Listening & Questioning Skill
Comm Skill Team FKUB
Every good conversation starts with good listening
Empathy
“The ability to imagine yourself in someone else's position and to intuit what that person is feeling."
“The capability to share another being's emotions and feelings”
Type of Empathy Paul Ekman identifies 3 basic types of empathy: Cognitive empathy involves simply sensing how another person feels and what they might be thinking, sometimes called perspective taking (Reflection of Content)
Emotional empathy occurs when a person senses and feels along with the emotions of another (Reflection of Feelings)
Compassionate empathy happens when a person senses the feelings of another and is moved to help (Take action)
Emphaty = Active listening Active listening by the clinician encourages the client to share information by providing verbal and nonverbal expressions of interest
Non Verbal Response
Proksemic : space between patient and clinician
Intimate : Physical Contact to 0.5 m (when appropriate or physical examination) Personal : 0.5 m – 1.25 m (ideal space) Social : 1.25 m – 3.5 m Public : 3.5 m – 7.5 m
Kinesic : facial expressions, gesture (ex : lean forward, nod your head) Paralinguistic : rhytm, pitch Artifactual : Attire – penampilan fisik dokter (remember your previous lecture!)
Active listening skills Active listening includes the following skills:
Attending
Reflection of content (Paraphrasing)
Reflection of feelings
Summarising
Listen with HEART : H : Hush! E : empati A : Ask & attend R : Reflect & paraphrase T : Tone
Attending Attending is expressing awareness and interest in what the client is communicating both verbally and nonverbally Attending helps the clinician
Better understand the client through careful observation
Attending helps the client Relax and feel comfortable Express their ideas and feelings freely in their own way Trust the clinician Take a more active role in their own sessions
Attending Skills Proper attending involves the following:
Appropriate eye contact, facial expressions
Maintaining a relaxed posture and leaning forward occasionally, using natural hand and arm movements
Verbally “following” the client, using a variety of brief encouragements such as “O begitu ya” or “Ya” or “Mmm” with nod your head
Observing the client’s body language
Attending 3 level : - Micro-skills behaviour - Body language - Social-emotional presence Tips: Use SOFTENER Space & Smile Open Forward Touch Eye contact Nodding Encourage Reframe
Example of attending Mm...gitu ya
Ya..ya (mengangguk)
Begitu ya..
Saya merasa bingung...mau tidur rasanya sulit
Baru tidur sebentar sudah terbangun..
Rasanya hidup dikejar-kejar masalah...
BARRIER to ACTIVE LISTENING
Reflection of Content/paraphrasing Paraphrasing is when the clinician restates the content of the client’s previous statement.
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Paraphrasing uses words that are similar to the client’s, but fewer. The purpose of paraphrasing is to communicate to the client that you understand what he or she is saying.
Reflection of feelings Reflection of feelings is when the clinician expresses the client’s feelings, either stated or implied. The clinician tries to perceive the emotional state of the client and respond in a way that demonstrates an understanding of the client’s emotional state. Remember...crying is not forbidden ! (Berilah izin klien untuk menangis, jika diperlukan)
Paraphrasing Paraphrasing helps the clinician
verify their perceptions of the client’s statements
spotlight an issue
Paraphrasing helps the client
realise that the clinician understands what they are saying
clarify their remarks
focus on what is important and relevant
Example of paraphrasing Semalam adalah hari tersulit dalam hidup saya. Sudah perut rasanya nyeri, anak yang kecil rewel, suami sibuk sendiri lagi.. Sepertinya semalam banyak problem dengan kesehatan dan keluarga ibu ya... Ya dok
Reflection of feelings Reflection of feelings helps the clinician
Check whether or not they accurately understand what the client is feeling Bring out problem areas without the client being pushed or forced
Reflection of feelings helps the client
Realise that the clinician understands what they feel Increase awareness of their feelings Learn that feelings and behaviour are connected
Example of reflection of feelings Maaf dok....saya ingin pakai alat KB tapi suami saya selalu tidak setuju. Padahal untuk saat ini saya takut hamil lagi....saya belum siap...
Sepertinya ibu bingung dan khawatir ya.... Ya dok
Reflection of Content & feelings (Gabungan) Maaf dok....saya ingin pakai alat KB tapi suami saya selalu tidak setuju. Padahal untuk saat ini saya takut hamil lagi....saya belum siap...
Sepertinya ibu bingung dengan sikap suami ibu dan khawatir kalau hamil lagi akan menimbulkan masalah baru. Begitu ya bu....
Ya dok
Summarising
Summarising is an important way for the clinician to gather together what has already been said, make sure that the client has been understood correctly, and prepare the client to move on. Summarising is putting together a group of reflections.
Summarising Summarising helps the clinician
Provide focus for the session Confirm the client’s perceptions Focus on one issue while acknowledging the existence of others Terminate an issue in a logical way
Summarising helps the client
Clarify what they mean Realise that the clinician understands Have a sense of movement and progress
Example of summarising Kita tadi mendiskusikan sikap suami ibu yang tidak setuju jika ibu memakai alat KB padahal ibu merasa masih belum siap untuk hamil. Ibu masih ingin membesarkan anak yang masih kecil. Ibu juga merasa sikap suami tidak meyakinkan ibu untuk hamil lagi karena suami sering cuek dan sibuk sendiri. Puncaknya, setiap malam ibu sering sulit tidur dan nyeri di bagian ulu hati. Begitu ya....
Ya dok sepertinya begitu
Other Way of Expressing Emphaty Skill
Example
Validation
“Saya sangat memahami kejenuhan bapak untuk meminum obat selama 6 bulan berturut turut”
Support
“Usaha bapak untuk mulai berhenti merokok sudah bagus sekali pak. Terus lanjutkan pak !”
Partnership
“Saya tahu ini berat tapi kami satu tim akan membantu bapak menyelesaikan masalah ini. Kami akan lakukan yang terbaik yang kami bisa”
Respect
“Saya sangat menghargai kesabaran bapak untuk terus minum obat walau sering di luar kota”
The Emphaty Communication Coding System (ECCS) – Byloun& Makoul, 2005 Levels of emphaty
Example
0- Denial/disconfirmation
Physician either ignores the patient’s emphatic opportunity or makes a disconforming statement Example : “Kalau tidak mau sakit terus ya operasi saja”
1-Perfunctory recognition
Physician gives automatic,scripted-type response, minimal recognition Example : “Ya memang sakit bu sakit ini (sambil mencatat)”
2- Implicit recognition
Focus on peripheral aspect of the statement and changes the topic Example : “Ya saya tahu ini sakit, kalau pusingnya gimana?” (Padahal pasien sangat khawatir dengan sakit di dadanya)
3-Acknowledgement
Explicitly acknowledge the central issue in emphatetic opportunity but does not pursue the topic Example : “Ya saya bisa memahami kekhawatiran ibu tentang sakitnya. Selanjutnya saya akan beri obat penahan sakit bu” (Dokter tidak mengeksplor sakitnya lebih lanjut dan tidak berusaha memberikan perhatian lebih pada kekhawatiran pasien)
Levels of emphaty
Example
4-Pursuit
Explicitly acknowledge the central issue in emphatetic opportunity and pursuing the topic by asking question Example : “Ya saya bisa memahami kekhawatiran ibu tentang sakit ini. Bisa diceritakan lebih jauh bu....apa yang membuat ibu sangat khawatir?”
5-Confirmation
Physician conveys the patient that expressed emotion is legitimate Example : “ Saya memahami perasaan ibu...ibu pasti merasa berat dengan sakit ibu ini.Tidak mengapa jika ibu menyampaikan perasaan ibu”
6-Shared feeling or experience
Physician self disloses, making an explicit statement that he or she eithr shares the patient emotion or has had similar experience Example : “ Saya memahami perasaan ibu...ibu pasti merasa berat dengan sakit ibu ini.Tidak mengapa jika ibu menyampaikan perasaan ibu. Beberapa pasien sebelumnya juga demikian, mereka memiliki masalah dengan perasaanya dan saya siap mendengarnya dan membantunya”
Questioning Skill
Open-ended question : An open-ended question is designed to encourage a full, meaningful answer using the subject's own knowledge and/or feelings. Closed-ended question : Yes or No answer
Flow in Medical Interview Van Dalen (2005)
1 Client leading
Open-ended question
3 2 Doctor leading Close ended question
3 Negotiation and agreement
Thank You.....
