01. Communication and Consultation Skills – 101

The core competencies in this domain are:

1. Communication is appropriate to the person and the sociocultural context.
2. Engages the patient to gather information about their symptoms, ideas, concerns, and expectations of healthcare and the full impact of their illness experience on their lives.
3. Matches modality of communication to patient needs, health literacy, and context.
4. Communicates effectively in routine and difficult situations.
5. Demonstrates active listening skills.
6. Uses a variety of communication techniques and materials (e.g., written or electronic) to adapt explanations to the needs of the patient.
7. Uses appropriate strategies to motivate and assist patients in maintaining health behaviours.
8. Adapts the consultation to facilitate optimal patient care.
9. Consults effectively in a focused manner within the time frame of a normal consultation.
10. Prioritizes problems, attending to both the patient’s and the doctor’s agendas.
11. Safety-netting and specific follow-up arrangements are made.

How To Demonstrate Communication and Consultation Skills

1. Communication is appropriate to the person and the sociocultural context.
   • A doctor ensures that their language and behaviour are respectful and considerate of the patient’s cultural background.
   • They may ask about and adhere to cultural norms that affect communication, such as preferences for discussing health issues with (or without) family members present.
   • A doctor might use different approaches depending on the patient’s age, gender, ethnicity, or religious beliefs.
     • For example, when discussing treatment options with an elderly patient from a conservative background, the doctor might include family members in the discussion to honour cultural expectations.
   • For ATSI patients, a number of opening formalities should be respected
2. Engages the patient to gather information about their symptoms, ideas, concerns, and expectations of healthcare and the full impact of their illness experience on their lives.
   • During a consultation, the doctor encourages the patient to share their thoughts and feelings about their illness.
   • They ask open-ended questions to better understand the patient’s perspective and expectations.
   • The doctor uses a patient-centred interview technique, allowing the patient to express their main ideas, concerns and expectations early in the conversation.
   • This approach helps the doctor understand the patient’s viewpoint and tailor the consultation to address those specific areas of concern.
   • Asking patients what they think is going on can be a key question, as this concern must be addressed.
3. Matches modality of communication to patient needs, health literacy, and context.
   • The doctor uses simple language or visual aids when explaining complex medical conditions to a patient with limited health literacy.
   • For a patient with visual impairments, all written materials are provided in large print or audio format.
   • For a patient who primarily speaks a language other than the doctor’s, an interpreter is used to ensure clear communication.
     • The Translating and Interpreting Service (TIS) is provided to GPs without charge.
   • For ATSI patients, the inclusion of an Aboriginal Health Worker is offered, and they can perform both cultural and language interpretation.
4. Communicates effectively in routine and difficult situations.
   • In a routine check-up, the doctor provides clear updates and answers questions directly.
   • In difficult situations, like disclosing a serious diagnosis, the doctor discusses the diagnosis sensitively, ensuring the patient understands and feels supported.
     • The use of a framework such as SPIKES is recommended.
   • Signposting can be used to indicate a new topic is now being discussed.
5. Demonstrates active listening skills.
   • The doctor shows they are listening by maintaining eye contact, nodding, and occasionally summarizing what the patient has said.
   • Reflection involves paraphrasing what the patient says to confirm understanding, such as, “I hear you saying that you are worried about the side effects of this medication.”
6. Uses a variety of communication techniques and materials (e.g., written or electronic) to adapt explanations to the needs of the patient.
   • The doctor provides both oral explanations and written brochures or links to reliable online resources.
     • Royal Childrens Hospital
     • Dermnet
     • NCBI hack – add the letter “NCBI” to any Google Search to go straight to the Medical Literature.
   • Depending on the patient’s comfort with technology, digital diagrams of medical issues, follow-up information via email, or access to a patient portal may be used.
7. Uses appropriate strategies to motivate and assist patients in maintaining health behaviours.
   • The doctor discusses the benefits of a healthy lifestyle in managing conditions like diabetes.
   • They provide personalized advice and connect patients with community resources like gym classes or nutrition counsellors.
8. Adapts the consultation to facilitate optimal patient care.
   • If the patient appears anxious or distressed, the consultation pace is slowed, and more focus is placed on addressing emotional concerns.
   • If the patient seems rushed or distracted, the doctor might offer a more convenient consultation time via telephone or video.
9. Consults effectively in a focused manner within the time frame of a normal consultation.
   • The doctor efficiently manages the consultation time by focusing on immediate health concerns first.
   • Tools like pre-appointment questionnaires are used to gather basic information beforehand, making the in-person session more productive.
10. Prioritizes problems, attending to both the patient’s and the doctor’s agendas.
    • The doctor first addresses the patient’s most pressing symptoms and then discusses routine health maintenance.
    • A shared decision-making approach is used to create a comprehensive plan that addresses both clinical and personal health priorities.
11. Safety-netting and specific follow-up arrangements are made.
    • Safety-netting is a key element in closing a consultation.
    • Before the patient leaves, they are given clear instructions on what to do if symptoms worsen.
    • The doctor ensures that the patient understands the next steps and has all necessary contact information for follow-up.