Communication Clinician flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Therapeutic alliance components

Agreement on goals, agreement on tasks, and an emotional bond. Weakness in any one component predicts dropout, so assess all three rather than focusing on rapport alone.

Accurate empathy

A learnable skill with four steps: recognize the patient's emotion, name it tentatively, check whether the naming is correct, and respond to the underlying need.

Countertransference

The clinician's own emotional reaction displaced onto the patient. Unrecognized, it distorts judgment, shortens encounters, and can produce avoidance of specific patients.

Open-to-closed funnel

Start with broad open questions to let the patient set the agenda, then narrow to focused and closed questions for detail. Reversing the order suppresses disclosure.

OLDCARTS mnemonic

A symptom characterization sequence: Onset, Location, Duration, Character, Aggravating and associated factors, Relieving factors, Timing, and Severity. Used to structure history of present illness.

Ideas, concerns, expectations

Three questions asked early in the interview to surface the patient's own explanation, worries, and goals. Unelicited concerns are a leading cause of missed diagnosis.

Normalizing preface

A statement that a sensitive question is asked of all patients, which lowers perceived judgment. It precedes direct questions about substance use, violence, or sexual history.

Teach-back method

The patient restates the plan in their own words. Asking whether they understand does not verify comprehension, because patients commonly answer yes to avoid embarrassment.

Chunk and check

Deliver one to three key points, confirm understanding, then continue. Limiting new concepts to about three per encounter improves recall and adherence.

Absolute versus relative risk

Relative risk reduction can look large while absolute change is small. Both must be stated, because patients systematically overestimate benefit when only relative figures are given.

Shared decision-making steps

Explain the options with risks and benefits, elicit the patient's values and preferences, reach a decision together, and document the decision and its rationale.

SPIKES protocol

A structure for bad news: Setting, Perception, Invitation, Knowledge, Emotions, and Strategy with summary. It organizes the conversation but is not read aloud as a script.

Warning shot

A brief statement that difficult news is coming, followed by a pause. It lets the patient prepare and reduces shock before the diagnosis is stated plainly.

NURSE statements

A response set for emotion: Name, Understand, Respect, Support, and Explore. Used after bad news to acknowledge feeling before offering information or plans.

Prognosis with uncertainty

Give a range rather than a single number, state explicitly that uncertainty exists, and pair it with achievable near-term goals so honesty and hope coexist.

SBAR handoff

Situation, Background, Assessment, Recommendation. The Recommendation is most often omitted and is the element that tells the receiver what action to take.

Closed-loop communication

The sender gives an instruction, the receiver repeats it back, and the sender confirms. Used for critical tasks where mishearing carries high risk.

Two-challenge rule

If a safety concern is raised twice and not addressed, the team member must escalate to a supervisor rather than repeat the concern a third time.

Psychological safety

The shared team belief that speaking up will not be punished. It is a property of the team environment and predicts error reporting and learning.

Qualified medical interpreter

A trained interpreter used for diagnosis, consent, and bad news. Family members, especially children, should not fill this role because of error and role conflict.

Speaking through an interpreter

Speak in first person, pause every two to three sentences, and address the patient rather than the interpreter. Interpreted encounters take substantially longer than untranslated ones.

Health literacy screening

A validated single item asks how confident the patient is filling out medical forms alone. Health literacy is distinct from education level and general literacy.

LEARN model

A cross-cultural sequence: Listen to the patient's explanation, Explain your view, Acknowledge differences, Recommend a plan, and Negotiate agreement.

Complaint response sequence

Listen without interruption, acknowledge the experience, apologize for the experience, clarify the facts, and agree on next steps. An apology for the experience is not an admission of fault.

De-escalating anger

Lower volume, slow speech, and avoid counter-argument. Matching hostility raises arousal. Reflective statements about the frustration work better than immediate explanation.

Reframing to shared goal

Opening a difficult conversation with a goal both parties hold, such as comfort at home, moves the exchange from opposition to joint problem-solving.

Valid informed consent

Requires capacity, adequate disclosure, comprehension, voluntariness, and authorization. A signed form without these elements does not constitute valid consent.

Capacity assessment elements

The patient must understand the information, appreciate how it applies to them, reason through options, and express a choice. Capacity is decision-specific and time-specific.

Reasonable-person disclosure standard

Disclose material risks and alternatives, including no treatment, that a reasonable person in the patient's position would want to know when deciding.

Substituted judgment

A surrogate decides based on what the patient would have wanted. Best interests is the fallback only when the patient's own wishes are unknown.

Emergency exception

Treatment without consent is permitted when delay would risk serious harm and no surrogate is available. The reasoning must be documented in the record.

Assent versus consent

Minors and adults with impaired capacity may give assent, an agreement to participate, while a surrogate provides the legal authorization. Both should be sought.