3. Handing Over.
Some strategies for handing over.
Negotiating
Influencing
Gift wrapping
· Doctor goes first
· Think aloud, be open about your thoughts
· State your position, e.g. "I don't prescribe temazepam but how are
we going to help you"
· Say what you expect to happen
· Fly some kite about possible options
· Give the patient choice
· Ask what the patient thinks
· If you don't see a "yes" then you have a "no"
State the obvious e.g. "my opinion is"
Use a stepwise approach to your final opinion rather than jumping straight to it. This allows the patient to follow your reasoning and allows you to check for acceptance.
Remember that the right hemisphere can cause problems and that
Don't means do
Won't means will
Can't means could
Shouldn't means should
e.g. Don't worry will make the patient worry
Use questions instead of statements
Statement: I think you drink too much
Questions: Have you ever thought that you drink too much?
Reframing
Try to reframe a problem in a better light
Shepherding
Influencing the patient in your chosen direction by
Using value laden phrases e.g.by choosing language with good or bad overtones
you can persuade the patient that a course of action is good or bad.
In discussing the use of NSAIDs in the management of a painful knee, compare the following:
· " I think we should use a mild anti inflammatory to help you"
· " Anti inflammatory tablets have all sorts of side effects so I think
it is best not to use them
Pre-empting
If you do this then that will happen
" if you take this antibiotic your cough will get better"
" if you wait a few days your cough will get better on it's own"
Using My friend John as before
This is the art of handing over so that the patient.
· Delivery should be at the right time
· Chunking, small amounts of information should be given in bite size
pieces
· Pausing, to allow for understanding
· Pacing at a pace that matches that of the patient, slowing down at
the important parts
· Good eye contact should be established
· Watch for minimal cues to help you maintain rapport and to gage the
patients acceptance of what you are saying
How to give instructions
· The rule of three:
say what your going to say, say it and then say what you have said
· Use a preface of what you are going to say
· Short words and sentences
· Avoid jargon
· Overlap your instructions
· Use an ordered list
· Write things down, or use an information leaflet
· Be specific
· Give illustrations
Be polite and respect the patients self-esteem