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Science and Art of Asking Questions

May 10 | 3:30 PM

We all know how important asking the right questions is when consulting with patients. While you ask questions every day and have been doing so from your professional training days, it is possible that many of you may not have learned the art of asking right questions. Learning the art of asking right questions will not only help you gather accurate information in time-sensitive clinical consultations but also establish trustworthy relationships with patients. Furthermore, expertise in this essential listening skill will help you to effectively manage challenges in clinical situations (dealing with angry patients and families members; discussing serious news). Join us live as Dr. Naineni covers all this and more.

[Music] good evening dear doctors on behalf of team netflix i extend a warm welcome to all of you i dr fatima welcome you all to this super super interesting session on science and art of asking questions by our metrics electri now coming to about dr krishnani he works as a general practitioner in the southeast region of england also member of the royal colleges of general practitioners and a faculty at brighton sussex medical school he is a passionate medical educator with an interest in listening centered clinical communications serving as a chair for international listening associations healthcare team also co-founder of the local academy which has been instrumental in delivering custom-made listening centered clinical communication skills training programs to healthcare professionals and organizations in india and uk sir enjoys long distance running and walking hates cooking but loves eating foods today our session is super interesting and we all know learning the art and asking the right questions will not only help us in our routine clinical consultation but will also help us establish trustworthy relationships with patients on this topic furthermore uh over to you dr krishnan thank you so much for joining us tonight thank you fatima thank you netflix okay so you've been through the instructions so let's start by asking netflix and fatima a question okay fatima started this session saying dear doctors in the registrations i see i've seen that there are people from physiotherapy dentists and other disciplines so i wonder what might be a better word to replace doctor when introducing um i will let fatima to mallow and come up with a better word towards the end of the session let's get started today's session is all about the right way of asking questions the signs and art of asking questions good evening all thank you for joining and we are grateful for your energy and passion and for your continued interest in learning clinical communication skills brilliant keep that going we need that energy remember we have started our journey in april about how effectively and efficiently we can deliver serious news discuss serious news or breaking bad news or manage patients and families who are angry we have learned in the in our first session that to do those things effectively we need mastery of three competencies listening intelligence perception and emotional intelligence for these three competencies to achieve mastery in these three competencies we need to learn at least six core clinical communication skills if you have been with me or with us on this journey we have learned emotional self-awareness expressing empathy and perception checking so far those who are joining for the first time we request you to go back after this session at some point and watch those videos you will find them very helpful and you will see that there is a continuity for these sessions we are building on each session builds on builds on the last session we took a slight detour um last week and we learned about self-knowledge we thought it's also important to learn uh about ourselves that that's the session is called reflexivity in clinical practice do watch it so today we are learning about art of asking questions and in the coming sessions we will learn reflective listening and validation so stay tuned as always our request is please listen with curiosity please listen to what is being said without immediately accepting or rejecting stay with us think on the things that we are sharing with you participate in the discussion if if at any point you you want clarification ask us post a question post a question we will try to explain is that clear my voice now is it audible is it audible guru so i can hear you perfectly well yeah but it's not loud it's very low the voice is very low okay let me talk loudly yes um okay thank you for that similarly do participate um in the discussion if at any point if you feel that you you don't completely agree with the point which i'm sharing please ask a question this is the learn we learn by engaging in a dialogue okay good so let's get started with this have you ever wondered why the word question contains within itself the word quest what is it trying to say to us let's get started post some comments why why does the word question has got quest in it why have a thing why what are we on the quest firm when we are asking questions i wonder to search what raj to search what so the dictionary definition of quest is the act of searching something i wonder what is what that something is to understand more of what curious to learn so when you are talking to patients when you are sharing news with a patient when you are consulting with patients what are you on the quest for diagnosis to understand more what else what else i wonder if we are on the quest firm because this is this is fundamental this is very very important to be aware of the importance of this quest quest for cure is it always quest for cure or is it quest for cure and quest for care to find out knowing them that's a good comment what do you want to know about them what do you want to find out is it the clinical narrative or anything more than that yes illness oh very good shaker severity of illness and how it is affecting them knowing their psychological problems yeah so they we talked about from your comments yes it's important to learn about physical complaints it's very important to learn about the psychological the impact of symptoms on them what else yes problem and context very well said anisha hunt for new symptoms yes hunt for new symptoms so that's great people please continue to participate with the same energy what made them to reach me it's a long search yes somebody has been googling up the quest definition it's a long search that's what oxford dictionary says it's a long search be mindful of that phrase long search i think in addition to everything you have shared in the comments i think it is also gently reminding us of the responsibilities okay if you're going on a quest for all these things that you have shared i wonder what are the responsibilities of the questioner what are the things that he should be consciously be aware of what he should be mindful of we'll come on to the responsibilities of the quash questioner in a moment but before that i would like to share this definition of asking questions i've shared this in the pre-course reading material i'm hoping that you have read the pre-course material if not i encourage you to go back and read it at some point um we've said all along that you're learning a lot you have capacity to learn more and more and more while we have the capacity to learn more it's not enough for learning to stick we need to keep practicing them we need to reflect we need to recall our learnings so people as well as coming to these sessions and learning new things we also request you to practice the learn skills have is anybody willing to come on stage and share for a minute or two anything that have they have been practicing and how they have been helpful for them anyone oh dr anisha agarwal thank you accepting accepting your request dranisha please turn on your if you have been practicing your learnings you can put that in in the comments how you have been practicing and how it has been helpful and what impact these learnings have been in the way you're communicating with others can you see i'm already asking lots of questions here to learn more about the learnings go on anisha hello sir hello everyone uh this is anisha uh i joined local academy back like i think it has been two years now somewhere and yes so i also joined just like you guys in some of the session and but i think the most important point is it is not about one session it is about going back and reflecting on what you learned and moreover it is about practicing daily with the patients so whenever you go with the patients always have some model which you can develop for yourself or anything that you learn and think about your own behavior because at the end of the day what i learned in these two years was everyone lacks something in their behavior which they can definitely like cultivate and become a better communicator so definitely practice and reflecting on oneself are the two key things apart from whatever dr krishna tells us today thank you oh very good thanks for sharing those insights anisha i'm sure many of you have practicing the learnings i'm sure we would we are curious to learn more actually to see how these sessions are helping you anyway more on that later okay so guru what do you think about open questions what are they guru we need to make the patient feel comfortable to us uh to ask questions directly keeping and not keeping the relatives of family attenders near us and making them feel comfortable to uh answer the questions what we ask them openly regarding their morbids or history whatever maybe okay that's questioning in general um that's the open attitude you were talking about but what does is anybody willing to share how they define okay sarvan how do you define open question thank you guru thank you sharon go ahead uh yeah dr krishna we're not able to see your videos up yes i've intentionally switched off so that the focus is on the side and what people are sharing hello okay go ahead yeah so it gives opportunity for the patient to express their uh [Music] whatever it is like if it's a symptom or um concern so it it is just a questions where it gives the freedom for the patient to express themselves but what's your favorite open question um how are you feeling today how are you feeling today fantastic anymore um tell me about your pain okay tell me about your page or tell me about what made you come to um consultation today what made you come to consultation today be mindful of that phrase we'll come back to it later an open-ended questioning is which gives the patient a chance okay very good good points are coming in the comments section thank you for sharing that point um a question which lets patients explore share their narrative they are usually used at the beginning of each major topic of the clinical interview is it not and the design encourages the patient to tell their story in their own way like you've been mentioning in the comments open questions welcomes patients to share their narrative it is one that allows patient to expand on their narrative shade it does not push nudge towards a particular way of framing the situation it gives them a space an open space a safe space for them to share whatever they want to share like some of you said open questions are fundamental for the success of medical consultations because because they remove clinicians agenda experience and assumptions from the questions you mentioned you have headache like shalom saying could you please tell me more about the headache or my favorite open question is can you begin at the beginning and tell me all about it i would like to know your journey when you ask open questions and be curious and listen to their responses without rushing and interrupting patients perceive that you care and when the follow-up questions come from their responses they perceive that you are genuinely interested in their narrative say for example i might ask you what have you particularly enjoyed about the sessions so far so that's a good open question so it encourages you to share your views and thoughts about the sessions i might also ask you what are your views about the session i might also ask you what would you suggest we improve about the sessions going forwards so these are the questions that that gives you space and time to share your thoughts i wonder then what is a closed question what is a closed question anybody who read the pre-course material are willing to share their view closed question i wonder what is a closed question ashwin kumar go ahead what is a closed question hello yes go ahead your close question is something asking a patient do you like this or that is your pain severe or uh mild something like that giving the lead to the patient that either replying yes or no something like that yes or no yes can you give me an example your favorite closed question in your local language okay okay good one very good thank you okay so i might ask you are you enjoying these sessions yeah yeah yes this this is a close closed closed question yeah yes close question so open question would have been what in particular are you enjoying about the session right okay yeah so if you're if you're mindful you realize that you open up every element of the consultation with a closed question say for example if you want to learn about medicines you might ask are you taking any medicines you know do you smoke what is your occupation what brings you here so these are in essence narrow focused questions you then use an open question to explore their said thing what i wonder then is a leading question suryakumar dubai wanted to share his views okay go ahead what i wonder do you get enough sleep okay yeah good question yes you are yeah so it's like when we have a hypothesis in our mind and we start asking them questions um towards that uh like is it um like associated symptoms uh i think that would be the leading questions yeah leading questions um i'm sharing my perspective here i'll be extremely cautious in asking leading questions in clinical practice you need to be very careful when and how you use the leading questions i have shade few points in the pre-course reading material i would encourage you to go back and look at them because i'll tell you why they're useful but please exercise caution when and how you use them say for example you might ask patient how would you describe the chest pain is it tightness or heaviness this is appropriate in certain situations if the patients are struggling to describe the chest pain you might nudge them by giving them options however it might it might be challenging if you only give them two options because you're forcing them to use one or the other options which you have given them avoid leading questions like like this one your chest pain isn't bothering you anymore is it your chest pain isn't bothering you anymore is it is anybody willing to translate this into hindi your chest pain isn't bothering you anymore is it how i wonder what would be it how would you translate this question into your local language anybody willing to translate into any language preferably hindi so that many would understand how would you okay kumar go ahead just a minute huh your chest pain isn't bothering you is it doctor please come on straight hi in an authoritative tone kumar like you are the big boss you've got all the power say it in authoritative part your chest pain isn't bothering you is it kumar okay so what what i wonder is is the challenge of that question if you ask in that tone and in that attitude why what happens come on oh the person would feel immigrated and he'll obviously say like no we'll most likely say no to satisfy you yeah yes okay promote do you have any other points to add thank you come on that's wonderful promote go ahead this is very important it's worthwhile spending a minute or two here dr pramon please turn on your audio video i have accepted your rings and yes patient would be compelled to give an answer very good point i don't know who made it it was dr primo okay so while she is coming like uh many of you shared your views in the comments and like kumar said please be mindful of these people we are practicing in a am i would i be right in saying a vertically hierarchical culture an authoritative culture most of the times when you are working in sachin or when you are practicing in such a culture asking that question in an authoritative tone patients may respond in the affirmative like somebody said patients might be compelled to say no even though that that response is incorrect because this question highlights the significance of being aware of what we ask and how we ask so please be mindful people of the leading questions please be mindful it's very important to be mindful of uh everything i wonder what would be a better way of asking that question you may ask how are your chest pain how are you feeling today that's much more open it gives them an opportunity to give a give them to share their honest answer i wonder then i wonder then how many of you spend more time in asking open questions when you ask open questions i wonder then how much time do we need to give patients how much time do we have to wait for them to share their responses it is very difficult question to answer depends on the nature of the open question however it is very important it is our responsibility to wait until they share the response because open questions are expensive and you are inviting patients to think reflect on their experiences and share their responses it is important to allow time and stay interested by displaying a curious and open body language when they are sharing their responses it is also important to facilitate the narrative by using encourages like uh-huh go on ah that's interesting let's put that into practice um this is an open question for all of you okay this is question let me ask that question again what have you particularly enjoyed about these sessions so far let's see it's a very open question go ahead what have you particularly enjoyed about these sessions so far so how much time shall i give you to answer this question 10 seconds 20 seconds is anybody willing to share their responses what have you particularly enjoyed about this session so far two-way communication tell me more about that two-way communication horizontal interaction sakshi can you tell me more what do you mean by horizontal interaction what do you mean by open you you used inverted common shaker what do you mean by being open open discussion engaging okay so i'm sure there is more for you to add and you're finding a few words to put it in the comment section so i'm sure you understand you you have understood uh okay hari priya you have forced me to call your name very good that's a good point no hesitation participation of so many people in their own style very good there you go so it is encouraging people to share their own thoughts there is no one right answer and i should be when i ask that question i should be open to whatever response i get or i read or read it okay is there a right order of asking questions is there a right order of asking questions i think there are few few people suggest recommend a funnel approach they say start with the open question and move on to closed questions in some in some context like if you're working in an casualty emergency department or if you are anaesthetist checking patients one final time before taking into the theater you may only rely on closed questions because yes is contextually appropriate i say it really doesn't matter what order you follow what matters is your attitude your intention and what you do with the responses you get if you asked a closed question what brings you here today they might say chest pain you might then follow it up by saying oh could you please tell me more about chest pain oh can you begin at the beginning and tell me all about it so that's very important that engages the patient in the conversation that establishes rapper so hence this slide for me it's a circular approach what is important is what information you're gathering and how you're gathering whatever may be your role i request you to ensure that you consider you consider including all types of questions closed question and open questions and if the situation demands you may want to use leading question as well okay clinical iceberg how many of you have heard of this before this session how many of you has anybody heard about clinical iceberg okay please pay attention to this slide very carefully because this will really help you in when you're consulting with your patients and when you're taking history from patients it really helps you so here so clinical okay in microbiology infectious diseases okay what did you learn wyoming what did you learn those who said they have learned about it it would be really helpful if one of you quickly come onto the stage and share what you have learned please quickly uh so we have a request from dr ranwalla okay go ahead yeah dr guru i'm accepting your request as well okay quickly people those who have heard about it quickly share what you have learned what did you what do you understand of clinical iceberg dr rangwala yeah accepting your request dr nirisha could you please turn on your audio video yes okay go ahead yes you are loud and clear go get narration yes so the one uh states the uh clinically apparent cases like visible are known to medical services so this uh two number two uh states they're aware of illness but uh um they were not seeking any advice so the three states um they were diseased but they were uh they doesn't know or they are not aware of the illness and four states uh healthy uh when uh people okay so where did you learn about it in eurasia and how is this helpful for this session in this session what i feel was regarding the reflectivity so because we do practice in our own style but we don't know the art of practicing or the proper way of uh practicing clinical practice so maybe that's that this will help us in the art of practicing yeah thank you teresha for those points and thank you for all those who have shared your responses and comments uh listen to me carefully because while this is very important from public health perspective we could use that information to establish wrapper with the patient we could actually it helps us in asking right questions in the right way and at the right time it does see how it does okay let me summarize for those who have not heard before so research into public health and epidemiology has shown that at any given time in the community there are people who are well and who are unaware that they are ill and people who are aware that they are ill but not yet sought medical input and people who are ill and sought medical input they are currently being treated in the hospitals and other places why is it important to learn about this in a session on art of asking questions because medical emergency is excluding listen to this carefully by the time by the time the person comes and sits before you there is already a story they have built a story however because everybody is under pressure and time is limited they only give you highlights of the story and might begin at different parts of the story as clinicians and healthcare professionals it is important for us to through the art of asking right questions request people to tell us the story in the chronological order can you begin at the beginning and tell me all about it our duty is to encourage them to tell their story that is very important for us some of you those who are attending the session today or either you or your family member may be nursing a problem they might have sprained their ankle or a knee or they may have a cold or a cough or a headache they might have consulted you or other family members and they are taking over the count of medication however they have not yet consulted the doctor officially they have sensed they have perceived that there is a problem and they are already taking some treatment when would you or they go and consult a doctor when it doesn't get better so when they go to a doctor it's important for them to learn everything that they have done so far and for how long they've been sitting on that problem so a a clinician who allows patient to share that story their journey they establish a better rapport with the patients our questions should help us discover the story the person has constructed during the course of the illness as they attempted to work out what might be wrong with them and what they've been doing to get better the question should unravel the story layer by layer i hope i made myself clear if anybody has got an experience to share that they are nursing a problem and they haven't yet consulted um a doctor then that might help others to understand this concept better is there anybody who is nursing a problem now like a like a sprained ankle or a knee or a headache anybody no okay so we have started the the presentation oh hari priya are you willing to share are you willing to share it will really help everybody to appreciate the concept better because this is crucial if you are you can raise your hand if not we understand can you say yes or no in the comments section that helps us to move on no sir okay uh we understand hillary but i hope you understood the the concept okay so moving on um do we have that slide fatima responsibilities of the questionnaire oh yes once again so those who have participated in the task on menti meta thank you uh we are grateful uh this these are your responses uh so we just have this slide as well yes it's still loading this uh okay so audience are you able to view the slide if you are able to view the slide shout out some of the responsibilities that you have answered what i wonder are the responsibilities of the questionnaire why is it uh still learning abina what are the responsibilities it's still loading for them understanding yes sheikha understanding curiosity oh very well said anisha i wonder what do you mean by curiosity curious attitude if you want to learn more about curiosity you may want to read or watch matilda situational awareness yes good point making them trusters how can you make them trust us to get more be patient it's still loading for them be patient to listen to their problem yes patience is very important valid questions valid questions i wonder what do you mean by valid question how do you know a question is valid oh here we go do not perceive anything or maybe they meant assume anything oh make it simple whoever put that thing there very good keeping it simple non-judgmental is a good point everything is a good point uh subjective okay politeness eye to eye contact empathetic looks like um this slide explains it all no i am able to view okay not blaming the patient for his problems or the idea yes that's a good point shaker yes okay you can you can upload my original presentation for them thank you for sharing your your thoughts on that for that question if you're consciously aware of the responsibilities then it makes your life very easier actually these are some of the other responsibilities which you have shade attentive curious everything calming the patient yes all these are important okay so mindful of the time now that's the science of it now let me give you some concrete things to take away so that you can actually put these things into practice however i really need your help here people this is for you so shout out as many responses as you can whenever possible ask before telling the patient so when you are discussing serious news or when you're breaking bad news or if you have just informed patient that they have got cancer they might at certain point in the consultation they might ask what's my prognosis i wonder how would you answer that question or what else you need to know how can you put this principle into action and what would be your follow-up question when or response when a patient asks you what's my prognosis so you've just informed patient that they have got lung cancer and after one or two exchanges the patient asks what's my prognosis i wonder what do you ask what do you what do you want to ask what would be a good follow-up question come on people put them in the comment section there is no right or wrong answer try it so what do you want to ask that person an experienced oncologist might be able to give an estimate prognosis so yeah what's your understanding of the disease okay anymore try try with y try with y what do you no no don't ask what do you think try with y prognosis that's a good point in terms of expectancy functionality yes that's a good point but what question okay being mindful of the time oh yeah oh yeah who asked that question why do you ask why do you ask why do you ask this no what do you ask what's the difference between the two ways which i've asked the question what do you ask what do you ask if you ask that question then they might share their story they will share their their worries their concerns they might say i really want to know i want to put my business in order i need to know how long i've got so that i can plan things yes very important am i dying people are do ask these questions i wonder why are you asking this question i'm curious to know so everybody you me every one of us we are building our own story we've got so many plans for our future when suddenly a something threatening comes our way we would like to know because we need to plan for the remaining future that is left people maybe want to see their kids graduating or kids getting married or they want to finish their studies and there are many stories you need to they will share their story with you when they ask you a challenging question are you sure about the diagnosis doctor maybe it's it's the fear it's the concern that is making them ask the question not that they are challenging you so you need to be calm you need to really be empathetic and ask a good follow-up question based on information that i have i'm confident although i'm i'm curious to know why you are why did why did you ask that question or why are you asking that question they might say are you sure you only did one test or you only did three tests do i need to have more tests do i need to see a specialist to confirm the diagnosis can you see they really want to be absolutely certain that's the first point people whenever possible when you are asked these challenging questions there is a story behind those questions or statements you need to learn about it so ask a an open question be curious and empathetic be mindful ask one question at a time as concisely as possible why is this important why is this important remember we are learning about how to discuss serious news how to break bad news it's an emotional and sensitive situation during that time it is very important to ask one question at a time why is that important to ask one question at a time anybody willing to share their response yes why some of you may have learned about this based on the cognitive psychologist a pioneering researcher mr george miller back in 1956 he said 7 plus or minus 2 that's how many elements of information that we can hold in our conscious mind in our active memory at a given time when you have shared a sensitive and emotional information with patients all their thoughts their mind is full of emotions their thoughts are about emotion their thoughts are about the diagnosis that jeff just heard yes snowflake picture very good if you ask complicated questions and more than one question there isn't any space in their mind at that moment to take him it's hand therefore being mindful that that may be happening in their mind it's we need to it is our responsibility it is our responsibility to ask one question at a time and using simple words and phrasing the question as concisely as possible very good somalia you that's exactly it you said it observe your role models observe your senior clinicians to see how they are navigating through these challenging conversations how many questions they are asking at any given time and what type of questions they are using what words they are using very important very important yes but it does help if you ask one question very clearly it does help the patient and they are with you and they also perceive that you really care you know you're attentive to their needs and you you're allowing time for them to process adjust the difficulty of questions to the patient's ability you as clinicians they come across people of all ages all cultures varying intellectual abilities some may have learning disabilities some may have difficulty in processing information so here intentional presence comes into play so how how closely are you reading the patient what do you know about the patient if if an elderly patient comes to you how to ask how do you change the way you ask the question if the patient with mild cognitive impairment comes to see you would you ask the same question which you asked a 40 year old previously or would you rephrase the question or would you change the question they request you to closely read the person in front of you to be intentionally present and modify and change the questions accordingly if you are using medical jargon in your questions if you are seeing a patient who does not know english then you need to be mindful of replacing all the jargon with the words the person understand if you're practicing in abroad like uk or us you may at times have to use interpreter to get the question right include questions that help patients explore their attitudes beliefs and feelings like some of you said at the beginning it's not only about the physical part of the illness the science of it it's also the psychological the social element of it as well and we all perceive the world differently we all have different beliefs and opinions and feelings we all are conditioned by the culture in which we are growing or have grown so it's very important to take that into consideration hence our responsibility like you said to be open to be empathetic to be attentive to be curious very important okay so we have covered this question this this principle quite a lot earlier on when i'm talking about open questions when you're asking an open question please wait see if i ask if i ask like i've asked you do you like this session yes or no what do you like about this session is an open question where you need more time similarly when you are talking to patient uh do you have pain yes or no can you tell me more about the pain they need time okay and also do you take medication yes or no what are the medication they might list how long have you been taking this medication they might need more time have you experienced any side effects from these medications during the period you've been taking the medication again they may want to go back and recollect so they might need more time so so as a questioner we need to be aware of the type of question we are asking and allow enough time accordingly hence people hence it is very important to put aside time when consulting with patients or when you are discussing serious news or when you are breaking bad news you can't rush those consultations it is our responsibility to make sure that you have put aside enough time when you are talking when you are sharing or discussing such news with the patient okay try being neutral when responding so if i say oh do you like this session if i if i if you say yes oh lovely so i'm already communicating uh my judgment with you if you say no what do you what do you like about this session again am i being neutral no so you can see from my verbal and non-verbal responses that either have become defensive or um i'm liking because you said you you you liked the session so instead i should be neutral have you liked are you liking these sessions yes or no if you say yes i should be neutral and say oh i'm curious to know what is that in particular you are enjoying about this session if you say no i sh i should still be neutral and say oh i'm curious to know what is that you're not appreciative of your feedback is very important for us so being neutral would allow that person to share their views if you say no and say what why don't you like my sessions what what is that you don't like then you might stay silent or you might not share what you really want to share i hope made myself clear on that point so be have an open attitude have an attentive attitude and be neutral all everything that we have covered so far can be summarized into this one slide that's the key it's the key slide represented by a key which is what are you attending to okay what do i know about this patient what is their level of engagement in the case like what is are they are they enjoying uh are they engaging in the conversation are they understanding my cause my my questions or should i rephrase my questions what are you attending to are you attending to their emotions to their clinical symptoms only your combination how you ask your questions is very important and what you ask only close questions or a mix of open and closed questions if you are asking closed questions are you then exploring further by asking your follow-up open question how you be is also very important in in consultations that's the behavior and how much time you're posing in between questions when you ask are you are you allowing enough time after you ask the question for the patient to think and respond or are you moving quickly because because of the time constraints this is my framework i use it quite a lot i request my trainees to use it quite a lot which is a conversation starter could be anything where is the weather how are you feeling nice day isn't it you know that's a conversation starter just to ease the patient focus and you might also ask what brings you here today and then they might say headache you may then ask can you tell me more about it i want to learn more about it begin at the beginning tell me all about it and then comes four elements quantification qualification explore and clarification this is it people this is the grid for you okay we learn by observing apprenticeship model seems to be the dominant mode of learning so when you are observing your role models your senior clinicians physician surgeons see how they are quantifying what questions they are asking to quantify the problem what is your chest pain can you tell me from 1 to 10 one being no pain 10 being severe or how is that affecting your day-to-day quality of life is it limiting your ability to go for a walk or two things the two ways you can quantify when patient presence with breathlessness how quickly the experienced clinicians are qualifying that problem into different systems yes command and subject knowledge is important but because of the limited time you should be able to ask right questions at the right time in the right way to qualify the problem into systems so breathlessness is a shade symptom respiratory cardiovascular hemological anemia can cause breathlessness so how can you qualify quickly so what are remember the clinical iceberg they have come to you today i'm sure they've been sitting on it for a few days if not few weeks why have they come today what are their worries what did they think that they have got or what are the what are they thinking now that they have got what what is that they they are expecting from you diagnosis statement or what investigations what is it and if the pay if the person is using jargon themselves i feel dizzy doctor i have headache tell me what what do you mean by headache what do you mean by disease can you tell me more about that what does that word mean to you when they're using vague words it's our responsibility to ask for clarification otherwise the meaning which we attribute to dizziness may be different to the meaning which they have attributed to dizziness so use this grid when you are observing others consulting with patients and also when if you are in a position that where juniors are observing you encourage them ask them to have this great grid as a framework and request them to observe how you are asking questions so that you can educate your colleagues and juniors so you are learning your practicing and your responsibilities to educate others as well okay let's get that one so this is very interesting people everybody asks why do we have to learn about communication skills what is there you know we get better isn't it what do you need to learn about all these things uh anybody who is on stage fatima how much what is 11 times 26 remember you have limited time in your clinical setting you see you don't have much time what is 11 times 26 anybody people anybody 286 how did you get that miracle 286 what is 11 times 34 what is 11 times 34 what is 11 times 35 what is 11 times 23 can you see there is a lag between me asking the question and you what if i say there are certain things that you could use to answer this question all you have to do is add 2 plus 6 and put that number in between so 2 plus 6 is what fatima what is it your you can't hear you yeah 8 yeah put that in between two and six so separate two on six put eight in between so what is eleven times what is eleven times thirty six uh nine two nine six three nine six thirty six three yeah what is 11 times 34 one second thirty four three eight and four three seven four three three seven four so very easy isn't it that's why people we have medical educators like us we have worked out those tricks for you that you can use in time constrained consultations yeah so that's why it's very important for you to practice these things i wonder what is 11 times answer this question people what is 11 times 26 so you onset 11 times 26 has 286 what is 75 times 11 what is 75 what is 11 times 75 what is 11 times 75 go ahead that principle doesn't work is it raj yeah pierce yeah the one which i've just shared yeah 11 times 25 principle doesn't work if you use that principle the answer you get is love 7 1 2 five so what is the little trick that you could do i will cover that in the next session that's the advanced okay so the point which i'm making is yes you can learn communication by observing by experience but you will be doing the same thing again and again you need effective ways of communicating you need efficient ways of communicating in the time constraint consultation so hence you need evidence-based strategies safeguards skills that you could integrate see how easy it is 11 times 26 is 286 wonderful thank you for listening and participating so i would this is a polite request you will get your certificates in irrespective of whether you do this task or not i want all of you one or two to come on stage five minutes will complete the session i promise five minutes i want you please spend 30 seconds what is that one inside that you have learned and what is your closing commitment from this session what is your closing commitment what is that you promised to yourself that you would do after this session please share that in your comment section can can you let one or two people onto the stage please sir uh dear doctors please come on stage by uh touching on the race and teacher it would help you know it gives me energy and boost to do more for you anybody willing to come on stage one last time and to share a couple of points and please type what is that one inside what is your closing commitment to yourself please but you're going to you can also drop it in the comment box thank you on you can do it you know it's easy you know come on stage fatima has been doing it and you're doing it your colleagues have been doing it who wants to come what is that one inside and one closing commitment thank you for your comment thank you anybody wants to join us okay go ahead so i'm very happy to you know do this learning with you today and uh it's just made me feel happy because this is already what i'm practicing so listening to my patient giving them more time yes and so i feel good that whatever i'm doing you have uh you know helped me my belief that i am yes you validated it thank you validated yes and and the commitment that i do to myself and with your learning is i'll continue to practice it and be more patient and because i believe that when a patient speaks to a doctor 90 percent they say 90 percent but i believe 70 to 80 percent their illness is gone yes by just speaking to the doctor so if we can be patient and good listeners i think we can help them much more so this is what i will do and thank you very much thank you bobby although you've been you now that you you could say that this is all i'm doing maybe this session has also given you some things that you could educate others can't you yeah yes yes definitely sir thank you okay thank you bobby anybody please you got three more minutes thank you dr bobby one inside um doctors anyone else bobby made our day anybody wonderful insights dr bobby uh do you do you bite i don't mind do you maybe they are scared of you fatima maybe they should disappear let me try that okay akash yes thank you it's good good comments coming through um yes okay anybody she's she's gone off stage so now she's come back okay please people couple more we would love to hear your insights dear doctors anyone willing to come and see it yes being a medical student final year i go to wards and i observed that after attending your this three four sessions there is a much more improvement in taking history and today's closing commitment is that i will be very aware of and i will be mindful of open closed and leading questions while taking the history from the patients in the wards yes oh wonderful well done keep a journal document everything you are practicing ajay wonderful so one more one more who can come on stage please your doctor accepting your request doctors please turn on your audio and video go ahead go ahead good evening sir and good evening good evening it's a very a wonderful encouragement session that we really enjoyed and we have learned as a learn so many things from your session because it's inside and outside both you have covered so how we can first go appreciate ourselves with the insight by taking the motivational interview for from our patient because i am a physiotherapist so i am a healer so i have to first ask the patient history so it is the motivational interview is the demand of that particular scenario so that the patient can openly they can explain their pain so where we start with the central senses sensitization by taking the history so that the patient feel comfortable then we move towards the closed questions that that related to their pain or their surroundings or their background so as you have explained so many things you have added in that how we can openly talk to the patient with the patients so it is a very good thing which you have explained us and i will say that after your session the one thing is very clear to me that um listening is really a learning platform when we are listen so it's also art to listen the person who wants to speak but sometimes uh people cut them in between their talk but as a medical profession we have to be a good listener so that we can listen our patient pain so it's a really wonderful session i really enjoyed and i have learned so many things so thank you so much sir thank you so much thank you bring all your colleagues to these sessions going forwards yeah yes definitely i will do thank you sir okay okay dr anisha wants to come on stage yeah doctors i have accepted your request uh dr anisha i've accepted your request could you turn on your audio video please yeah thank you so it was a really a great session uh i like took this type of session back in 2020 and then when i went into practice and so now today's session was like knowledge plus the experience of like practicing with the patients so now the difference when uh i'm i listen to the same principles again but then now i can relate a lot better than before so that aside from the session and also while discussing like when when i was having a consultation so there are a lot of factors uh which comes together like it is not only about question it is about a lot of things together in just 15 minutes but then we dissect them and think about the small small principles ultimately at the end of the day the small principles make a change so basically going forward what my commitment will be to respond to the questions in a better way than i'm doing currently i think i definitely need improvement somewhere there and that will be going forward thank you yeah hence it is called learning ing it's an ongoing process thank you anishin so we'll hear from muhammad and we'll close the session thank you dr anisha dr mantha could you please turn on your audio in video good evening i've been listening to your sessions since long they're definitely inspiring and i have been practicing in a similar way since long i'm a family physician and it has helped me a lot because with time there were patients uh coming to me flowing to me with the confidence saying that you were the one who is comforting others in the rest of the hospitals they were always feared and given uh different types of diagnosis and they were made to they were not comforted and this my basically my nature is i'm a very patient listener so that has helped me throughout my practice and the leading questions what you are talking about uh i think those things should definitely be taken into consideration because sometimes uh in hastiness many physicians ask leading questions and the patient is unable to put up his own history so i think uh that has it also has helped me a lot and thank you so much sir i have uh uh wish to see some more sessions on this on the practical uh approach thank you so much sir thank you thank you i'm glad to learn that you're making a difference while listening wonderful okay people uh thank you for your active participation as always keep that energy coming um on you know in in the future sessions as well there are many more i think we should thank netflix for uh providing this opportunity and giving a space on their lovely platform to share different perspectives and we're delighted that they are doing it and we need you of course me and fatima can you can talk forever but we need audience without you uh our presentations stay in the vacuum so we need you to come to learn and to practice and learn more and of course give us feedback and say what more you want to learn what type of sessions you want to see okay and please follow us on our instagram page it's full of educational material thank you oh yeah and at the physiotherapist i forgot the name already what's it done they're already yes they've already said about it motivational interviewing so reflective listening is a part of it which is very essential when dealing with sensitive and emotional situations all the best thank you so much uh dr krishna this was wonderful as usual looking forward to the next one and uh we have another raised hand requester okay we have time for that quick question getting you on stage and um so you're going to come up with a new word fatima the doctors clinicians of the health care professionals i liked what dr jutu said healers it stuck with me yes okay yes yes next one oh yeah thank you yeah sorry there is some there is some network problem okay so thank you very much it's a great session for me and we know that uh some patients have a different type of mindset and and they are very shy and to know about their history is very difficult being for diagnose so it's a very great session not only for me but so but also all for the person all students all professionals okay akash we are grateful uh the technology is not uh favoring you maybe it's time to go to bed sixth sense is saying you need to take some rest um wonderful thank you yeah thank you dr akash we will look forward to seeing you in the next one as well bye sir good night

BEING ATTENDED BY

Dr. Sandip Singh & 1446 others

SPEAKERS

dr. Krishna Naineni

Dr. Krishna Naineni

Director & Co-Founder of Glocal Academy | Member of International Listening Association (ILA) | Member of Royal College of General Practitioners since 2011 and a training faculty at The Brighton and S...

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dr. Krishna Naineni

Dr. Krishna Naineni

Director & Co-Founder of Glocal Academy | Mem...

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