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\levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext\'01\u-3913 ?;}{\levelnumbers;}\f3\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li2880\jclisttab\tx2880 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0 \levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext\'01o;}{\levelnumbers;}\f2\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li3600\jclisttab\tx3600 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0 \levelstartat1\levelspace0\levelindent0{\leveltext\'01\u-3929 ?;}{\levelnumbers;}\f14\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li4320\jclisttab\tx4320 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0 \levelstartat1\levelspace0\levelindent0{\leveltext\'01\u-3913 ?;}{\levelnumbers;}\f3\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li5040\jclisttab\tx5040 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0 \levelstartat1\levelspace0\levelindent0{\leveltext\'01o;}{\levelnumbers;}\f2\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li5760\jclisttab\tx5760 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1 \levelspace0\levelindent0{\leveltext\'01\u-3929 ?;}{\levelnumbers;}\f14\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li6480\jclisttab\tx6480 }{\listname ;}\listid1688821939}{\list\listtemplateid1210472170\listhybrid{\listlevel \levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace72\levelindent0{\leveltext\leveltemplateid-1347925626\'01\u-3913 ?;}{\levelnumbers;}\f3\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li1080 \jclisttab\tx1080 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace72\levelindent0{\leveltext\leveltemplateid-461087466\'01o;}{\levelnumbers;}\f2\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li2088\jclisttab\tx2088 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace72\levelindent0{\leveltext\leveltemplateid-1734292368\'01\u-3929 ?;}{\levelnumbers;}\f14\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li2808\jclisttab\tx2808 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace72\levelindent0{\leveltext\leveltemplateid-2132522900\'01\u-3913 ?;}{\levelnumbers;}\f3\chbrdr \brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li3528\jclisttab\tx3528 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace72\levelindent0{\leveltext\leveltemplateid-956009190\'01o;}{\levelnumbers;}\f2 \chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li4248\jclisttab\tx4248 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace72\levelindent0{\leveltext\leveltemplateid-635774730 \'01\u-3929 ?;}{\levelnumbers;}\f14\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li4968\jclisttab\tx4968 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace72\levelindent0{\leveltext \leveltemplateid-205389028\'01\u-3913 ?;}{\levelnumbers;}\f3\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li5688\jclisttab\tx5688 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace72 \levelindent0{\leveltext\leveltemplateid-1898798114\'01o;}{\levelnumbers;}\f2\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li6408\jclisttab\tx6408 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1 \levelspace72\levelindent0{\leveltext\leveltemplateid275918782\'01\u-3929 ?;}{\levelnumbers;}\f14\chbrdr\brdrnone\brdrcf1 \chshdng0\chcfpat1\chcbpat1\fbias0 \fi-360\li7128\jclisttab\tx7128 }{\listname ;}\listid2041584169}}{\*\listoverridetable {\listoverride\listid1188250149\listoverridecount0\ls1}{\listoverride\listid1619793224\listoverridecount0\ls2}{\listoverride\listid1688821939\listoverridecount0\ls3}{\listoverride\listid637226377\listoverridecount0\ls4}{\listoverride\listid235864789 \listoverridecount0\ls5}{\listoverride\listid1502545495\listoverridecount0\ls6}{\listoverride\listid278463391\listoverridecount0\ls7}{\listoverride\listid2041584169\listoverridecount0\ls8}}{\*\revtbl {Unknown;}{Suzanne Kurtz;}}{\info {\title CALGARY - CAMBRIDGE OBSERVATION GUIDE TO THE CONSULTATION }{\author Jonathan Silverman}{\operator Peter Draper}{\creatim\yr2003\mo5\dy23\hr18\min25}{\revtim\yr2003\mo5\dy23\hr18\min25}{\printim\yr2002\mo9\dy18\hr19\min5}{\version2}{\edmins0} {\nofpages4}{\nofwords1367}{\nofchars7792}{\nofcharsws0}{\vern8247}}\paperw11880\paperh16800\margl562\margr562\margt432\margb792 \widowctrl\ftnbj\aendnotes\hyphhotz0\ftnnrlc\aftnnar\sprstsp\otblrul\brkfrm\noxlattoyen\expshrtn\noultrlspc\dntblnsbdb\sprstsm\truncex\nolead\nospaceforul\msmcap\lytprtmet\hyphcaps0\horzdoc\dghspace120\dgvspace120\dghorigin1701\dgvorigin1984\dghshow1 \dgvshow0\jexpand\viewkind1\viewscale75\pgbrdrhead\pgbrdrfoot\bdrrlswsix\nolnhtadjtbl \fet0\sectd \psz9\sbknone\linex0\headery706\footery706\linebetcol\colno1\colw10756\sectdefaultcl {\*\pnseclvl1\pnucrm\pnstart1\pnindent720\pnhang{\pntxta .}} {\*\pnseclvl2\pnucltr\pnstart1\pnindent720\pnhang{\pntxta .}}{\*\pnseclvl3\pndec\pnstart1\pnindent720\pnhang{\pntxta .}}{\*\pnseclvl4\pnlcltr\pnstart1\pnindent720\pnhang{\pntxta )}}{\*\pnseclvl5\pndec\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}} {\*\pnseclvl6\pnlcltr\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl8\pnlcltr\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl9 \pnlcrm\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}\pard\plain \qc \li0\ri15\nowidctlpar \tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\rin15\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 { \b\f0\fs20 CALGARY - CAMBRIDGE GUIDE TO THE}{\b\caps\f0\fs20 medical interview \endash Communication process \par }\pard \ql \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\rin15\lin0\itap0 {\b\f0\fs18 {\pict{\*\picprop\shplid1025{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn fillColor}{\sv 8421504}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn alignHR}{\sv 1}}{\sp{\sn dxHeightHR}{\sv 30}} {\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fStandardHR}{\sv 1}}{\sp{\sn fHorizRule}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}\picscalex563\picscaley6\piccropl0\piccropr0\piccropt0\piccropb0 \picw1764\pich882\picwgoal1000\pichgoal500\wmetafile8\bliptag979344143\blipupi1439{\*\blipuid 3a5f9b0f7d4c0de404d567749d32d10a}010009000003310000000000070000000000050000000b0200000000050000000c02f401e803070000001b04f401e80300000000050000001402000000000500 00001302f401e803050000001402f40100000500000013020000e8030300000000000000}}{\b\f0\fs20 \par }\pard \qc \li0\ri14\sl120\slmult1\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\rin14\lin0\itap0 {\b\f0\fs18 \sect }\sectd \marglsxn576\margrsxn576\margtsxn864\margbsxn864\sbknone\headery0\footery0\cols2\linebetcol\colno1\colw5994\colsr720\colno2\colw4014\sectdefaultcl \pard\plain \s4\ql \li0\ri0\keepn\widctlpar\nooverflow\faroman\outlinelevel3\rin0\lin0\itap0 \b\caps\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {INITIATING THE SESSION}{\revised\revauth1\revdttm-2039913467 \par }\pard\plain \ql \li0\ri0\widctlpar\nooverflow\faroman\ql \li0\ri0\widctlpar\nooverflow\faroman\pnrauth1\pnrdate-2039913467\pnrnot1\rin0\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 { \par }\pard\plain \s1\ql \li0\ri15\keepn\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\outlinelevel0\rin15\lin0\itap0 \b\caps\f4\fs18\ul\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\caps0\f0 Establishing initial rapport \par }\pard\plain \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs18 1. }{\b\f0\fs18 Greets}{\f0\fs18 patient and obtains patient\rquote s name \par }{\f0\fs16 \par }{\f0\fs18 2. }{\b\f0\fs18 Introduces}{\f0\fs18 self, role and nature of interview; obtains consent if necessary \par }{\f0\fs16 \par }{\f0\fs18 3. }{\b\f0\fs18 Demonstrates}{\f0\fs18 }{\b\f0\fs18 respect }{\f0\fs18 and interest, attends to patient\rquote s physical comfort \par }{\f0\fs16 \par \par }{\b\f0\fs18\ul Identifying the reason(s) for the consultation \par }\pard\plain \s18\qj \li0\ri-45\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx7920\nooverflow\faroman\rin-45\lin0\itap0 \fs18\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {4. }{\b Identifies}{ the patient\rquote s problems or the issues that the patient wishes to address with appropriate }{\b opening question}{ (e.g. \'93What problems brought you to the hospital?\'94 or \'93What would you like to discuss today?\'94 or \'93 What questions did you hope to get answered today?\'94) \par }\pard\plain \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs16 \par }{\f0\fs18 5. }{\b\f0\fs18 Listens}{\f0\fs18 attentively to the patient\rquote s opening statement, without interrupting or directing patient\rquote s response \par }{\f0\fs16 \par }{\f0\fs18 6. }{\b\f0\fs18\crauth1\crdate-2039913465 Confirms list and}{\f0\fs18 }{\b\f0\fs18 screens}{\f0\fs18 for further problems (e.g. \'93so that\rquote s headaches and tiredness; anything else\'85\'85?\'94) \par }{\f0\fs16 \par }{\f0\fs18 7. }{\b\f0\fs18 Negotiates agenda}{\f0\fs18 taking both patient\rquote s and physician\rquote s needs into account \par }{\f0\fs16 \par }\pard \ql \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 {\b\f0\fs18 {\pict{\*\picprop\shplid1026{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn fillColor}{\sv 8421504}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn alignHR}{\sv 1}}{\sp{\sn dxHeightHR}{\sv 30}} {\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fStandardHR}{\sv 1}}{\sp{\sn fHorizRule}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}\picscalex563\picscaley6\piccropl0\piccropr0\piccropt0\piccropb0 \picw1764\pich882\picwgoal1000\pichgoal500\wmetafile8\bliptag-590881912\blipupi1439{\*\blipuid dcc7db888cbf76a6040ff6e85880c52e} 010009000003310000000000070000000000050000000b0200000000050000000c02f401e803070000001b04f401e8030000000005000000140200000000050000001302f401e803050000001402f40100000500000013020000e8030300000000003200}}{\b\f0\fs18\ul \par }\pard\plain \s5\ql \li0\ri15\keepn\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\outlinelevel4\rin15\lin0\itap0 \b\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {GATHERING INFORMATION \par }\pard\plain \ql \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs18 \par }\pard\plain \s3\qj \li0\ri15\keepn\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\outlinelevel2\rin15\lin0\itap0 \b\fs18\ul\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Exploration of patient\rquote s problems \par }\pard\plain \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs18 8. }{\b\f0\fs18\crauth1\crdate-2039913466 Encourages patient to}{\f0\fs18 }{\b\f0\fs18 tell the story}{\f0\fs18 of the problem(s) from when first started to the present in own words (clarifying reason for presenting now) \par }{\f0\fs16 \par }\pard\plain \s19\qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 \fs18\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {9. }{\b\crauth1\crdate-2039913465 Uses }{\b open and closed questioning technique}{, appropriately moving from open to closed \par }\pard\plain \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs16 \par }\pard\plain \s19\qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\rin15\lin0\itap0 \fs18\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {10. }{\b Listens}{ attentively, allowing patient to complete statements without interruption and leaving space for patient to think before answering or go on after pausing \par }\pard\plain \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs16 \par }\pard\plain \s19\qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\rin15\lin0\itap0 \fs18\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {11. }{\b Facilitates}{ patient's responses verbally and non\endash verbally e.g. use of encouragement, silence, repetition, paraphrasing, interpretation \par }\pard\plain \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs16 \par }\pard \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\rin15\lin0\itap0 {\f0\fs18 12. }{ \b\f0\fs18\crauth1\crdate-2039913465 Picks up }{\f0\fs18 verbal and non\endash verbal }{\b\f0\fs18 cues}{\f0\fs18 (body language, speech, facial expression, affect); }{\b\f0\fs18\crauth1\crdate-2039913465 checks out and acknowledges}{\f0\fs18 as appropriate \par }\pard \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 {\f0\fs16 \par }{\f0\fs18 13.}{\b\f0\fs18 Clarifies}{\f0\fs18 patient\rquote s statements that are unclear or need amplification (e.g. \'93Could you explain what you mean by light headed") \par \par 14. }{\b\f0\fs18 Periodically summarises}{\f0\fs18 to verify own understanding of what the patient has said; invites patient to correct interpretation or provide further information. \par \par 15. }{\b\f0\fs18\crauth1\crdate-2039913464 Uses }{\f0\fs18\crauth1\crdate-2039913464 concise,}{\b\f0\fs18\crauth1\crdate-2039913464 easily understood}{\f0\fs18 }{\b\f0\fs18 questions and comments}{\f0\fs18 , avoids or adequately explains jargon \par \par 16. }{\deleted\f0\fs18\revauthdel1\revdttmdel-2039913467 -}{\b\f0\fs18\crauth1\crdate-2039913467 Establishes dates}{\f0\fs18 }{\b\f0\fs18\crauth1\crdate-2039913466 and}{\f0\fs18 }{\b\f0\fs18\crauth1\crdate-2039913466 sequence}{\f0\fs18 of events \par }{\f0\fs16 \par \par }{\b\f0\fs18\ul Additional skills for understanding the patient\rquote s perspective \par }\pard \ql \li0\ri-45\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx7920\nooverflow\faroman\rin-45\lin0\itap0 {\f0\fs18 17. Actively }{\b\f0\fs18 determines and appropriately explores}{\f0\fs18 : \par {\listtext\pard\plain\s17 \f3\fs18\lang2057\langfe1033\langnp2057 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \s17\ql \fi-360\li1080\ri-45\nowidctlpar \jclisttab\tx1080\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx7920\nooverflow\faroman\ls8\rin-45\lin1080\itap0 \fs18\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {patient\rquote s }{\b ideas}{ (i.e. beliefs re cause) \par {\listtext\pard\plain\s17 \f3\fs18\lang2057\langfe1033\langnp2057 \loch\af3\dbch\af0\hich\f3 \'b7\tab}patient\rquote s }{\b concerns}{ (i.e. worries) regarding each problem \par {\listtext\pard\plain\f3\fs18\lang2057\langfe1033\langnp2057 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \qj \fi-360\li1080\ri15\nowidctlpar \jclisttab\tx1080\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\ls8\rin15\lin1080\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs18 patient\rquote s }{\b\f0\fs18 expectations }{\f0\fs18 (i.e., goals, what help the patient had expected for each problem) \par {\listtext\pard\plain\f3\fs18\lang2057\langfe1033\langnp2057 \loch\af3\dbch\af0\hich\f3 \'b7\tab}effects: how each problem }{\b\f0\fs18 affects}{\f0\fs18 the patient\rquote s life \par }\pard \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\rin15\lin0\itap0 {\f0\fs18 \par 18. }{\b\f0\fs18 Encourages patient to express feelings }{\f0\fs18 \par }{\f0\fs18 {\pict{\*\picprop\shplid1027{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn fillColor}{\sv 8421504}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn alignHR}{\sv 1}}{\sp{\sn dxHeightHR}{\sv 30}} {\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fStandardHR}{\sv 1}}{\sp{\sn fHorizRule}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}\picscalex401\picscaley6\piccropl0\piccropr0\piccropt0\piccropb0 \picw1764\pich882\picwgoal1000\pichgoal500\wmetafile8\bliptag-590881912\blipupi1439{\*\blipuid dcc7db888cbf76a6040ff6e85880c52e} 010009000003310000000000070000000000050000000b0200000000050000000c02f401e803070000001b04f401e8030000000005000000140200000000050000001302f401e803050000001402f40100000500000013020000e8030300000000003200}}{\f0\fs18 \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \page \par }\pard\plain \s1\ql \li0\ri15\keepn\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\outlinelevel0\rin15\lin0\itap0 \b\caps\f4\fs18\ul\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs20\ulnone Providing structure \par }\pard\plain \ql \li0\ri0\widctlpar\tx3330\nooverflow\faroman\rin0\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs4 \par }\pard\plain \s3\qj \li0\ri15\keepn\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\outlinelevel2\rin15\lin0\itap0 \b\fs18\ul\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Making organisation overt}{\v\fs14\cf17 \par }\pard\plain \ql \li0\ri0\widctlpar\nooverflow\faroman\rin0\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\v\cf18 \par }\pard \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 {\f0\fs18 \par 19. }{\b\f0\fs18 Summarises}{\f0\fs18 at the end of a specific line of inquiry to confirm understanding before moving on to the next section \par }{\f0\fs16 \par }{\f0\fs18 20. Progresses from one section to another using }{\b\f0\fs18 signposting}{\b\f0\fs18\revised\revauth1\revdttm-2039913463 , transitional statements}{\f0\fs18 ; includes rationale for next section \par \par }\pard\plain \s3\qj \li0\ri15\keepn\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\outlinelevel2\rin15\lin0\itap0 \b\fs18\ul\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Attending to flow \par }\pard\plain \ql \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs18 21. Structures interview in }{\b\f0\fs18\crauth1\crdate-2039913464 logical }{\b\f0\fs18 sequence}{\f0\fs18 \par }\pard \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 {\f0\fs16 \par }{\f0\fs18 22. Attends to }{\b\f0\fs18 timing}{\f0\fs18 and keeping interview on task \par \par \par }{\f0\fs18 {\pict{\*\picprop\shplid1028{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn fillColor}{\sv 8421504}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn alignHR}{\sv 1}}{\sp{\sn dxHeightHR}{\sv 30}} {\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fStandardHR}{\sv 1}}{\sp{\sn fHorizRule}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}\picscalex401\picscaley6\piccropl0\piccropr0\piccropt0\piccropb0 \picw1764\pich882\picwgoal1000\pichgoal500\wmetafile8\bliptag-590881912\blipupi1439{\*\blipuid dcc7db888cbf76a6040ff6e85880c52e} 010009000003310000000000070000000000050000000b0200000000050000000c02f401e803070000001b04f401e8030000000005000000140200000000050000001302f401e803050000001402f40100000500000013020000e8030300000000003200}}{\f0\fs18 \par }\pard\plain \s1\ql \li0\ri15\keepn\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\outlinelevel0\rin15\lin0\itap0 \b\caps\f4\fs18\ul\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\caps0\f0\fs20\ulnone BUILDING RELATIONSHIP \par }\pard\plain \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs16 \par }\pard \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\rin15\lin0\itap0 {\b\f0\fs18\ul Using appropriate non-verbal behaviour \par }{\f0\fs18 23. }{\b\f0\fs18\crauth1\crdate-2039913462 Demonstrates appropriate}{\f0\fs18 }{\b\f0\fs18 non\endash verbal behaviour \par {\listtext\pard\plain\f3\fs18\lang2057\langfe1033\langnp2057 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \qj \fi-360\li1080\ri15\nowidctlpar \jclisttab\tx1080\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\ls6\rin15\lin1080\itap0 {\f0\fs18 eye contact, facial expression \par {\listtext\pard\plain\f3\fs18\lang2057\langfe1033\langnp2057 \loch\af3\dbch\af0\hich\f3 \'b7\tab}posture, position & movement \par {\listtext\pard\plain\f3\fs18\lang2057\langfe1033\langnp2057 \loch\af3\dbch\af0\hich\f3 \'b7\tab}vocal cues e.g. rate, volume, tone}{\b\f0\fs18 }{\f0\fs18 \par }\pard \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 {\f0\fs16 \par }\pard \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\rin15\lin0\itap0 {\f0\fs18 24. If reads, writes }{\b\f0\fs18 notes}{\f0\fs18 or uses computer, does }{\b\f0\fs18\crauth1\crdate-2039913462 in a manner that does not interfere with dialogue or rapport \par }{\f0\fs18 \par 25. }{\b\f0\fs18\crauth1\crdate-2039913462 Demonstrates}{\f0\fs18 appropriate }{\b\f0\fs18\crauth1\crdate-2039913462 confidence}{\f0\fs18 \par }\pard \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 {\f0\fs16 \par \par }\pard\plain \s3\qj \li0\ri15\keepn\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\outlinelevel2\rin15\lin0\itap0 \b\fs18\ul\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Developing rapport \par }\pard\plain \qj \li0\ri0\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\rin0\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs18 26.}{\b\f0\fs18 Accepts}{\f0\fs18 legitimacy of patient\rquote s views and feelings; is not judgmental}{\f0 \par }\pard \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 {\f0\fs16 \par }\pard \qj \li0\ri0\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\rin0\lin0\itap0 {\f0\fs18 27. }{ \b\f0\fs18\crauth1\crdate-2039913461 Uses }{\b\f0\fs18 empathy }{\f0\fs18 to communicate understanding and appreciation of the patient\rquote s feelings or predicament; overtly }{\b\f0\fs18 a}{\b\f0\fs18\crauth1\crdate-2039913461 cknowledges patient's views}{\f0\fs18 and feelings}{\b\f0 \par }\pard \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\rin15\lin0\itap0 {\f0\fs18 \par 28. }{\b\f0\fs18\crauth1\crdate-2039913461 Provides }{\b\f0\fs18 support}{\f0\fs18 : expresses concern, understanding, willingness to help; acknowledges coping efforts and appropriate self care; offers partnership }{\b\f0\fs18 \par }\pard \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 {\f0\fs16 \par }\pard \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\rin15\lin0\itap0 {\f0\fs18 29. }{ \b\f0\fs18\crauth1\crdate-2039913461 Deals}{\b\f0\fs18\cf1\crauth1\crdate-2039913461 }{\b\f0\fs18\cf1 sensitively}{\f0\fs18\cf1 with embarrassing and disturbing topics and physical pain, including when associated with physical examination}{\f0\fs18 \par }\pard \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 {\f0\fs16 \par \par }\pard\plain \s3\qj \li0\ri15\keepn\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\outlinelevel2\rin15\lin0\itap0 \b\fs18\ul\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Involving the patient \par }\pard\plain \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\rin15\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs18 30. }{\b\f0\fs18 Shares thinking}{\f0\fs18 with patient to encourage patient\rquote s involvement (e.g. \'93What I\rquote m thinking now is....\'94) \par }\pard \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx7880\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\nooverflow\faroman\rin15\lin0\itap0 {\f0\fs16 \par }{\f0\fs18 31. }{\b\f0\fs18 Explains rationale}{\f0\fs18 for questions or parts of physical examination that could appear to be non-sequiturs \par }{\f0\fs16 \par }\pard \qj \li0\ri15\nowidctlpar\tx1440\tx2160\tqc\tx4460\tqr\tx8440\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\tx13842\tx14562\tx15282\tx16002\tx16722\tx17442\tx18162\tx18882\nooverflow\faroman\rin15\lin0\itap0 {\f0\fs18 32. During }{ \b\f0\fs18 physical examination}{\f0\fs18 , explains process, asks permission \par }\pard \ql \li0\ri15\nowidctlpar\tx162\tx882\tx1602\tx2322\tx3042\tx3762\tx4482\tx5202\tx5922\tx6642\tx7362\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\nooverflow\faroman\rin15\lin0\itap0 {\b\f0\fs18 {\pict{\*\picprop\shplid1029{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn fillColor}{\sv 8421504}}{\sp{\sn fFilled}{\sv 1}}{\sp{\sn fLine}{\sv 0}}{\sp{\sn alignHR}{\sv 1}}{\sp{\sn dxHeightHR}{\sv 30}} {\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fStandardHR}{\sv 1}}{\sp{\sn fHorizRule}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}\picscalex437\picscaley6\piccropl0\piccropr0\piccropt0\piccropb0 \picw1764\pich882\picwgoal1000\pichgoal500\wmetafile8\bliptag-590881912\blipupi1439{\*\blipuid dcc7db888cbf76a6040ff6e85880c52e} 010009000003310000000000070000000000050000000b0200000000050000000c02f401e803070000001b04f401e8030000000005000000140200000000050000001302f401e803050000001402f40100000500000013020000e8030300000000003200}}{\b\f0\fs18 \par }{\b\f0\fs18\ul \par }{\b\f0\fs20 EXPLANATION AND PLANNING \par }\pard \qj \li0\ri-64\widctlpar\tx1440\nooverflow\faroman\rin-64\lin0\itap0 {\b\f0\fs18\ul \par Providing the correct amount and type of information}{\f0\fs18\ul \par }\pard \qj \li0\ri-64\widctlpar\nooverflow\faroman\rin-64\lin0\itap0 {\f0\fs18 33. }{\b\f0\fs18 Chunks and checks:}{\f0\fs18 gives information in manageable chunks, checks for understanding, uses patient\rquote s response as a guide to how to proceed \par \par 34. }{\b\f0\fs18 Assesses patient\rquote s starting point:}{\f0\fs18 asks for patient\rquote s prior knowledge early on when giving information, discovers extent of patient\rquote s wish for information \par \par 35. }{\b\f0\fs18 Asks patients what other information would be helpful }{\f0\fs18 e.g. aetiology, prognosis \par \par 36. }{\b\f0\fs18 Gives explanation at appropriate times:}{\f0\fs18 avoids giving advice, information or reassurance prematurely \par \par \par }\pard \ql \li0\ri15\nowidctlpar\tx162\tx882\tx1602\tx2322\tx3042\tx3762\tx4482\tx5202\tx5922\tx6642\tx7362\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\nooverflow\faroman\rin15\lin0\itap0 {\b\f0\fs18\ul \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par }\pard \qj \li0\ri-64\widctlpar\nooverflow\faroman\rin-64\lin0\itap0 {\b\f0\fs18\ul \page }{\f0\fs18 \par }\pard \qj \li0\ri-64\nowidctlpar\tx162\tx882\tx1602\tx2322\tx3042\tx3762\tx4482\tx5202\tx5922\tx6642\tx7362\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\nooverflow\faroman\rin-64\lin0\itap0 {\b\f0\fs20 EXPLANATION AND PLANNING (conti) \par }{\b\f0\fs18\ul \par Aiding accurate recall and understanding \par }\pard \qj \li0\ri-64\nowidctlpar\tx162\tx900\tx2322\tx3042\tx3762\tx4482\tx5202\tx5922\tx6642\tx7362\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\nooverflow\faroman\rin-64\lin0\itap0 {\f0\fs18 37. }{\b\f0\fs18 Organises explanation:}{ \f0\fs18 divides into discrete sections, develops a logical sequence \par \par }\pard \qj \li0\ri-64\nowidctlpar\tx162\tx882\tx1602\tx2322\tx3042\tx3762\tx4482\tx5202\tx5922\tx6642\tx7362\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\nooverflow\faroman\rin-64\lin0\itap0 {\f0\fs18 38. }{\b\f0\fs18 Uses explicit categorisation or signposting}{\f0\fs18 (e.g. \'93There are three important things that I would like to discuss. 1st...\'94 \'93Now, shall we move on to.\'94) \par \par 39}{\b\f0\fs18 . Uses repetition and summarising}{\f0\fs18 to reinforce information \par \par 40. }{\b\f0\fs18 Uses }{\f0\fs18 concise, }{\b\f0\fs18 easily understood}{\f0\fs18 }{\b\f0\fs18 language}{\f0\fs18 , avoids or explains jargon \par \par 41. }{\b\f0\fs18 Uses visual methods of conveying information:}{\f0\fs18 diagrams, models, written information and instructions \par \par 42. }{\b\f0\fs18 Checks}{\f0\fs18 }{\b\f0\fs18 patient\rquote s understanding}{\f0\fs18 of information given (or plans made): e.g. by asking patient to restate in own words; clarifies as necessary \par }\pard \qj \li0\ri-64\widctlpar\nooverflow\faroman\rin-64\lin0\itap0 {\f0\fs18 \par \par }\pard \qj \li0\ri26\widctlpar\tx630\nooverflow\faroman\rin26\lin0\itap0 {\b\f0\fs18\ul Achieving a shared understanding: incorporating the patient\rquote s perspective}{\b\caps\f0\fs18\ul \par }\pard \qj \li0\ri-64\widctlpar\nooverflow\faroman\rin-64\lin0\itap0 {\f0\fs18 43. }{\b\f0\fs18 Relates explanations to patient\rquote s illness framework:}{\f0\fs18 to previously elicited ideas, concerns and expectations \par \par 44. }{\b\f0\fs18 Provides opportunities and encourages patient to contribute:}{\f0\fs18 to ask questions, seek clarification or express doubts; responds appropriately \par \par 45. }{\b\f0\fs18 Picks up verbal and non-verbal cues}{\f0\fs18 e.g. patient\rquote s need to contribute information or ask questions, information overload, distress \par \par 46. }{\b\f0\fs18 Elicits patient's beliefs, reactions and feelings}{\f0\fs18 re information given, terms used; acknowledges and addresses where necessary \par \par \par }\pard\plain \s2\qj \li0\ri-64\keepn\widctlpar\nooverflow\faroman\outlinelevel1\rin-64\lin0\itap0 \b\fs18\ul\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Planning: shared decision making}{\caps \par }\pard\plain \qj \li0\ri-64\widctlpar\nooverflow\faroman\rin-64\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs18 47. }{\b\f0\fs18 Shares own thinking as appropriate:}{\f0\fs18 ideas, thought processes, dilemmas \par \par 48. }{\b\f0\fs18 Involves patient}{\f0\fs18 by making suggestions rather than directives \par \par 49. }{\b\f0\fs18 Encourages patient to contribute their thoughts:}{\f0\fs18 ideas, suggestions and preferences \par \par 50. }{\b\f0\fs18 Negotiates}{\f0\fs18 a mutually }{\b\f0\fs18 acceptable plan }{\f0\fs18 \par \par 51}{\b\f0\fs18 . Offers choices: }{\f0\fs18 encourages patient to make choices and decisions to the level that they wish}{\b\f0\fs18 \par \par }{\f0\fs18 52.}{\b\f0\fs18 Checks with patient}{\f0\fs18 if accepts plans, if concerns have been addressed \par }{\f0\fs18 {\pict{\*\picprop\shplid1030{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn fillColor}{\sv 8421504}}{\sp{\sn fFilled}{\sv 1}} {\sp{\sn fLine}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}\picscalex571\picscaley6\piccropl0\piccropr0\piccropt0\piccropb0 \picw1764\pich882\picwgoal1000\pichgoal500\wmetafile8\bliptag-590881912\blipupi1439{\*\blipuid dcc7db888cbf76a6040ff6e85880c52e} 010009000003310000000000070000000000050000000b0200000000050000000c02f401e803070000001b04f401e8030000000005000000140200000000050000001302f401e803050000001402f40100000500000013020000e8030300000000003200}}{\f0\fs18 \par \par \par }\pard\plain \s1\ql \li0\ri15\keepn\nowidctlpar\tx162\tx882\tx1602\tx2322\tx3042\tx3762\tx4482\tx5202\tx5922\tx6642\tx7362\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\nooverflow\faroman\outlinelevel0\rin15\lin0\itap0 \b\caps\f4\fs18\ul\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\caps0\f0\fs20\ulnone CLOSING THE SESSION \par }\pard\plain \ql \li0\ri0\widctlpar\nooverflow\faroman\rin0\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 { \par }\pard\plain \s2\qj \li0\ri-64\keepn\widctlpar\nooverflow\faroman\outlinelevel1\rin-64\lin0\itap0 \b\fs18\ul\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {Forward planning \par }\pard\plain \qj \li0\ri15\nowidctlpar\tx162\tx882\tx1602\tx2322\tx3042\tx3762\tx4482\tx5202\tx5922\tx6642\tx7362\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\nooverflow\faroman\rin15\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs18 53. }{\b\f0\fs18 Contracts}{\f0\fs18 with patient re next steps for patient and physician \par \par 54. }{\b\f0\fs18 Safety nets}{\f0\fs18 , explaining possible unexpected outcomes, what to do if plan is not working, when and how to seek help \par }\pard\plain \s2\qj \li0\ri-64\keepn\widctlpar\nooverflow\faroman\outlinelevel1\rin-64\lin0\itap0 \b\fs18\ul\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 { \par Ensuring appropriate point of closure}{\v\fs24\cf18 \par }\pard\plain \qj \li0\ri15\nowidctlpar\tx162\tx882\tx1602\tx2322\tx3042\tx3762\tx4482\tx5202\tx5922\tx6642\tx7362\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\nooverflow\faroman\rin15\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs18 \par 55. }{\b\f0\fs18 Summarises session }{\f0\fs18 briefly and clarifies plan of care \par \par 56. }{\b\f0\fs18 Final check}{\f0\fs18 that patient agrees and is comfortable with plan and asks if any corrections, questions or other items to discuss \par \par }\pard \qj \li0\ri-64\widctlpar\nooverflow\faroman\rin-64\lin0\itap0 {\f0\fs18 {\pict{\*\picprop\shplid1031{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn fillColor}{\sv 8421504}}{\sp{\sn fFilled}{\sv 1}} {\sp{\sn fLine}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}\picscalex571\picscaley6\piccropl0\piccropr0\piccropt0\piccropb0 \picw1764\pich882\picwgoal1000\pichgoal500\wmetafile8\bliptag-590881912\blipupi1439{\*\blipuid dcc7db888cbf76a6040ff6e85880c52e} 010009000003310000000000070000000000050000000b0200000000050000000c02f401e803070000001b04f401e8030000000005000000140200000000050000001302f401e803050000001402f40100000500000013020000e8030300000000003200}}{\f0\fs18 \par }\pard \qj \li0\ri15\nowidctlpar\tx162\tx882\tx1602\tx2322\tx3042\tx3762\tx4482\tx5202\tx5922\tx6642\tx7362\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\nooverflow\faroman\rin15\lin0\itap0 {\f0\fs16 \par }\pard \ql \li0\ri0\widctlpar\nooverflow\faroman\rin0\lin0\itap0 { \par }\pard \ql \li0\ri15\nowidctlpar\tx162\tx882\tx1602\tx2322\tx3042\tx3762\tx4482\tx5202\tx5922\tx6642\tx7362\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\nooverflow\faroman\rin15\lin0\itap0 {\b\f0\fs18\ul \par \par \par \par }\pard \qj \li0\ri-64\widctlpar\nooverflow\faroman\rin-64\lin0\itap0 {\caps\f0 \page }{\b\f0\fs18 }{\f0\fs18 \par }\pard\plain \s1\ql \li0\ri15\keepn\nowidctlpar\tx162\tx882\tx1602\tx2322\tx3042\tx3762\tx4482\tx5202\tx5922\tx6642\tx7362\tx8082\tx8802\tx10242\tx10800\tx10962\tx11682\tx12402\tx13122\nooverflow\faroman\outlinelevel0\rin15\lin0\itap0 \b\caps\f4\fs18\ul\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\caps0\f0\fs20\ulnone OPTIONS IN EXPLANATION AND PLANNING (includes content) \par }\pard\plain \ql \li0\ri0\widctlpar\nooverflow\faroman\rin0\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs18 \par }\pard\plain \s6\ql \li0\ri0\keepn\widctlpar\nooverflow\faroman\outlinelevel5\rin0\lin0\itap0 \b\f4\fs18\ul\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0 IF discussing investigations and procedures \par }\pard\plain \ql \li0\ri0\widctlpar\nooverflow\faroman\rin0\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs18 57. Provides clear information on procedures, eg, what patient might experience, how patient will be informed of results \par \par 58. Relates procedures to treatment plan: value, purpose \par \par 59. Encourages questions about and discussion of potential anxieties or negative outcomes \par \par }\pard\plain \s6\ql \li0\ri0\keepn\widctlpar\nooverflow\faroman\outlinelevel5\rin0\lin0\itap0 \b\f4\fs18\ul\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0 IF discussing opinion and significance of problem \par }\pard\plain \ql \li0\ri0\widctlpar\nooverflow\faroman\rin0\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs18 60. Offers opinion of what is going on and names if possible \par \par 61. Reveals rationale for opinion \par \par 62. Explains causation, seriousness, expected outcome, short and long term consequences \par \par 63. Elicits patient\rquote s beliefs, reactions, concerns re opinion \par \par }\pard\plain \s6\ql \li0\ri0\keepn\widctlpar\nooverflow\faroman\outlinelevel5\rin0\lin0\itap0 \b\f4\fs18\ul\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0 IF negotiating mutual plan of action \par }\pard\plain \ql \li0\ri0\widctlpar\nooverflow\faroman\rin0\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f0\fs18 64. Discusses options eg, no action, investigation, medication or surgery, non-drug treatments (physiotherapy, walking aides, fluids, counselling, preventive measures) \par \par 65. Provides information on action or treatment offered \par }\pard \ql \fi720\li0\ri0\widctlpar\nooverflow\faroman\rin0\lin0\itap0 {\f0\fs18 name \par steps involved, how it works \par benefits and advantages \par possible side effects \par }\pard \ql \li0\ri0\widctlpar\nooverflow\faroman\rin0\lin0\itap0 {\f0\fs18 \par 66. Obtains patient\rquote s view of need for action, perceived benefits, barriers, motivation \par \par 67. Accepts patient\rquote s views, advocates alternative viewpoint as necessary \par \par 68. Elicits patient\rquote s reactions and concerns about plans and treatments including acceptability \par \par 69. Takes patient\rquote s lifestyle, beliefs, cultural background and abilities into consideration \par \par 70. Encourages patient to be involved in implementing plans, to take responsibility and be self-reliant \par \par 71. Asks about patient support systems, discusses other support available \par }{\b\f0\fs18 {\pict{\*\picprop\shplid1032{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn fillColor}{\sv 8421504}}{\sp{\sn fFilled}{\sv 1}} {\sp{\sn fLine}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}\picscalex402\picscaley6\piccropl0\piccropr0\piccropt0\piccropb0 \picw1764\pich882\picwgoal1000\pichgoal500\wmetafile8\bliptag-590881912\blipupi1439{\*\blipuid dcc7db888cbf76a6040ff6e85880c52e} 010009000003310000000000070000000000050000000b0200000000050000000c02f401e803070000001b04f401e8030000000005000000140200000000050000001302f401e803050000001402f40100000500000013020000e8030300000000003200}}{\f0\fs18 \par }\pard \qj \li0\ri0\sl200\slmult0\nowidctlpar\tx8640\nooverflow\faroman\rin0\lin0\itap0 {\b\f0\fs18 \par \par \par \par \par \par \par \par \par \par \par }\pard\plain \s16\qj \li0\ri0\sl200\slmult0\nowidctlpar\tx8640\nooverflow\faroman\rin0\lin0\itap0 \b\fs18\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\fs16 References: \par Kurtz SM, Silverman JD, Draper J (1998) Teaching and Learning Communication Skills in Medicine. Radcliffe Medical Press (Oxford) \par }{\b0\fs16 \par }\pard\plain \qj \li0\ri0\sl200\slmult0\nowidctlpar\tx8640\nooverflow\faroman\rin0\lin0\itap0 \f4\fs24\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\b\f0\fs16 Silverman JD, Kurtz SM, Draper J (1998) Skills for Communicating with Patients. Radcliffe Medical Press (Oxford) \par \par Kurtz SM, Silverman JD, Benson J and Draper J (2003) Marrying Content and Process in Clinical Method Teaching: Enhancing the Calgary-Cambridge Guides Academic Medicine In press \par }{\b\f0\fs18 \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par \par }}