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Table 1 The Four Habits Model

From: Engaging communication experts in a Delphi process to identify patient behaviors that could enhance communication in medical encounters

Habit

Skills

Techniques & Examples

Pay-off

Invest in the

beginning

Create rapport

quickly

• Introduce self to everyone in the room

• Acknowledge wait

• Convey knowledge of patient's history by commenting on prior visit or problem

• Attend to patient's comfort

• Make a social comment or ask a non-medical question to put patient at ease

• Adapt own language, pace, and posture in response to patient

• Establishes a welcoming atmosphere

• Allows faster access to real reason for visit

• Increases diagnostic accuracy

• Requires less work

• Minimizes "Oh, by the way..." at the end of the visit

• Facilitates negotiating an agenda

 

Elicit the

patient's

concerns

• Start with open-ended questions:

- "What would you like help with today?" or,

- "I understand you're here for... Could you tell me more about that?" or,

- What else?"

• Speak directly with the patient when using an interpreter

 
 

Plan the visit

with the

patient

• Repeat concerns back to check understanding

• Let patient know what to expect: "How about if we start with talking more about...then, I'll do an exam, and then we'll go over possible tests/ways to treat this? Sound OK?"

• Prioritize when necessary: "Let's make sure we talk about X and Y. It sounds like you also want to make sure we cover Z. If we can't get to the other concerns, lets..."

 

Elicit the

patient's

perspective

Ask for

patient's

ideas

• Assess patient's point of view:

- "What do you think is causing your symptoms?"

- "What worries you most about this problem?"

• Ask about ideas from significant others

• Respects diversity

• Allows patient to provide important diagnostic clues

• Uncovers hidden concerns

• Reveals use of alternative treatments or requests for tests

• Improves diagnosis depression and anxiety

 

Elicit specific

requests

• Determine patient's goal in seeking care:

"When you've been thinking about this visit, how were you hoping I could help?"

 
 

Explore the

impact on the

patient's life

• Check context: "How has the illness affected your daily activities, work, or family?"

 

Demonstrate

empathy

Be open to

patient's

emotions

• Assess changes in body language and voice tone

• Look for opportunities to use brief empathic comments or gestures

• Adds depth and meaning to the visit

• Builds trust, leading to better diagnostic information, adherence, and outcomes

 

Make at least

one empathic

statement

• Name a likely emotion: "That sounds really upsetting."

• Compliment patients on efforts to address problem

• Makes limit-setting or saying "no" easier

 

Be aware of

your own

reactions

• Use own emotional response as a clue to what patient might be feeling

• Take a brief break if necessary

 

Invest in the

end

Deliver

diagnostic

information

• Frame diagnosis in terms of patient's original concerns

• Test patient's comprehension

• Improves adherence

• Increases potential for collaboration

• Influences health outcomes

• Improves adherence

• Reduces return calls and visits

 

Provide

education

• Explain rationale for tests and treatments

• Review possible side effects and expected course of recovery

• Recommend lifestyle changes

• Provide written materials and refer to other sources

Encourages self care

 

Involve patient in

decision making

• Discuss treatment goals

• Explore options, listening for the patient's preferences

• Set limits respectfully: "I can understand how getting that test makes sense to you. From my point of view, since the results won't help us diagnose or treat your symptoms, I suggest we consider this instead."

• Assess patient's ability and motivation to carry out plan

 
 

Complete the

visit

• Ask for additional questions: "What questions do you have?"

• Assess satisfaction: "Did you get what you needed?"

• Reassure patient of ongoing care

 
  1. ©1996, 1999, 2003 by The Permanente Medical Group, Inc., Physician Education and Development Rao et al. BMC Health Services Research 2010 10:97 doi:10.1186/1472-6963-10-97