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Communication Skills
Neil Constantine-Smith takes a look at competencies involving communication and how best to show you have the relevant skill set
As most pre-reg students are now undertaking their Visit 3 assessment, from now on I will be considering competencies from the 3rd visit.
Three competencies in visit 3 cover practitioner/patient communication. They are:-
• 1.8 An ability to understand the patient's expectations and aspirations and manage empathetically situations where these cannot be met.
• 1.9 The ability to communicate with patients who have poor, or non-verbal, communication skills, or those who are confused, reticent or who might mislead.
• 1.10 The ability to communicate bad news to patients in an empathic and understandable way
To many 'old school' optometrists and some supervisors these competency statements can seem vague and 'touchy feely'. To graduate optometrists they are challenging as they are not easily 'revised' (Kanksi isn't much help here!). There isn't a nice, definitive answer to communications questions as with management plans or with identification of clinical information. By its very nature communication is absolutely subjective, so each individual may have a completely different take on what each statement is getting at. These competencies are left to the 3rd visit as they require a lot of experience of patient interaction to become adept at. Also a relevant patient type that could be used as evidence would be rarely encountered.
All 3 competencies begin with 'The ability to' which means that they do require evidence of the student demonstrating appropriate actions whether that be a patient record (PR), or less likely witness testimony (WT), or even less likely by direct observation (DO). In almost all cases though, when I have assessed these competencies, I have needed to also give a case scenario (CS) to cover all aspects thoroughly.
1.9 is probably the most obvious of the communication competencies to evidence. 'Poor, or non-verbal communication..' could include a deaf patient or a mentally disabled patient. 'Confused' patients would really only be someone with Alzheimer's or other form of dementia. A malingerer (or child with ocular conversion reaction) would fit the 'reticent or who might mislead' patient type. An assessor wouldn't expect PRs of all these types of patients, but a couple would be good and if correctly annotated would go a long way to achieving this competency straight off. When I say 'correctly annotated', I would expect the record to state somewhere why the patient was relevant to the competency and a short note as to what communication style or strategy was used because of this. This sounds like an obvious statement but many times have I had a PR presented that at first look seem to have nothing to do with the competency. I would expect an assessor to ask questions about the PR, especially if a malingering patient is use. This is probably the easiest type of patient to find and has a number of strategies which can be employed when effectively communicating with them.
Giving Bad News
Competency statement 1.10 begs the question - what sort of bad news could an optometrist need to give to a patient? Probably the commonest 'bad news' needed to be broken to a patient could be poor prognosis for regaining vision with AMD. A step up from this would be any indication of a life threatening disease such as papilledema or melanoma. A relatively low loss of acuity or field loss could be bad news if it would stop someone from driving. All of these episodes mentioned would make good PR evidence if a short note is made on the record about advice given.
A PR about failing to reach driving standard vision would also make a good PR for 1.8 which is a bit more tricky to find evidence for.
How to communicate effectively and actually being good at it takes time to learn which is why these competencies are in the 3rd visit not the first. Communication is best learnt from observing other experienced members of the practice team - mostly your supervisor but also DOs and optical assistants who have to deal with the general public all day. Empathy doesn't mean telling a patient everything will be OK when there's a possibility it won't. Empathy is being sympathetic and friendly though. Patients respond best to clear explanations which honestly informs them of what's happening while avoiding incomprehensible optical terminology. An assessor will know you can do all this if you present a number of good quality PRs and can show your skills with any CS given.
Neil Constantine-Smith is...