Information giving – an overview


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Information giving – an overview

Qualified doctors, regardless of speciality or context, frequently have to give information
to patients during consultations. It may form part of the consultation or be the sole reason
why the consultation was arranged. Some examples include:
Explaining a surgical procedure before gaining consent
Explaining how to use an inhaler
Explaining a new diagnosis and treatment plan
Lifestyle advice to help the patient lose weight
Although you are not expected to give information to patients as a medical student during
training, it is imperative that you know the clinical communication techniques to handle
these situations as effectively as possible so to be well prepared for working life.
Effective information giving enables patients to be well informed and have a clear
understanding when making decisions/following treatment plans. It can strengthen rapport
between the doctor and patient and reduce patient anxiety. The following sections discuss
the key principles for effective information giving.
Preparation
As with every clinical communication scenario, each situation must be handled individually
depending on the clinical context, background and patient.
Ensure you have a good understanding of the subject/procedure before you start giving
information – this is imperative or you might give unclear information or be unable to
answer the patient’s que
Look at the patient’s previous consultations (if relevant) – have they been perhaps been
given information on this before? Have they been told the diagnosis? Were they given
reading material in the previous consultation that they might have questions they want to
ask about?
Consider the approach – are you giving the patient information that might be difficult for
them to receive? (might it be useful to consider principles related to breaking bad news in
conjunction?)
Introduction
As with every clinical communication consultation, begin your consultation with a good
introduction:
Check you have the correct confirm they are happy to be called by their name e.g.
Joanna or Mrs Smith
Introduce your full name and role and purpose of the interview (e.g. ‘I have been
asked to speak to you about some recent investigations you have had’)
If you are seeing the patient instead of their usual doctor – apologise for the
change/explain that you are stepping in for whatever reason. They may be expecting
to have the conversation with someone else.
Gain consent – check they are happy to discuss the topic with you
Mention confidentiality if relevant
Build rapport from the start – e.g. offer a chair, ask them how they are today etc.
Check the patient’s agenda
Before launching into giving the information you want to give the patient (i.e. part of your
agenda), check to see what the patient’s expectations of the consultation are – they might
be different to yours. You might already know the answers to the question from previous
notes or the briefing you are given, but it is wise to double check.
Are they ready/willing to receive information today?
Were they expecting to receive information today?
Were they planning to discuss something else?
‘What were you expecting from today’s consultation?’
‘Was there anything else aside from the results you were hoping to discuss today?’
(This is also a way of integrating ‘ Ideas, Concerns and Expectations (ICE)’ into your
consultation, which often sounds artificial and out of context if asked at the end, unless it
directly relates to the context of what is being discussed)
Check the patient’s prior knowledge
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Check to see what the patient’s understanding of the subject is already.
It is important you ‘pitch’ the information you are giving accurately, otherwise you might be
wasting time telling the patient what they already know and not addressing specific
concerns or questions.
Structure and adapt your questions to the specific context. This will vary depending on the
scenario.
‘In your consultation last week, were the results of your recent investigations
explained?’
‘Tell me what you understand about your condition’
This way, you can miss out parts of the information that your patient already knows, and
spend time exploring more detailed aspects or anything they don’t understand.
Allow the patient to speak completely and start speaking again when there is a natural
pause.
If your patient has explained that they want to receive the information today, you might
need to explain why you need to gather information first. You could phrase this like this.
This is called signposting.
‘Before I go into the actual steps of procedure, I’d like to check what you know already,
if that’s ok?’
When your patient explaining what they already know listen carefully and watch their facial
and body language. Respond to what you see after the patient has finished speaking.
The patient might show that they are confused/unclear about the information they
already know
They may demonstrate emotion related to subject matter – anxiety, or sadness for
example
Context
Once you have checked the patient’s agenda and prior knowledge, it’s appropriate to
commence information giving.
Signpost, if not done already, about what information you would like to give the patient:
‘Today I would like to talk you through how to use an inhaler’
You could also explain the steps you are going to take:
‘First I will talk through the steps and I’ll demonstrate afterwards’
Chunk and Check
When giving information it’s important you break down the information into sizeable
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chunks. In addition, ask your patient to tell you if you are going to fast for them. Allow
processing time.
Watch the patient’s face whilst giving information – look for possibly non-verbal cues that
they are feeling overloaded by information.
Check understanding, but using phrases like ‘Are you with me?’ often result in patients
saying yes even if they aren’t clear. A good way to check understanding is to ask the patient
to repeat the information back to you.
Try to check understanding at intervals, rather than at the end as it may be too much for the
patient to repeat back.
The difficulty comes when with trying not to make this sound patronizing. One method is by
recognizing that the elements of the subject area may be complex and that often IQ has
nothing to do with understanding/retaining new information. A possible example phrase
could be: ‘Just to make sure I explained it correctly, could you repeat back to me what your
understanding of x is?’
Invite dialogue and link the information
Encourage the patient to ask comment or ask questions during the explanation – this
can help to ensure the patient is understanding.
Try to link the information to what has been mentioned already by the patient.
This might include mentioning what the receiver already knows/understands or the
context behind why they need to be given the information
E.g.‘You mentioned earlier that the problem is with the stomach lining, which is why the
procedure needs to take a sample from it.’
Avoid jargon
Ensure you explain the information using non-technical language.
Watch the patient’s face when giving information – they may demonstrate non-verbal
cues that they aren’t understanding the information correctly
Be aware that you can base the level of technicality on what the patient volunteers
initially, using slightly more complex words to explain the procedure if better outlined
this way.
Thank the patient and offer additional help
Thank the patient
Offer to help give the information using a variety of formats
Acknowledge the amount of information you gave might be a large amount
Offer the patient leaflets/websites so they can read more about the information
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General clinical communication tips
As with all consultations, ensure you are utilizing clinical communication skills to enhance
the quality of your interaction.
These might include the following
Signposting
Summarising
Demonstrating Empathy
Building Rapport
Demonstrating active listening skills