NBOME
COMLEX-USA MASTER BLUEPRINT

5. Interpersonal and Communication Skills in the Practice of Osteopathic Medicine

Overview

Osteopathic physicians must demonstrate the knowledge, skills, experience, attitudes, values, and behaviors that facilitate accurate and efficient information gathering, empathetic rapport building, and effective information giving in interactions with the patient and surrogates, the patient’s family members and caregivers, and other members of the interprofessional collaborative team. Osteopathic physicians must also demonstrate the ability to effectively document and synthesize clinical findings, diagnostic impressions, and diagnostic and treatment instructions in verbal, written, and electronic format. Communication in the English language is essential, as is communication with other members of the health care team, patients, and others when language barriers or other challenges to effective communication are encountered. Interpersonal and communication skills for osteopathic medical practice are based on the incorporation of appropriate knowledge, experience, attitudes, values, and behaviors to determine the nature of the patient’s concern or complaint; to develop, maintain, and conclude the therapeutic relationship; and to facilitate patient education, shared decision making, and implementation of diagnostic and care plans. These skills include active listening involving verbal and nonverbal behaviors, as well as effective documentation and synthesis of clinical findings and impressions. This set of knowledge, skills, experience, attitudes, values, and behaviors extends to the medical interview and to communication with the patient, family members, caregivers, and other members of the interprofessional collaborative team. It is essential for osteopathic medical practice that the approach be patient centered, holistic, comprehensive, compassionate, and respectful, contributing to an understanding of the patient, family, and caregiver perspectives and facilitating trust and therapeutic patient-physician relationships.

Required Elements

5.1 Eliciting Information

DEFINITION The osteopathic physician must communicate effectively with the patient, the patient’s family, and other caregivers in order to establish a diagnostic impression and to help ascertain the nature of the concern or complaint. The osteopathic physician must open patient interviews by encouraging the patient to fully express concerns and must further gather information in a manner that results in effective exchange of information and collaboration with patients, their families, and other health care professionals. MEASURED OUTCOMES The osteopathic physician must:
  • allow patients (or other persons being interviewed) to complete their opening statements without interruption in order to elicit the full set of patient concerns.
  • use open-ended and closed-ended questions effectively.
  • listen actively, using appropriate verbal and nonverbal techniques, including appropriate eye contact and touch.
  • use interpretation services effectively as necessary to communicate with patients and to minimize potential barriers to effective information exchange with patients and family members; these services include language-interpreting services and hearing-impaired services.

5.2 Rapport Building

DEFINITION The osteopathic physician must develop, maintain, and conclude the therapeutic relationship and demonstrate competence in the rapport-building functions of the medical interview. MEASURED OUTCOMES The osteopathic physician must:
  • communicate interest in, respect for, support of, and empathy for the patient.
  • understand the patient, family, and caregiver’s perspectives, concerns, complaints, and issues.
  • provide closure to interviews by summarizing and affirming agreements, asking whether the patient has other issues or concerns, and planning follow-up (eg, next visit and plan for unexpected outcomes).
  • communicate effectively with patients who are exhibiting anger or who present other challenges in order to resolve relational barriers between the physician, other health care professionals, and the patient.
  • communicate effectively and encourage open communication with the patient, as appropriate, during clinical procedures, including OMT.
  • clarify his/her role in the patient’s care and/or on the health care team with the patient.
  • understand and appreciate the role of other health care professionals in the care of patients and work in cooperation with them when applicable to provide high-quality patient-centered care.

5.3 Information Giving

DEFINITION The osteopathic physician must effectively provide patient education and information, ensuring that the patient (or caregiver) understands his/her condition and the diagnostic and/or treatment options and recommendations. This includes achieving consensus between the patient (or caregiver) and the physician. It also includes facilitating the informed consent process and recommending mutually agreed-upon diagnostic and/or therapeutic steps, or health promotion and disease prevention strategies. Additionally, it includes enhancing patient coping mechanisms and encouraging appropriate lifestyle changes to avoid illness and to promote and maintain health. MEASURED OUTCOMES The osteopathic physician must:
  • share information using appropriate terminology and concepts that the patient, patient’s family, and/or legal decision maker can understand and, as indicated, use language-interpreting services, hearing-impaired services, or other services to minimize potential barriers to effective information exchange.
  • summarize discussions, check for understanding, and conclude conversations by ensuring all questions and concerns have been thoroughly addressed.
  • encourage active patient participation in decision making while verifying the patient’s willingness and ability to follow the care plan as part of informed consent.
  • communicate to the patient the philosophy of osteopathic principles and practice and of OMT.
  • communicate with compassion any news that may evoke in the patient and the patient’s family or caregiver distress, sorrow, anger, or other emotion, such as any applicable information relative to terminal illness, disability, death, and dying.
  • enhance the patient’s coping ability by actively exploring and utilizing biopsychosocial concepts and addressing the social and psychological consequences of the condition and the treatment.
  • recommend and explain appropriate disease prevention and health promotion strategies, including lifestyle changes and available community support services.

5.4 Written and/or Electronic Documentation and Communication

DEFINITION The osteopathic physician must demonstrate effective written and electronic communication in patient care and in working as a member of the interprofessional collaborative team. MEASURED OUTCOMES The osteopathic physician must:
  • document subjective elements (eg, information provided by the patient or a secondary source) of the medical, surgical, family, medication, allergy, social, cultural, and sexual histories and review of systems, as appropriate.
  • document objective patient information (eg, physical examination findings, laboratory/diagnostic test results, imaging results) as appropriate.
  • document a reasonable diagnostic assessment or differential diagnosis as supported by diagnostic hypotheses, as well as subjective and objective findings and data as appropriate.
  • document elements of the patient care and follow-up or disposition plan as appropriate.
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