Professional Documents
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Tjakra W. Manuaba Dept of General Surgery School of Medicine. University of Udayana Sanglah Academic Hospital. Bali
What is Communication
Is the act by which information is shared between humans. Such encounter might cover: Desires Needs Perceptions Knowledge Affective states
The ability to communicate well with patients to build up a trusting relationship within which curing relieving and comforting can take place, is a great challenge Why good medical communication is important? better care for our patients
Sir Charles Fletcher
In recent years, some medical practitioners have warned their colleagues of the trend away from the treatment of the human being and the commitment to the patient. They recommend moving from a problem focus to a person focus. Dr. C. Everett Koop, former surgeon general, stresses that health care professionals have a spiritual heritage of cherishing life.
Dr. Koop points out, however, that We put too much emphasis on curing, especially when a disease is fatal, and not enough on caring.curing costs millions but caring comes from the heart and soul. I hope Americans never run out of it either As scientific advances have proliferated, it is widely believed that concentrating on treating the disease has come to predominate over treating the illness of the patient.
It is also widely recognized that nursing has become less patient-oriented and more scientifically oriented. Nurses increasingly are more involved with the technology of care. Complex machinery and excessive paperwork... As a result they may be distracted from some of their more caring functions.
Some medical literature contains a large number of research studies that have evaluated physicianpatient interactions and documented the undesirable results of ineffective communication in such interviews. A recent study found that in encounters lasting 20 minutes, doctors spent just a little over a minute giving information to their patients.
In medical school and in their internship or residency training, physicians learn to ask many questions in taking medical histories, yet the interrogative mode in a subtle way communicates, I am in charge here. Physicians who ask many questions are keeping tight control over the relationship. No wonder so many patients complain that the doctor doesnt listen to them.
One way that improvement of treatment should be realized by physicians, is through increasing patient compliance or cooperation with the physicians orders. Noncompliance with prescribed medication regimens has been shown to be a significant cause of hospital admissions.
Medical Communcation
Medical communication is the usual communication encounter between doctor and the patient It can be classified according to the purpose of the interview into 4 types
History taking Consultation Obtaining Informed Consent Breaking bad news
Not anymore paternalism Should be partnership basis. Doctor-Patient collaboration vs health problem Equal
Medical Ethics respect the autonomy of patients Paternalism only to patients who are not able to be autonomous The only way of interfering with individual autonomy is where it prevent harm to third party or self harm
Components of professionalism
ALTRUISM
COMPETENCE
HUMANISM
- RESPECT - COMPASSION - EMPATHY - HONOR - INTEGRITY
EXELLENCE
ACCOUNTABILLITY
Communication, between patients and health professionals, is seen as the core clinical procedure for diagnosing, treating, and caring for patients. Patients satisfaction is strongly influenced by the quality of the communication that occurs. Studies show that patients dissatisfaction can seriously reduce their compliance with their treatment regimen.
Gordon & Edwards
Dissatisfaction in communication can trigger patient doubts about the competence of their physician. It can negatively affect how long it takes to recover. It can increase the frequency of patient malpractice sue.
Doctors would not listen Doctors would not give information Doctors showed lack of concern & lack of respect for the patients
Lloyd and Bor, 1996.
Physician
Patient
Communication Skills
To diagnose and treat diseases To establish/ maintain a therapeutic relationship To offer information and educate
Communication Skills
To diagnose and treat disease and maintain a therapeutic relationship: - Data from the patient must be objective, precise, and reliable - You must demonstrate respect, genuineness and empathy - These skills can be learned and practice
Empathy
Art
Therapeutic Relationship
Communication Skills
You must demonstrate - Respect - Genuineness - Empathy These skills can be learned with practice
Respect
Remember that every patient could be you, your mom, your brother or your boy/ girlfriend For example: How would he or she feel waiting for the doctor to come into the room?
Respect
Introduce yourself to the patient/ family Explain who you are and your role Shake hands, but dont force physical contact if patient is uncomfortable Call the adult patient MrMrsMs (do not use first name)
Respect
Maintain privacy Keep doors and curtain closed Acknowledge and greet others in the room Maintain a professional appearance clean, neat, conservative, white coat, name tag (professional authority)
Respect
Make sure the patient is comfortable Sit at the patient level Be aware of the patients personal space (can vary among cultures) Continue to consider the patient comfort during history taking and physical examination
Respect
Appear interested and ready to listen Use your posture to do this - S -- Sit square to the patient - O -- Open to the patient - L -- Lean toward the patient - E -- Eye contact with the patient - R -- Relax
Genuineness
Genuineness
It is OK to laugh at patients jokes If patients spouse has died you might say: I am sorry to hear that. How are you doing? Show your true interest in the patient
Empathy
Is the ability to understand the patients experiences and feeling accurately as well as to demonstrate that understanding to the patient Is an active process Is more than sympathy, or feeling sorry for someone
Empathy
If you are empathetic you will maximize your ability to gather accurate and objective data about patients thoughts and feelings
Empathy
Observe the patient Pay attention to the patients nonverbal communication Is the patient looking away, fidgeting or leaning away from you while he or she talks?
Empathy
Dont interrupt In one study 69% physician interrupted patients within 18 seconds 77% of patients didnt get to fully explain their problem
Empathy
Enhance empathy by the way you respond to what the patient says Show the patient you have been listening to the content of their problem Show the patient you understand their perspective on the problem
Empathy
Do not ignore what the patient says Avoid minimizing his or her symptoms Instead, reflect back to the patient
Reassurance
To solve problem
Communication
To alleviate distress To give information To Convey Feelings
To persuade
To make Decision
Symptoms
- Psychological Factors anxiety, depression, anger, denial - Previous Experience of medical care - Current experience medical care - PTSD
in communication skills
Beginning an Interview?
A comfortable setting Being greeted by name & handshake Being shown where to sit The interviewer introducing her/himself & explaining the procedure An easy first question The Interviewer appearing interesting in your remarks
Ending The Interview - Summarize what patient has told you and ask if your summary is accurate - Ask if they would like to add anything - Thank the patient
BETTER COMMUNICATION
-Clearer -More effective & efficient communication -Honesty & openness. -Trust -Mutual respect -Politeness -Adherence -Collaboration. -More accurate information -Prevention of violent situation -Informed consent -Legal aspects
Bad News
Inevitable part of medical practice Not widely taught in medical schools Studies how patients/ families cope with bad news not the process of breaking bad news Bad news is a relative concept & should depend on patients interpretation of information & their reaction to it where patients feel the news will adversely affect their future
To whom should bad news be given Who should give bad news When should bad news be given How much bad news should be given Should you give hope and reassurance along with bad news
Personal preparation The Physical Setting Talking to patient and responding to concerns Arranging for follow-up or referral Feed and handover to colleagues
KEY CORE SKILL FOR BREAKING BAD NEWS EXPLANATION & PLANNING.
Preparation Summarizing Negotiating the Agenda Listening Picking up Cues The use of Silence Discovering the patients concern and ideas Encouraging the expression of feeling Picking up the non verbal cues
Conclusions
Do doctors need communication? Doctors need to learn essentials of good communication more than under professionals because patients are human with sensitive needs. Doctors can not practice medicine without effective communication skills Poor communication causes a lot of medico-legal and ethical problems
Thank you