Counselling of Patients

COUNSELLING OF
PATIENT
Amir Masaud Pirzada
ENT & HNS SZABMU PIMS
Objectives
• Definition
• Communication
• Providing all the required information
• To avoid unwanted events
Definition of Counselling
• Patient counseling is a broad term
which describes the process through
which health care professionals attempt
to increase patient knowledge of health
care issues.
Cont..
• Patient counseling
• verbal or written
performed on an individual basis or in groups, & provide
directly to the patient or caregiver.
• This process provides for the exchange of information
between the patient & health practitioner.
• This information gathered is needed to assess the

patient’s medical condition to further design, select,
implement, evaluate & modify health interventions
Importance of Counselling
• RECOGNITION about their well being.
• ENCOURAGES the patient to establish a working

relationship with doctor/healthcare provider.
• MOTIVATES the patient to take medicine for

improvement of his/her health status.
• IMPROVES the coping strategies to deal with

treatment options.
Patient counseling methods:
A. Introduction of the session.
B. Content of the session.
C. Process followed.
D. Conclusion of the session.

INTRODUCTION
• Review the patient record.
• Introduce yourself
• Explain the purpose of counselling session.
• Obtain pertinent initial drug related information.
• Always Always provide friendly enviornment.

Contents of Counselling
• Discuss the name and indication of the
medication/treatment/surgery.
• Explain the dosage regimen including duration of
therapy when appropriate.
• Assist the patient in developing a plan to incorporate
the medication regimen into his/her daily routine.
• Explain how long it will take for the drug to show its
effect.
• Emphasize the benefits of completing the medication
as prescribed.
• Discuss the potential side effect of drugs and
outcomes of Procedure.
Cont..
• Discuss how to prevent or manage the side effects of
the drug/complication of procedure.
• Discuss the precautions.
• Discuss the significant drug‐drug, drug‐food, and
drug‐disease interaction.
• Explain precisely what to do if the patient misses the
dose.
• Explore the potential problems of the patient
Counselling process items:
• Provide accurate information.
• Use language that the patient is likely to understand.
• Use the appropriate counselling aids to support counselling.
• Present the fact and order in a logical order.
• Maintain control & direction of the counseling session.
• Probes for additional information.
• Use open‐ended question.
• Display effective non‐verbal behaviours.

Counseling conclusion steps:
• Verify the patient understanding via feedback.
• Summaries by acknowledging or emphasizing key

points of information.
• Provide an opportunity for final concerns or

questions.
• Help the patient to plan, follow up and next

consecutive steps.
• For better counselling and to achieve desired results,
it is important to have;
Good
communication Skills.
Communication
• is the transfer of information meaningful to those involved.
• It is the process in which messages are generated and
sent by one person and received and translated by
another person. However, the meaning generated by the
receiver can be different from the sender’s intended
message.
Primary functions
1. It establishes an ongoing relationship between the

professional and the patient.
2. It provides the exchange of information necessary to

assess a patient’s health condition, implement
treatment of medical problems, and evaluate the effects
of treatment on a patient’s quality of life.
Questions in mind of Patient
• They have unanswered questions

• They have misunderstandings
• They experience problems to therapy
• They can “monitor” their own responses to treatment
• They make their own decisions regarding therapy
• They may not reveal information to you unless you initiate
a dialogue
Communication about Management
Plan
• Purpose of medication/Treatment/surgery
• How medication works
• Dose and duration of therapy
• Goals of therapy/treatment
• How effectiveness will be monitored
• Adverse effects and how to deal with them
• Drug/treatment specific issues
The healthcare professional must be
able to
• Understand the illness experience of the patient
• Perceive each patient’s experience as unique
• Good relationship with patients
• Build a therapeutic alliance with patients to meet mutually
understood goals of therapy
• Develop self-awareness of personal effects on patients
Key elements of Interactive
communication:
• open ‐ended questions
• Awareness of nonverbal cues
• Active listening
• Reflective responses
• Verification of understanding.
Open‐ended questions
• A key component of interactive communication is
using open‐ended questions.
• Open‐ended questions are questions that start with

who, what, where, when, how and why and require
more than a yes/no response. These questions
encourage disclosure of information.
• Closed‐ended questions and leading/restrictive

questions elicit yes/no responses and limit the
information sought from the receiver. These types of
questions should be avoided.
Nonverbal cues
• Appropriate nonverbal cues are also critical for
effective communication.
• Facial expressions, body posture, gestures, tone of

voice and use of eye contact are all forms of
nonverbal communication.
• People tend to believe the nonverbal message.1
1. Harvey M. Rappaport et al. The Guidebook for Patient Counselling. Lancaster, Pennsylvania:
Technomic
Publishing Company, 1994
• Friendly and smiling facial expressions.
• Varied eye contact(consistent, but not startling.)
• Professional appearance.
• Relaxed, warm and comfortable gestures.
• Attentive body posture(slightly leaning forward)
• Appropriate personal space(18‐48 inches).2
• Varied voice rate and volume to keep the individual

interested. However, a high pitched voice should be
avoided.
2. Tindall, William N, Robert S. Beardsley, Carole L. Kimberlin.
Communication Skills in Pharmacy Practice
(fourth edition). Baltimore, Maryland and Philadelphia, Pennsylvania :
Lippincott Williams & Wilkins, 2003
Distracting non-verbal clues
• Lack of eye contact may indicate little confidence or
interest.
• Any gesture which can produce disturbance
• Unfavorable tone of voice
• Slouching or weight shifted to one side(may indicate

lack of interest)
• Messy work environment

Active listening
• When we think of communication skills, we usually
think of skills relating to the manner in which we
speak. Equally important, and perhaps more difficult
to learn, is the ability to listen well.
How to be an Active Listener
• One time one Task, don’t be distracted.
• Don’t jump to conclusion before discussing all pros

and cons of treatment plan.
• Communicating stereotypes that you have

internalized. (Solution is react to information, not the
person).
• Faking interest in what is being discussed. (Solution

Use good eye contact, this will help you concentrate)
• Judging the individual based upon his or her
appearance or condition. (Solution Focus on content,
nonverbal cues and the manner in which something is
said).
Active feed back.
• I see…
• No, I don’t feel that way, but tell me why you do…
• Yes, that’s how I’ve found it to be...

Reflective responses
• Reflective responses reflect back to the sender the
receiver's understanding of both the content of what
was said and the feelings that were expressed.
• A major advantage of these responses is that they

allow an individual to be empathic without having to
agree.
Verification of understanding
• Verifying understanding prevents misunderstandings.
It is an important skill in the communication process
because it is a checkpoint for communication.
• This process involves asking the receiver to state

back the message that was sent by the sender and
enables confirmation of what a person knows ... not
what we think they know.
• E.g "Just to make sure I've discussed everything, can

you tell me how you are going to take your
medication?"
Breaking Bad News
• The aim for any health-professional is to use their
skills to deliver bad news clearly, honestly and
sensitively in order that patients can both understand
and feel supported.
• SPIKES - The Six-Step Protocol for Delivering Bad
News
• STEP 1: SETTING UP the Interview

• STEP 2: Assessing the Patient’s PERCEPTION
• STEP 3: Obtaining the Patient’s INVITATION
• STEP 4: Giving KNOWLEDGE and Information to the
Patient
• STEP 5: Addressing the Patient’s EMOTIONS with
empathic responses
• STEP 6: Strategy and Summary
Concluding Points
• Know the purpose of counselling
• Know the record of patient
• Good background knowledge
• Good communication skills
• Be empathic
• Be logical

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COUNSELLING OF

• This information gathered is needed to assess the

• ENCOURAGES the patient to establish a working

• MOTIVATES the patient to take medicine for

• IMPROVES the coping strategies to deal with

A. Introduction of the session.

B. Content of the session.

D. Conclusion of the session.

• Explain the purpose of counselling session.

• Obtain pertinent initial drug related information.

• Always Always provide friendly enviornment.

• Use language that the patient is likely to understand.

• Use the appropriate counselling aids to support counselling.

• Present the fact and order in a logical order.

• Maintain control & direction of the counseling session.

• Probes for additional information.

• Use open‐ended question.

• Display effective non‐verbal behaviours.

• Summaries by acknowledging or emphasizing key

• Provide an opportunity for final concerns or

• Help the patient to plan, follow up and next

1. It establishes an ongoing relationship between the

2. It provides the exchange of information necessary to

• They have unanswered questions

• Awareness of nonverbal cues

• Open‐ended questions are questions that start with

• Closed‐ended questions and leading/restrictive

• Facial expressions, body posture, gestures, tone of

• People tend to believe the nonverbal message.1

• Varied eye contact(consistent, but not startling.)

• Relaxed, warm and comfortable gestures.

• Attentive body posture(slightly leaning forward)

• Appropriate personal space(18‐48 inches).2

• Varied voice rate and volume to keep the individual

• Any gesture which can produce disturbance

• Unfavorable tone of voice

• Slouching or weight shifted to one side(may indicate

• Messy work environment

• Don’t jump to conclusion before discussing all pros

• Communicating stereotypes that you have

• Faking interest in what is being discussed. (Solution

• Yes, that’s how I’ve found it to be...

• A major advantage of these responses is that they

• This process involves asking the receiver to state

• E.g "Just to make sure I've discussed everything, can

• STEP 1: SETTING UP the Interview

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