All content is copyright by original owners

On any reprints please include references as shown on the last page of the guide
CALGARY - CAMBRIDG G!ID "O "# MDICAL I$"R%I& ' COMM!$ICA"IO$ (ROC))
I$I"IA"I$G "# )))IO$
st a * lis h in g in iti a l ra pp or t
1. Greets patient and obtains patients name
2. Introduces self, role and nature of interview; obtains consent if necessary
3. De+onstrates respect and interest, attends to patients physical comfort
I d e n tif y in g th e re a s o n ,s- fo r t h e c o n s u lt a ti o n
4. Identifies the patients problems or the issues that the patient wishes to address
with appropriate opening .uestion (e.g. !hat problems brought you to the
hospital"# or !hat would you li$e to discuss today"# or !hat %uestions did you
hope to get answered today"#&
'. Listens attentively to the patients opening statement, without interrupting or
directing patients response
(. Confir+s list and screens for further problems (e.g. so thats headaches and
tiredness; anything else))"#&
*. $egotiates agenda ta$ing both patients and physicians needs into account
GA"#RI$G I$/ORMA"IO$
0 p lora ti o n of pa ti e n t1s pro* le + s
+. ncourages patient to tell the story of the problem(s& from when first started
to the present in own words (clarifying reason for presenting now&
,. !ses open and closed .uestioning techni.ue, appropriately moving from open
to closed
1-. Listens attentively, allowing patient to complete statements without
interruption and leaving space for patient to thin$ before answering or go on after
pausing
11. /acilitates patient.s responses verbally and non/verbally e.g. use of
encouragement, silence, repetition, paraphrasing, interpretation
12. (ic2s up verbal and non/verbal cues (body language, speech, facial
e0pression, affect&; chec2s out and ac2nowledges as appropriate
13.Clarifies patients statements that are unclear or need amplification (e.g.
1ould you e0plain what you mean by light headed2&
14. (eriodically su++arises to verify own understanding of what the patient has
said; invites patient to correct interpretation or provide further information.
1'. !ses concise, easily understood .uestions and co++ents, avoids or
ade%uately e0plains 3argon
1(. sta*lishes dates and se.uence of events
A dd iti o n a l s 2 ills fo r und ersta nd in g th e p a tie n t1s p ers p ecti 3 e
1*. 4ctively deter+ines and appropriately e0plores5
patients ideas (i.e. beliefs re cause&
patients concerns (i.e. worries& regarding each problem
patients e0pectations (i.e., goals, what help the patient had
e0pected for each problem&
effects5 how each problem affects the patients life
1+. ncourages patient to e0press feelings
(RO%IDI$G )"R!C"!R
M a 2 ing or g an isa ti on o3ert
1,. )u++arises at the end of a specific line of in%uiry to confirm understanding
before moving on to the ne0t section
2-. 6rogresses from one section to another using signposting4 transitional
state+ents; includes rationale for ne0t section
Atte nd in g to fl o w
21. 7tructures interview in logical se.uence
22. 4ttends to ti+ing and $eeping interview on tas$
B!ILDI$G RLA"IO$)#I(
!s in g appropr ia te non -3er*al *eha3 iour
23. De+onstrates appropriate non'3er*al *eha3iour
eye contact, facial e0pression
posture, position 8 movement
vocal cues e.g. rate, volume, tone
24. 9f reads, writes notes or uses computer, does in a +anner that does not
interfere with dialogue or rapport
2'. De+onstrates appropriate confidence
D e 3 e lo p ing ra ppo r t
2(. Accepts legitimacy of patients views and feelings; is not 3udgmental
2*. !ses e+pathy to communicate understanding and appreciation of the patients
feelings or predicament; overtly ac2nowledges patient5s 3iews and feelings
2+. (ro3ides support5 e0presses concern, understanding, willingness to help;
ac$nowledges coping efforts and appropriate self care; offers partnership
2,. Deals sensiti3ely with embarrassing and disturbing topics and physical pain,
including when associated with physical e0amination
In3o l3 ing th e pa ti ent
3-. )hares thin2ing with patient to encourage patients involvement (e.g. !hat
9m thin$ing now is....#&
31. 0plains rationale for %uestions or parts of physical e0amination that could
appear to be non:se%uiturs
32. ;uring physical e0a+ination, e0plains process, as$s permission
6(LA$A"IO$ A$D (LA$$I$G
( ro3 id in g th e correct a + o un t a n d t y p e of in for + at io n
33. Chun2s and chec2s7 gives information in manageable chun$s, chec$s for
understanding, uses patients response as a guide to how to proceed
34. Assesses patient1s starting point7 as$s for patients prior $nowledge early on
when giving information, discovers e0tent of patients wish for information
3'. As2s patients what other infor+ation would *e helpful e.g. aetiology,
prognosis
3(. Gi3es e0planation at appropriate ti+es7 avoids giving advice, information or
reassurance prematurely
A id ing accura te reca ll and unders tand ing
3*. Organises e0planation7 divides into discrete sections, develops a logical
se%uence
3+. !ses e0plicit categorisation or signposting (e.g. <here are three important
things that 9 would li$e to discuss. 1st...# =ow, shall we move on to.#&
3,8 !ses repetition and su++arising to reinforce information
4-. !ses concise, easily understood language, avoids or e0plains 3argon
41. !ses 3isual +ethods of con3eying infor+ation7 diagrams, models, written
information and instructions
42. Chec2s patient1s understanding of information given (or plans made&5 e.g. by
as$ing patient to restate in own words; clarifies as necessary
Ac h ie3 in g a s h ared und ersta nd in g 7 i n cor p orat in g th e p at ie n t1s p ers p ect i3 e
43. Relates e0planations to patient1s illness fra+ewor27 to previously elicited
ideas, concerns and e0pectations
44. (ro3ides opportunities and encourages patient to contri*ute7 to as$
%uestions, see$ clarification or e0press doubts; responds appropriately
4'. (ic2s up 3er*al and non-3er*al cues e.g. patients need to contribute
information or as$ %uestions, information overload, distress
4(. licits patient5s *eliefs4 reactions and feelings re information given, terms
used; ac$nowledges and addresses where necessary
(l ann in g 7 s ha re d d ec isi on + a 2 ing
4*. )hares own thin2ing as appropriate7 ideas, thought processes, dilemmas
4+. In3ol3es patient by ma$ing suggestions rather than directives
4,. ncourages patient to contri*ute their thoughts7 ideas, suggestions and
preferences
'-. $egotiates a mutually accepta*le plan
'18 Offers choices7 encourages patient to ma$e choices and decisions to the level
that they wish
'2. Chec2s with patient if accepts plans, if concerns have been addressed
CLO)I$G "# )))IO$
/ or w a r d p lann ing
'3. Contracts with patient re ne0t steps for patient and physician
'4. )afety nets, e0plaining possible une0pected outcomes, what to do if plan is
not wor$ing, when and how to see$ help
n sur ing appropr ia te po in t of c losure
''. )u++arises session briefly and clarifies plan of care
'(. /inal chec2 that patient agrees and is comfortable with plan and as$s if any
corrections, %uestions or other items to discuss
O("IO$) I$ 6(LA$A"IO$ A$D (LA$$I$G ,includes content-
I/ d is c u ssi ng in3 e sti g a ti o ns and p r o ce du re s
'*. 6rovides clear information on procedures, eg, what patient might e0perience,
how patient will be informed of results
'+. >elates procedures to treatment plan5 value, purpose
',. ?ncourages %uestions about and discussion of potential an0ieties or negative
outcomes
I/ d is c u ssi ng op in io n and si g n ifi c an c e of p r o* le +
(-. @ffers opinion of what is going on and names if possible
(1. >eveals rationale for opinion
(2. ?0plains causation, seriousness, e0pected outcome, short and long term
conse%uences
(3. ?licits patients beliefs, reactions, concerns re opinion
I/ ne g o ti a ti n g + u tu al p lan of ac ti on
(4. ;iscusses options eg, no action, investigation, medication or surgery, non:drug
treatments (physiotherapy, wal$ing aides, fluids, counselling, preventive
measures&
('. 6rovides information on action or treatment offered
name
steps involved, how it wor$s
benefits and advantages
possible side effects
((. @btains patients view of need for action, perceived benefits, barriers,
motivation
(*. 4ccepts patients views, advocates alternative viewpoint as necessary
(+. ?licits patients reactions and concerns about plans and treatments including
acceptability
(,. <a$es patients lifestyle, beliefs, cultural bac$ground and abilities into
consideration
*-. ?ncourages patient to be involved in implementing plans, to ta$e responsibility
and be self:reliant
*1. 4s$s about patient support systems, discusses other support available
References7
9urt: )M4 )il3er+an ;D4 Draper ; ,<==>- "eaching and Learning Co++unication
)2ills in Medicine8 Radcliffe Medical (ress ,O0ford-
)il3er+an ;D4 9urt: )M4 Draper ; ,<==>- )2ills for Co++unicating with (atients8
Radcliffe Medical (ress ,O0ford-