As promised, here are "more details of my communication skills thing"

First time experiencing talking to a patient, though he was to be a simulated patient. Got two mentors. I was REALLY apprehensive, seeing as we had to converse with the patient in front of the whole group and the two mentors. Some of my friends had said that they did not manage to get a turn as their groups had run out of time so I thought if it was really hard or scary I would probably just sit in silence and wait for the time to be up. They had also said that I should actually try to be the first to volunteer as the first person has it the easiest and it subsequently gets harder as it gets to the next person.

We were told that our patient had had chest pains in the past and been to a surgery. He/she seldom visits the GP as he/she does not like to. One of my group members volunteered to be the first and gave a brief introduction of who he was and what he was going to do. In the end I didn’t volunteer at all and was the last person to interview John *not real name* as it just got harder and harder to think of new questions. As we progressed we also found out more dos and don’ts which made me more conscious of what kinds of questions I should and should not ask, making me even more apprehensive about volunteering. However, it turned out that there are advantages and disadvantages of going the first and last. In the end it did not matter who went first as everyone had their good and bad experiences. Going first was definitely easier as the person would have a standard set of questions to ask before he or she got stuck. However, going later meant that though we had to wait nervously for our turn, we could watch and learn a lot from the others and at the same time, think of questions to ask and going at a more challenging stage meant we could learn more it got harder for us to ask questions.

Apparently, we got a really nice patient for our first try. John was extremely cooperative and told us many useful things without much prompting, which allowed us to continue with the flow of conversation easily. He enjoys gardening and was pushing his wheelbarrow one day when he slipped on some wet leaves and fell. Subsequently, he experienced a constant, dull, ache in his right lower back which radiated all the way through his leg. Despite taking paracetamols and trying different resting positions, the pain persisted and thus, he decided to visit the GP to see what the doctor could do. The pain has been causing him great discomfort and he has never experience a back pain like that before.

Blahblahblah...

By the time it got to my turn the GP tutor asked if I remembered the summary he had given about John. This included the chest pains, which had not yet been brought up. Thus, being the last to interview the patient, I had to try to structure my interview effectively and bring in all the relevant questions smoothly and naturally. I started off by introducing myself. I greeted him and shook his name, telling him my name, status and purpose of speaking to him. I started off with an open question of asking him how he felt in order to get the conversation started. Subsequently I asked several questions about his general home and work situation in order to identify how he had been coping and possible problems that could arise due to the accident. I started by referring back to the pain in his leg and asked if he had difficulty moving about the house and walking. He told me he could move around though his wife pointed out that he tended to lean forward awkwardly while doing so. I asked if there was anyone else to help him around the house besides his wife, such as up and down the stairs or into and out of bed and he said there was no one else at home but it was manageable as he lived in a bungalow and there were not too many stairs.

Recalling what Mr Wilkinson had said about being anxious to return to work but not daring to drive as he was not confident of his right leg being able to control the car pedals, I asked him general questions about his work, such as the distance to work and how he planned to get there. When he said he normally drives to work, I asked if there was anyone he knew who could give him a lift, or perhaps whether he had children who could drive him there. This led me to find out that he had two children, both of whom are married and live far from the parents. This led me to find out blah blah blah..........

I later switched to general lifestyle, whereby I questioned him on his diet and gradually led that to social habits such as smoking and drinking. Blah blah blah... I later asked if he had had any follow up treatments as I wanted to make sure that he was certain that he was fine.

I interrupted the patient once, having misinterpreted a pause as an end to his answer. I smiled and told him to carry on, after which I allowed him long periods to talk. I learnt that sometimes just keeping quiet would give a cue to patients to keep talking and this might, inadvertently, to say more than they would have done if I had used the pause to ask them another question. Even if a patient has finished speaking, perhaps maintaining the silence for a while longer would be good not only to ascertain that he had indeed finished what he intended to say but sometimes serves as a prompt for the patient to voluntarily tell me more. Naturally, smiling, nodding and eye contact are essential to telling a patient that I am listening. A useful technique I learnt is agreeing and repeating what a patient has said at the appropriate moments to assure them that I had understood and heard what they had said. This encourages them totell me more as they know that I am really interested and have taken the trouble to listen and remember what they had said. Sometimes, to keep the conversation flowing, merely repeating what they had said is a good silence breaker.

Furthermore, clarifying and sometimes summarizing what a patient had previously told me tells them that I have heard what they said and allows both parties to be sure that the correct information has been understood clearly. Also, asking open questions also prompts patients to talk more and get used to talking. Try not to give options such as or to allow the patient to elaborate and describe situations themselves. This inadvertently causes them to give more information and gets them more comfortable talking. Body language of the patient is also important. John was obviously in great discomfort as he kept shifting about in his seat and trying to find a comfortable position.

Obviously that was not written in blooging style. Omitted the extra parts though still very long. Haha that is part of my first reflective diary which I wrote some 3 weeks ago. Which explains the slight formality. Haha i'm so high and blogging TWICE IN A DAY coz I just called my patient!!! Oh my god!!! But I still have NO IDEA how to get there. But still. Getting somwhere... Hee

Once again, PRO MAN