Explanation Closing the Gap 1 b Explanation Explanation

Explanation Closing the Gap 1 b

Explanation �Explanation is not doctor centred �Bidirectional �Avoid medical jargon �Explain things adequately �Cover anything else patient wants to know �Check they have understood everything

Evidence – Explanation Teaching and Learning Communication skills in medicine” Kurtz, Silverman, Draper; 2 nd edition Pages 14 -20 �Checking Understanding - improves retention by 30% (Bertakis 77) �Categorisation, summarisation, signposting, diagrams, clarity – all increase recall (Ley 88)

Evidence �“While I am here” is reduced �Patient satisfaction increased �Complaints reduced �Litigation reduced (discount on MDU in USA) �Information retention improved �Concordance improved �Consultation shortened! (Levinson 2000)

What makes a good explanation? �Check it is wanted �Provide correct amount and type of information �Aids Recall and Understanding

What makes a good explanation? Provides Correct amount and Type Information � Baseline Knowledge � Appropriate Language � Chunk and Check Aids Recall and Understanding � Organises explanation logically � Signposts (there are three things…. . ) � Repeats for emphasis � Summarise � Check Understanding

Explanation 1 - Signposting �Suggest you are going onto the explanation bit �State your diagnosis briefly 1. Is it ok for me to explain what is going on 2. Then you can tell me how you feel about it 3. From what you have told…. �Next, DON’T continue with the explanation of diagnosis �PAUSE for a few seconds -let the diagnosis sink in

Explanation 2 identify patient’s starting point �Have you heard about it? �What does it mean to you? �Have you read about it? �Maybe someone you know has it? Yes, I know about it � Explore how much the patient knows.

Explanation 3 Build on what the patient already knows �First confirm what the patient has said is right and correct which is not. �Weaving – Try and use what the patient said – ‘you are right’ , ‘ like you said…’ �Flexibility – Be flexible in your explanation. Keep checking what the patient knows so you can continue to build on that.

Explanation 3 - continued �Weaving – Try and incorporate the patient’s health beliefs in your explanation. 1. You need to remember the ideas, concerns raised in the early part of the consultation. 2. For patients to accept your diagnosis, you need to start with their perception. 3. If both your thoughts are different you have to explain why you don’t think it is …. . ( ex. Not angina, it is MSK, antibiotics not needed for viral infection )

Explanation 4 –Help the patient remember what is being said �How much do they want to know? Eg : diabetes �Chunking – When there is a lot of information and you need a structure 1. First, what is diabetes 2. How we can work together 3. Third the complications �Repetition and Summarising – Recap

Checking understanding �Check patient has understood everything �Check two things: 1. They have understood the diagnosis/explanation 2. They have understood the management plan �Two key elements to do it successfully : 1. Explore the patient’s understanding of the diagnosis/treatment 2. Giving a reactive explanation of the understanding or treatment.