Patient Communication Skills Flashcards

A grieving family member expresses anger at the ICU team, saying 'You didn't do enough.' The most therapeutically effective immediate response is:

Answer: Acknowledge the pain behind the anger and invite the family member to share their concerns

Acknowledging the emotional pain behind anger before responding to its content de-escalates conflict and builds the trust needed for productive dialogue.

Which concept best describes the phenomenon where ICU clinicians assume families understand more about prognosis than they actually do?

Answer: The curse of knowledge

The curse of knowledge describes the clinician's difficulty appreciating how unfamiliar medical concepts are to families once the clinician has expertise.

For a patient who lacks capacity and has no known family or advance directive, decisions about life-sustaining treatment in England should involve:

Answer: An Independent Mental Capacity Advocate (IMCA) and a best-interests decision process under the Mental Capacity Act

When a patient lacking capacity has no family or representative, the Mental Capacity Act 2005 mandates IMCA involvement in serious medical decisions.

Open visiting policies in the ICU are associated with which of the following outcomes compared to restricted visiting?

Answer: Reduced family anxiety and improved patient-centred care without increased infection risk

Evidence consistently shows open visiting reduces family anxiety and does not significantly increase infection rates, supporting its adoption as best practice.

A nurse reports to the intensivist that a patient has been communicating sadness and asking about death. The appropriate response to the patient is:

Answer: Engage the patient directly in a sensitive conversation about their concerns, exploring psychological needs

Direct, empathic engagement with a patient's existential concerns is the foundation of psychological support and may reveal unmet needs including pain, fear, or unresolved family issues.

Which of the following most accurately defines 'surrogate decision-maker substituted judgement standard'?

Answer: The surrogate decides based on what the patient would have chosen given their known values and preferences

Substituted judgement requires the surrogate to reconstruct what the patient would have decided, not what the surrogate prefers, prioritising patient autonomy.

A resident is observed interrupting a family member repeatedly during a goals-of-care meeting. As the supervising intensivist, the most effective educational response is:

Answer: Continue the meeting and provide structured private feedback immediately afterwards using a reflective framework

Post-encounter debrief using a structured reflective framework (e.g., Pendleton's rules) is the evidence-based approach for communication skills feedback in medical education.