Telephone consultations: working with verbal cues

Monday 10th August 2020

GatewayC and the Maguire Communication Skills Training Unit have partnered to produce this resource below. Missed our free webinar on Effective Telephone Consultations? Watch it here.

What are cues?

It is often the case that people do not disclose their worries and concerns explicitly, but test the water by hinting in a verbal or non-verbal way that all is not well. These hints of worries or concerns are referred to as cues.

Cues can be defined as hints or a statement of negative emotion that suggest there may be an underlying concern. Cues need to be actively acknowledged and explored in order to establish if there is a concern and what it relates to. As we discussed in a previous blog, establishing concerns is crucial to a patient-centred consultation.

Many healthcare professionals are anxious that when managing consultations on the telephone, important information may be missed because of the lack of visual cues.

However, although visual cues are helpful, the verbal cues offered by patients are often even stronger hints but we may be less used to recognising them.

How to work with cues: acknowledge what has been said, pause to allow patient to respond and continue, follow up with a question or clarification if needed to explore further in order to establish the nature and extent of the concerns.

Why is acknowledgement of cues important?

We may know that we’ve heard, and it may seem implicit in the questions that we go on to ask, but verbal acknowledgement makes sure the patient knows they have been heard and allows them to confirm, correct or expand further.

What’s the difference between acknowledgment and empathic acknowledgment- and why does it matter.

 Acknowledgement:               “You asked about the future” or “I understand”.

Neither of these examples explicitly name nor take an educated guess at the emotion the patient is experiencing.

Empathic acknowledgement:  “I can hear that you are upset and worried about the future”.

Empathic acknowledgement helps to dampen strong emotions thereby reducing distress and promoting cognitive processing and decision making  (Harari et al, 2000).

Why does the pause matter? When a patient has the opportunity verbalise the emotion, neural pathways are stimulated in the prefrontal cortex and the hormone oxytocin is released. Oxytocin acts to immediately dampen the effect of adrenaline and cortisol.

Without the pause for example “you must be upset, can you tell me why” or “I can see you’re upset and this is what we can do for you”, the patient loses the chance to say out loud…”Yes I am upset”. As a consequence, there is no change in the activity of the neural pathways, and the patient remains upset/ distressed.

For further advice and training in effective, compassionate communication please contact the Maguire Communication Skills Unit the-christie.maguire.unit@nhs.net

Find out more:

• Read this useful resource on evidence underpinning working with cues and empathetic acknowledgement
• Read this blog’s full list of references
• Learn more about the Maguire Communication Skills Training Unit here

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