Clinical Communication with People who have Stroke Related Hemiplegia

In clinical dental consultations in multilingual contexts, medical interpreting is often performed by the supporting staff as part of routine triadic formulations. As academic dentistry becomes increasingly internationalised, issues of language and culture add to the interactional complexity of clinical communication and education. A multivariate approach was adopted to investigate one case of multilingualism in dentistry in Asia. Collection of both survey (n=86) and interactional data provided empirical evidence regarding language use and language demands across integrated Polyclinics. Descriptive statistics of Dental Surgery Assistant (DSA) perception data and conversation analysis (CA) of mediated interpretation indicate that, as members of the oral healthcare team, DSAs in Hong Kong are an essential resource in their role of intercultural mediators between patients and clinicians, both staff and students. Discussion of sociolinguistic notions of place-as-location and place-as-meaning supports a wider conceptualisation of the role of support staff as interpreters in clinical settings. Implications are drawn for policy, curriculum and staff development.

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‘Are we on the same wavelength?’ International nurses and the process of confronting and adjusting to clinical communication in Australia

Communication & Medicine ◽

10.1558/cam.28953 ◽

2017 ◽

Vol 13 (3) ◽

pp. 263-274 ◽

Cited By ~ 1

Author(s):

Tonia Crawford ◽

Peter Roger ◽

Sally Candlin

Keyword(s):

Communication Skills ◽

Thematic Analysis ◽

Care Setting ◽

Linguistically Diverse ◽

The Other ◽

Culturally And Linguistically Diverse ◽

Central Theme ◽

Structured Interviews ◽

Clinical Communication ◽

Professional Experiences

Effective communication skills are important in the health care setting in order to develop rapport and trust with patients, provide reassurance, assess patients effectively and provide education in a way that patients easily understand (Candlin and Candlin, 2003). However with many nurses from culturally and linguistically diverse (CALD) backgrounds being recruited to fill the workforce shortfall in Australia, communication across cultures with the potential for miscommunication and ensuing risks to patient safety has gained increasing focus in recent years (Shakya and Horsefall, 2000; Chiang and Crickmore, 2009). This paper reports on the first phase of a study that examines intercultural nurse patient communication from the perspective of four Registered Nurses from CALD backgrounds working in Australia. Five interrelating themes that were derived from thematic analysis of semi-structured interviews are discussed. The central theme of ‘adjustment’ was identified as fundamental to the experiences of the RNs and this theme interrelated with each of the other themes that emerged: professional experiences with communication, ways of showing respect, displaying empathy, and vulnerability.

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Opinions of medical students about standardized patient use in clinical communication skills assessment

Türkiye Aile Hekimliği Dergisi ◽

10.2399/tahd.09.023 ◽

2009 ◽

Vol 13 (1) ◽

pp. 23-26 ◽

Cited By ~ 2

Author(s):

Güzel Dişcigil

Keyword(s):

Medical Students ◽

Communication Skills ◽

Skills Assessment ◽

Standardized Patient ◽

Clinical Communication ◽

Patient Use

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The use of the standard exercise test to establish the clinical significance of mild echocardiographic changes in a Thoroughbred poor performer : clinical communication

Journal of the South African Veterinary Association ◽

10.4102/jsava.v75i2.461 ◽

2004 ◽

Vol 75 (2) ◽

Cited By ~ 1

Author(s):

C. Meyer ◽

R. Gerber ◽

A.J. Guthrie

Keyword(s):

Exercise Test ◽

Poor Performance ◽

Respiratory Alkalosis ◽

Mitral Valve Insufficiency ◽

Cardiac Insufficiency ◽

Strenuous Exercise ◽

Clinical Communication ◽

Valve Insufficiency ◽

Blood Gas Analyses ◽

Work Up

A 4-year-old Thoroughbred gelding racehorse was referred to the Onderstepoort Veterinary Academic Hospital (OVAH) with a history of post-race distress and collapse. In the absence of any obvious abnormalities in the preceding diagnostic work-up, a standard exercise test was performed to determine an underlying cause for the post-race distress reported. In this particular case oxygen desaturation became evident at speeds as slow as 6 m/s, where PO2 was measured at 82.3 mm Hg. Similarly at a blood pH of 7.28, PCO2 had dropped to 30.0mm Hg indicating a combined metabolic acidosis and respiratory alkalosis. The cause of the distress was attributed to a severe hypoxia, with an associated hypocapnoea, confirmed on blood gas analyses, where PO2 levels obtained were as low as 56.6 mm Hg with a mean PCO2 level of 25.4 mm Hg during strenuous exercise. Arterial oxygenation returned to normal immediately after cessation of exercise to 106.44 mm Hg, while the hypocapnoeic alkalosis, PCO2 25.67 mm Hg, persisted until the animal's breathing normalized. The results obtained were indicative of a dynamic cardiac insufficiency present during exercise. The combination of an aortic stenosis and a mitral valve insufficiency may have resulted in a condition similar to that described as high-altitude pulmonary oedema, with respiratory changes and compensation as for acute altitude disease. The results obtained were indicative of a dynamic cardiac insufficiency present during exercise and substantiate the fact that an extensive diagnostic regime may be required to establish a cause for poor performance and that the standard exercise test remains an integral part of this work-up.

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Medical Students and Patients Benefit from Virtual Non-Medical Interactions Due to COVID-19

Journal of Medical Education and Curricular Development ◽

10.1177/23821205211028343 ◽

2021 ◽

Vol 8 ◽

pp. 238212052110283

Author(s):

Taylor M Coe ◽

Trevor J McBroom ◽

Sarah A Brownlee ◽

Karen Regan ◽

Stephen Bartels ◽

...

Keyword(s):

Medical Students ◽

Communication Skills ◽

Patient Experience ◽

Clinical Medicine ◽

Organ Transplant ◽

Medical Patient ◽

Pilot Program ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Clinical Communication

Background: Patient care restrictions created by the COVID-19 pandemic constrained medical students’ ability to interact directly with patients. Additionally, organ transplant recipients faced increasing isolation due to the rise of telemedicine, the importance of social distancing and their immunosuppressed state. We created a pilot program to pair students with transplant patients for structured, virtual encounters and studied its impact on medical students and patients. Methods: In May 2020, medical students conducted virtual visits with patients via telephone or video conferencing. Patients and students were surveyed regarding their experiences and independent focus groups were conducted. The survey responses and focus group discussions were deidentified, transcribed, and analyzed for themes. Results: Ten participating students were in their first, second, or final year of medical school. The 14 patients were liver or kidney transplant recipients or kidney donors. All interactions lasted longer than 30 minutes, with 56% greater than 1 hour. Three themes emerged related to the student experience: improvement of their clinical communication skills, development of knowledge and attitudes related to organ transplantation and donation, and independent management of a patient encounter. Three themes related to the patient experience: appreciation of the opportunity to share their personal patient experience to help educate future physicians, a cathartic and personally illuminating experience and an opportunity to share the message of donation. Conclusions: This pilot program provided a novel opportunity for virtual student-patient interactions that was feasible, well-received, and mutually beneficial. The use of virtual non-medical patient experiences allowed for experiential learning during which students learned about both clinical medicine and enhanced their communication skills directly from patients. Additionally, patients were able to engage with medical students in a new way, as teachers of clinical interactions, and reported a high level of satisfaction in addition to deriving personal benefit.

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Virtual Environments to Study Emotional Responses to Clinical Communication: A scoping review

Patient Education and Counseling ◽

10.1016/j.pec.2021.04.022 ◽

2021 ◽

Author(s):

Justin J Sanders ◽

Emma Caponigro ◽

Jonathan D. Ericson ◽

Manisha Dubey ◽

Ja-Nae Duane ◽

...

Keyword(s):

Virtual Environments ◽

Scoping Review ◽

Emotional Responses ◽

Clinical Communication

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Secondary care interface: optimising communication between teams within secondary care to improve the rehabilitation journey for older people

BMJ Open Quality ◽

10.1136/bmjoq-2020-001274 ◽

2021 ◽

Vol 10 (1) ◽

pp. e001274

Author(s):

Sean Testrow ◽

Ryan McGovern ◽

Vicki Tully

Keyword(s):

Information Sharing ◽

Secondary Care ◽

Royal Victoria Hospital ◽

Treatment Plan ◽

Electronic System ◽

The Elderly ◽

Communication Tool ◽

Clinical Communication ◽

Transfer Of Information ◽

Intervention Clinic

Effective communication between members of the multidisciplinary team is imperative for patient safety. Within the Medicine for the Elderly wards at Royal Victoria Hospital (RVH) in Dundee, we identified an inefficient process of information-sharing between the orthopaedics outpatient department (OPD) at the main teaching hospital and our hospital’s rehabilitation teams, and sought to improve this by introducing several changes to the work system. Our aim was for all patients who attended the OPD clinic to have a plan communicated to the RVH team within 24 hours.Before our intervention, clinic letters containing important instructions for ongoing rehabilitation were dictated by the OPD team, transcribed and uploaded to an electronic system before the RVH team could access them. We analysed clinic attendances over a 4-week period and found that it took 15 days on average for letters to be shared with the RVH teams. We worked with both teams to develop a clinical communication tool and new processes, aiming to expedite the sharing of key information. Patients attended the OPD with this form, the clinician completed it at the time of their appointment and the form returned with the patient to RVH on the same day.We completed multiple Plan–Do–Study–Act cycles; before our project was curtailed by the COVID-19 pandemic. During our study period, seven patients attended the OPD with a form, with all seven returning to RVH with a completed treatment plan documented by the OPD clinician. This allowed rehabilitation teams to have access to clinic instructions generated by orthopaedic surgeons almost immediately after a patient attended the clinic, essentially eliminating the delay in information-sharing.The introduction of a simple communication tool and processes to ensure reliable transfer of information can expedite information-sharing between secondary care teams and can potentially reduce delays in rehabilitation.

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How Do Patients Want Us to Use the Computer During Medical Encounters?—A Discrete Choice Experiment Study

Journal of General Internal Medicine ◽

10.1007/s11606-021-06753-1 ◽

2021 ◽

Author(s):

Cédric Lanier ◽

Melissa Dominicé Dao ◽

Dave Baer ◽

Dagmar M. Haller ◽

Johanna Sommer ◽

...

Keyword(s):

Discrete Choice Experiment ◽

Discrete Choice ◽

Choice Experiment ◽

Primary Care Physicians ◽

Skills Training ◽

Experiment Study ◽

Visual Contact ◽

Patient Centered ◽

Clinical Communication ◽

French Speaking

Abstract Background Primary care physicians (PCPs) now widely use electronic health records (EHRs) during medical encounters. Experts in clinical communication issued recommendations for a patient-centered use of EHRs. However, they have never been validated by patients themselves. Objective To explore patients’ preferences regarding physicians’ EHR-related behaviors. Design Discrete choice experiment study. Patients French-speaking patients waiting for a medical consultation at two outpatient clinics in Geneva, Switzerland. Main Measures We invited patients to watch videos displaying 2 or 3 variations of four specific EHR-related behaviors and asked them to indicate which one they preferred. EHR-related behaviors were (1) typing: continuous/intermittent/handwriting in biomedical or psychosocial focused consultations; (2) maintaining contact while typing: visual/verbal/both; (3) signposting the use of EHR: with/without; (4) position of physicians’ hands and bust: on the keyboard and towards the patient/away from the keyboard and towards the patient/on the keyboard and towards the screen. Key Results Three hundred thirty-six patients participated (response rate 61.4%). They preferred intermittent typing versus handwriting or continuous typing for biomedical issues (32.7%; 95% CI: 26.0–40.2% vs 31.6%; 95% CI: 24.9–39.0% or 14.9%; 95% CI: 10.2–21.1%) and psychosocial issues (38.7%; 95% CI: 31.6–46.3% vs 24.4% 95% CI: 18.4–31.5% or 17.9%; 95% CI; 12.7–24.4%). They favored visual and verbal contact (38.9%; 95% CI: 31.9–46.3%) over verbal (30.3%; 95% CI: 23.9–37.5%) or visual contact only (11.4%; 95% CI: 7.5–17.1%) while the doctor was typing. A majority preferred signposting the use of EHR versus no signposting (58.9%; 95% CI: 53.5–64.0% vs 34.8%; 95% CI: 29.9–40.1%). Finally, half of the patients (49.7%; 95% CI: 42.0–57.4%) favored the position with the physician’s bust towards the patient and hands away from the keyboard. Conclusions Our study shows that patients’ preferences regarding EHR-related behaviors are in line with most experts’ recommendations. Such recommendations should be more consistently integrated into under- and postgraduate communication skills training.

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