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Case reviews and clinical rounds

Using Case Reviews

When reviewing patient histories whether at a multidisciplinary team meeting, or as part of a presentation-based review, one way of ensuring that communication and relationship issues are brought to the fore is by adding a standing item on "communication/relationship issues" (or something similar) to the agenda or checklist for the meeting. 

This then acts as a reminder to consider communication and relationship issues that the practitioner may have experienced whilst caring for an individual patient.  It helps to have the principles of good communication to hand during such reviews so that all those who have been interacting with the patient can briefly reflect on how well they are upholding these principles.  It also provides time for practitioners to support each other in thinking of strategies to overcome any difficulties and to highlight good practice. 

Making this part of the standard discussions that happen around patient care will help to embed and mainstream the principles and practice of good communication and human relationships into everyday culture in the health system.

Using Rounds

In hospitals, 'rounds' can be effectively used to support learning on effective communication and relationships.  Normal patient care rounds can be used to allow practitioners to model the practice of seniors and other professionals (Modelling). 

Teaching rounds can be even more productive, especially if carried out separately from patient care rounds so that sufficient time and focus can be given to the teaching.  For teaching rounds to be effective, it is ideal if a session is started away from the patient in a separate room, followed by a spell with the patient and concluding with a discussion away from the patient again.  This enables practitioners to debrief the encounter without making a patient feel any more uncomfortable. 

For example, if a patient gives non-verbal cues that are incongruous with what they have actually said, instead of suggesting to the practitioner that they have missed something it is more helpful if the professional leading the teaching round models good practice to try and elicit the patient's concerns whilst still with them.