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1、中医临床技能实训 中医国际接诊能力实训,Communication Skills in English for the Medical Practitioner,What to be learned?,to develop the language skills in English,to maintain harmony between doctors and their patients,enabling medical practitioners to carry out their duties in English more effectively and with greater
2、confidence.,What is communication?,voice management,verbal communication,cultural awareness,non-verbal communication,active listening,P,Film,Step 1 Receiving the patient(接诊),Learning outcomes,Greet patients and put them at ease,Introduce yourself and your role,As the opening question and set the age
3、nda for the interview,Putting yourself in the patients shoes!,Establishing initial contact,Step 1 Receiving the patient,Greeting and putting your patient at ease,Step 1 Receiving the patient,Greet the patient and obtain the address,Introduce yourself and clarify your role,Explain the purpose&agenda
4、of interview,Obtain permission for special circumstance,Conveying warmth,welcoming or unwelcoming?,Showing a welcoming voice,A welcoming voice is shown through a moderated pitch and speed,and a gentle rise and fall intonation pattern.,e.g.Good evening.Ms Finley,isnt it?e.g.Im Dr Cameron.I hope Im no
5、t disturbing you.,Step 1 Receiving the patient,Asking the opening question:,So whats the problem?,whats up?,Step 1 Receiving the patient,Different types of opening questions,1.Your GP has explained the situation,but I wonder if you could tell me in your own words?2.What would you like to discuss tod
6、ay?3.Am I right in thinking youve come for baby Killians routine check-up?4.How are things with the new tables?5.What brings you here today?6.Has there been any improvement since I saw you last?7.How are you feeling today?8.I have your notes from your doctor,but could you tell me whats been happenin
7、g?9.So,what have you come to see me about today?10.So,how is little Rhana doing?,Step 1 Receiving the patient,The Fellow-up questions to ensure the patient to be able to express himself fully,Is there anything else you would like to discuss today/while youre here today?Is anything else bothering you
8、 at the moment?Do you have any other issues youd like to address today?,Step 1 Receiving the patient,Setting the agenda:,Language for setting the agendaShall we/Lets start with the headache?Shall we start by discussing/looking at the headaches?Well come back to the arthritis later/after that.Well ta
9、lk about the arthritis later/after that.If thats all right/OK with you?Does that sound all right/OK?,Step 1 Receiving the patient,End of Step 1,Step 2 The presenting complaint(主诉),Learning outcomes,Encourage patients to express themselves in their own words,Take an accurate history of the presenting
10、 complaint,Ask about the intensity and degree of pain,Use techniques such as facilitation,repetition and clarification,Doctor-centered approach or Patient-centered approach,Step 2 The presenting complaint,Question types,Open questions,(what,why,where type question),Closed question,(yes,no or a speci
11、fic piece of information),Step 2 The presenting complaint,Doctors are encouraged to avoid the following question types,Multiple questions,several questions asked at the same time,Leading questions,those lead the patient towards a particular answer,Tag questions,tend to guide patients in their respon
12、se,Step 2 The presenting complaint,Categorize the following questions C Closed L Leading M Multiple O Open T Tag,Presenting complain:hay-fever-type symptoms1.Does the sneezing start when the dog is in the house?C,L2.Has he been wheezing as well?_3.So the symptoms are there all the time,are they?_4.I
13、s he getting these attacks while hes outside,too?Do they come on suddenly with no warning?What typically happens?_5.Did your sons allergy start after you bought the dog?_6.And youve already taken him to see your GP about this problem,havent you?_,Step 2 The presenting complaint,C L M,C,C L,C,C L T,R
14、ewrite those sentences,1.When does the sneezing start/do you start sneezing?2.Does he suffer from/Do you have any other symptoms at all?3.How often does he experience the symptoms/do you sneeze?4.Can you explain what typically happens when your son has/you have an attack?5.Tell me how you(sons)aller
15、gy started?6.How have you been treating your allergy till now?,Step 2 The presenting complaint,How to describe the pain-Metaphor,Step 2 The presenting complaint,match the adjectives with the ailments,Step 2 The presenting complaint,migraine(偏头痛)urinary infectionperiod painchest painheart attackheada
16、chetoothacheindigestionpins and needlestension headache,shooting painburning sensationcrushing sensationgripping painpounding feelingcramping painstabbing paintingling sensationblinding headachethrobbing pain,Ask the patient if they have ever experienced a migraine,bad toothache or a broken leg and
17、then ask them to compare the current pain to that.,Step 2 The presenting complaint,Seven Attributes of a Symptom,LocationQualityQuatity/SeverityTimingSetting(in which it occurs)Aggravating/alleviatingAssociated manifestations,Step 2 The presenting complaint,Clarification(阐述)Facilitation(鼓励)&Repetiti
18、on(重复),Decide whether each of these is an example of clarification,facilitation or repetition.,Step 2 The presenting complaint,End of Step 2,Step 3 Past medical and family history,Learning outcomes,Request the patients past medical history,Take effective notes during an interview,write an effective
19、patient note,Past illnesses,Childhood illnesses,Immunisations,Surgical procedures,Accidents and injuries,Allergies,Pregnancies,Medication,Step 3 Past medical and family history,The use of past tenses and prepositions to obtain a Precise medication history,Step 3 Past medical and family history,Stand
20、ard medical abbreviations,HTN M b yo cig CXR MRI Abd r h/o l f FH w ICU,hypertension,male,black,year(s)old,cigarettes,chest X-ray,magnetic resonance imaging,abdomen,right,history of,left,female,family history,white,Intensive care unit,Step 3 Past medical and family history,Write an effective patient
21、 note,Step 3 Past medical and family history,Step 3 Past medical and family history,End of Step 3,中医临床技能实训 中医国际接诊能力实训,Examining a patient,At the end of this unit you will be able to:give effective instructions in a patient-friendly manner,Learning outcomes:,Lead in:Put yourselves in the patients sho
22、es.,How do you feel before being examined?,*anxious*Nervous*overexposed*humiliated*embarrassed,Communication Skills,EmbarrassmentNervousnessFear,*Take off your shoes*Lie back*Raise your underclothes in height*Rest your arms by your side*Relax,Listen to Consultation in detail and complete the doctors
23、 instructions.1._ for me,please,Julie.2._ to lift your left leg as high as you can.3._ off your shoes and your tights.4._ your skirt over your knee.5._ if it starts to feel uncomfortable.,Using indirect language for instruction,If you could stand up,Id just like you to,(please,)If you could take,Wou
24、ld you mind just lifting,I want you to tell me,Why do you think the doctor tend to use indirect language(modal)for instruction?,Direct language:too direct;as a command rather than an instruction;abrupt and impolite.Indirect language:soften the instruction;it come across more as a request;more polite
25、;lessen anxiety and fear.,*Take off your shoes*Lie back*raise your underclothes in height*Rest your arms by your side*Relax,*Would you mind doing*Id just like you to do*(please,)If you could do*I want you to tell me if it starts to feel uncomfortable.,Role play,As doctors,how can you give instructio
26、ns in a patient-friendly manner?,A.CircumductionB.Adduction C.Pronation D.Inhale E.Exhale,Medical terms Simple terms,Make small circles with(your arm)b.Rotate/turn inwardc.Turn your palm downd.Breathe ine.Breathe out,Read the dialogue and underline all the instructions written in a formal style.The
27、first one is done for you.Replace the formal words with following less formal equivalents(sit up,breathe in,nose,breathe out).Presenting complaint:asthmaPatient(wheezing heavily)Doctor:Mrs Daniels,can you sit in the upright position for me,please?I can see youre having difficulties today.Im just goi
28、ng to listen to your chest.Patient:Sure.Doctor:Good.Now,I want you to inhale through your nasal passage.Inhale deeply Thats it.Now exhale.And again inhale and exhale.,As doctors,how can you give instructions in a patient-friendly manner?,Read aloud the following instructions,then decide what effect
29、the word just creates?A:I d just like you to lift your leg.I d like you to lift your leg.B:1.One more examination left.2.Just one more examination left.C:It looks like a minor fracture.It just looks like a minor fracture.,It is important to use softeners such as“just”to establish and maintain good i
30、nterpersonal relations in English-speaking cultures.An absence of softeners can convey a lack of warmth and tact.-by Loveday(1982),The following instructions sound a little abrupt,please soften them:1.I want you to lift your left leg.2.Relax you leg.3.I am going to feel your shoulder for any fractur
31、es.4.It looks like a minor fracture.,Watch the video clip,pay attention to the communicational skills the doctor used in physical examination:Indirect languageSimple/informal instructionSoftenerBesides,dont forget to1._2._3._,Wash hands,Cover body of the patient to preserve patient dignity,Warm hand
32、s or stethoscope,Piecing it all togetherRole Play,Practise the 3 communication skills in the consulting room.(46 students one room)Base your practice on the case you choose.Complete the Progress Check for the unit.,Table of Progress checkDoctors name:=be professional in this area,x=need more work in this area,
