Rapport in healthcare

[Dub]

used the search button and did not find a rapport thread....

Have a test in our Foundations of Medicine course, one of the topics which is emphasized is building rapport with your patient. It seems to me that given the limited time docs have with most patients you can either view rapport as a pie in the sky goal, or as a challenge to use your rapport building skills as effectively as possible in the short time you have to facilitate the interview and information you can gather. So on that note I would like to learn from the BTDTs of there techniques for building rapport, with a slant towards a medical environment, which can brings its associated challenges, but anyone with experience in rapport builiding jump in.

A few of the textbook rapport skills and how they can help you get information you need:

Nonverbal skills—of attentiveness include:

Position of physician and patient in the room

Eye contact

Posture

Gestures

Moving closer to a patient in sympathy


Open-ended questions—allow the patient latitude in choosing a response.


Directed questions—closed ended; ie: ROS, fever, chills, diarrhea. Must be carefully worded, in a neutral fashion, to avoid influencing the answer. When used prematurely, they can discourage the patient from disclosing other important data


Reflection or echoing—of the patient’s words can encourage the patient to give you more details about the facts and his or her feelings.


Facilitation—includes any comment or behavior that encourages the patient to keep talking. Ie: head nodding, attentive silence, repeating the last few words of the patient, and “tell me more”


Clarification and direction—include questions that clarify ambiguity or direct the process and flow of the interview. They may be useful in the early interview. Ie “describe what you mean by a dizzy feeling” or “I would like to learn more about your back pain before we talk about the hay fever”


Checking/summary—of the info gathered to that point.



So what do you do to build rapport and get the info you need?

[VXMerlinXV]

Dub,
I would say from my experience rapport isn't just a big thing, but rather, one of the biggest things. It does not matter how vast your knowledge base is, or how precise your clinical abilities are, if your patients do not trust you, because that means they will not listen to you. This applies to every level of patient care, from EMT all the way up to MD. I have the advantage of working both in an ED and on an ambulance, and I see rapport of all kinds being developed. The only thing I can say is the most basic form of rapport can be built in the first 30 seconds of your H&P, and once you loose it with a patient it pretty much doesn't come back. Until a patient decides to listen to you, and that you know what you're talking about, you're just a talking head in a white coat.
Where does rapport building skill come from? Experience. It is a clinical skill no different than IV access or intubating. It takes practice and it definitely diminishes over time if not used. You can learn the theory from a book, but you learn the skill from others more experienced than you.

[Dub]

I agree rapport is key. Experience is important, but I think good training can make you better at rapport in addition to experience, and rapport is something that you can get better at via training and learning, before its all the real thing.


A couple more:

Legitimation- while you may not necessarily agree with the patient, but you can express understanding

Partnership- lets discuss it together

Respect

Honest concern

[DocReeves]

My 2cents:

I work as a Registered Nurse in ICU and sometimes get floated to ER and other areas of the hospital. I've been in healthcare for over 10 years now and the last four have been as a RN. Somehow I always seem to please my patients and have never had any complaints. I even get the occasional thank you card that most nurses don't receive. Unfortunately, my talent sometimes lands me the assignment of taking care of disgruntled patients and family members. These are the folks that the other nurses have had problems with or just don't want to deal with.

Tips:
I truly do my best to show that I care. I take as much time as possible to listen to the patients concerns and ask if they have any questions. I also try to explain as much as possible to the patient and their family members. This saves me from answering questions later on when I might be busy and it instills a sense of "I know what I'm doing." Patients seem to like this and feel comfortable almost immediately after I have explained simple things like how to read the Cardiac Monitor(EKG, spO2, resp, BP). I also do my best to explain medications and why they're receiving them.

I also try to touch my patient when I introduce myself and before I leave the room. I hand shake on introduction and usually pat a shoulder, arm or foot upon exiting the room. I do this just to show some compassion, human touch, and to let them know that I'm not afraid to take care of them and their illness.

Finding common ground is something else I strive to do. Things I ususally find in common with my patients are: Previous military experience, Police Officers(my dad is retired LEO), part of town they reside in, what college they went to or children go to, sports, food, movies, music, etc.

I also do my best to be extremely attentive. Make them feel as though then just rented a room at the Ritz Carlton. "Are you warm enough? Can I get you another blanket? Can I get you more ice water? You get the point.

Things I try to stay away from unless absolutely necessary are: Religion, Politics, and sexual preferences. These can get you into heated conversations that people have a lot of emotion about. When they come up in conversation, I just make a neutral statement and change the subject. It usually works.

Main thing is to just show that you really care. This can be hard when you're feeling bad yourself or are having a bad day.

Atleast pretend you care.

Be professional.

[AngelsSix]

Report = attentiveness.

I am disgusted with doctors that are distracted and do not bother to hear me out. Let me tell you what is wrong....I know what my body does every day. Do not discount the symptoms as "stress". If a patient walks into your room and starts listing symptoms, write it down on a separate paper....do some research, then make a diagnosis. Do some blood work, and do a thorough exam. Most of the docs at the clinic seem distracted and rushed. Seems like the majority of them are so tired of the folks coming in with sniffles that they blow off the ones who may really have a problem. There is no harm in telling a patient they are NOT sick.....but do the research!!