure top quality remedy. more and more public know-how of health and wellbeing concerns and the prepared availability of overall healthiness info have lead the general public to be extra commonly knowledgeable approximately universal stipulations and the remedies to be had. sufferers consequently attend a clinical session higher expert so the necessity for more advantageous communique talents is even better. ability in verbal exchange is an issue of private skill which varies broadly among participants within the clinical career as in the other. In reaction, the purpose of this publication is to dispel the anxieties which give a contribution to bad communication.This ebook covers moral and felony concerns, making plans tough conversations, the patient's and doctor's views, matters surrounding specific teams reminiscent of teenagers and the aged, and conversations with sufferers from varied cultural backgrounds. Outlines of attainable scientific circumstances posing particular difficulties are incorporated with suggestions on the best way to deal with them.

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Qxd 28/7/04 7:17 AM Page 15 FUNDAMENTALS OF GOOD COMMUNICATION effectively halted the spontaneous flow of information from the patient. We can conclude, therefore, that giving the patient one or two more minutes to list his problems at the start of the discussion will reap dividends in saved time talking ‘off the point’ and facilitate a much more productive use of time later in the interview. Response to cues Most serious conversations in life contain layers of meaning and when discussing matters of importance we tend to flag up some peripheral issues by means of phraseology or expression.

These aspects of conversation analysis may be concurrent or sequential. For example, empathy is as demonstrable in the early phase as in the concluding negotiation. qxd 28/7/04 7:17 AM Page 11 FUNDAMENTALS OF GOOD COMMUNICATION Other writers have identified what is described as clinical ‘hypo-competence’ (in other words deficient skills) in this area and have highlighted issues such as inattention to primary symptoms, incomplete patient-centred history taking, a highly controlling style, and failure to form a late working hypothesis (Platt and McMath 1979).

The assessment of value judgements may require several different approaches. These might include comparison of the decision under consideration with those made in other cases, to ensure consistency. They might also include the clarification of key concepts, such as, for example, ‘best interest’. It is sometimes also useful to focus on the logical structure of the arguments for and against different options. This will involve consideration of both the truth of the claims being made to support an argument, and of whether the claims, even if true, do in fact support the conclusion claimed for them.

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