Communication Let’s focus on challenges and

antibiotics use
MSF OCB Gaza
Dr Mathilde Berghmans & Dr Laetitia Fagnoul
 Identify the communication challenges
Objectives faced during a consultation

Evaluate antibiotic prescription

Practical exercise
Why focus on communication ?
• “Communication in medicine is a series of learned skills rather than
just a matter of personality.”

• Effective communication significantly improves:

• Accuracy, efficiency and supportiveness
• Health outcomes for patients
• Satisfaction for both patient and doctor
• The therapeutic relationship

• “(…)Communication skills lead to a more prudent prescribing

behaviour of antibiotics (…)” (ref: Strumann et al. 2020)
Graphic representation of a medical interview
CALGARY-CAMBRIDGE GUIDES: Communication process skills

Ref: Kurtz S., Silverman J., Draper J. :Teaching and Learning Communication Skills in Medicine, 2005.
 Initiating the session
• Preparation
• Establishing initial rapport
• Identifying the reasons for the patient consultation

Take 5 minutes to think of :

1. How do I identify the reasons for the patient consultation? and what could be
the challenges in this step ?
2. How do I address these challenges ?
3. How do I know if the patient comes for an antibiotic prescription ?
Does the patient want antibiotic ?

• Study about Antibiotic use for Emergency department patients with

upper respiratory infections:
“ Physicians were more likely to prescribe antibiotics to patients who they believed expected
them, although they correctly identified only about 1 in 4 of those patients.” (Ref: Ong et al., 2007)
• Doctor’s perception of patient expectation remains a strong
determinant in antibiotic prescription

• Patients expectations about antibiotics are difficult to identify for

physicians
Let’s continue the consultation…
CALGARY-CAMBRIDGE GUIDES: Communication process skills

Ref: Kurtz S., Silverman J., Draper J. :Teaching and Learning Communication Skills in Medicine, 2005.
 Gathering information

Exploration of the patient’s problems to discover the :

• Biomedical perspective
• Patient’s perspective
• Background information-context

Take 5 minutes to think of :

1. Which barriers can exist for the patient to explain his/her perspective?
2. How do I overcome these barriers ?
3. Which questions could I ask to assess the patients knowledge of antibiotics ?
From the patient perspective…

Sink yourself into the role of a

patient with a sore throat :
• Share ideas
• Concerns and feelings
• Expectations of the doctor
Back to the consultation…
CALGARY-CAMBRIDGE GUIDES: Communication process skills

Ref: Kurtz S., Silverman J., Draper J. :Teaching and Learning Communication Skills in Medicine, 2005.
 Physical examination

Take 5 minutes to think of :

1. Is physical examination necessary in every
patient assessment ? Why? Why not ?
2. What could be the reasons not to perform a
physical examination ?
3. Does the patient always expect a physical
examination ?
 Table: Barriers to physical assessment mentioned by nurses. Cross-
sectional study in China. (Shi et al. 2020)

Barriers to physical assessment Proportion of nurses

Lack of a uniform physical assessment 79.8%

documentation form
Common barriers to
physical examination Lack of time 60.8%

Lack of support and encouragement 55.16 %

 Physical examination
Oversights in the physical examination may be a major contributor to
(Verghese et al. 2015) :
• missed or delayed diagnosis
• unnecessary exposure to contrast and radiation
• incorrect treatment
• and other adverse consequences

Performing a physical examination has advantages (Asif et al. 2017):

• Enhanced physician-patient relationship

• Improved patient safety
• Fewer diagnostic errors
• Lower financial costs
Next step of our medical interview…
CALGARY-CAMBRIDGE GUIDES: Communication process skills

Ref: Kurtz S., Silverman J., Draper J. :Teaching and Learning Communication Skills in Medicine, 2005.
 Explanation and planning
• Providing the correct type and amount of information
• Aiding accurate recall and understanding
• Achieving a shared understanding
• Planning: shared decision making

Take 5 minutes to think of :

1. What can be an incorrect type and amount of information to give to a
patient ?
2. What can influence patient understanding ?
3. How can I involve patients in the decision making ?
The end of the consultation…
CALGARY-CAMBRIDGE GUIDES: Communication process skills

Ref: Kurtz S., Silverman J., Draper J. :Teaching and Learning Communication Skills in Medicine, 2005.
 Closing the session
• Forward planning
• Ensuring appropriate point of closure

Take 5 minutes to think of:

1. What would you include in the forward planning when managing an
infection ?
2. Which challenges can you encounter at the end of your consultation ?
CALGARY-CAMBRIDGE GUIDES: Summary

Ref: Kurtz S., Silverman J., Draper J. :Teaching and Learning Communication Skills in Medicine, 2005.
Let’s focus now on antibiotic
prescription and use
To prescribe an antibiotic can be easier than not to prescribe one.
Reasons for using antibiotics

Ref: Tompson, A.C. & Chandler, C.I.R. (2021) Addressing antibiotic use: insights from social science around the world, London School of Hygiene and Tropical Medicine
For you what are acceptable
and inacceptable reasons to
prescribe antibiotics ?
Why do we use antibiotics in Gaza ?
• Factors influencing antibiotic prescriptions according to doctors :
(Ref: Bardawil O., Van Erps O., Antibiotics and resistance, HP assessment report, MSF OCB, Gaza, 2021)
• Socio economic state of patient and the patient’s living environment
• The stock availability
• The patient’s physical condition
• Age of the patient
• Time during the day when the prescription is done
• The pressure and threats from the patients
• Proper diagnosis (using blood, urine, stool analysis, clinical examinations, and x-rays)
and identification of the pathogen causing the infection
• Doctor’s awareness of the patient’s medical history
• The location of the inflammation in the body
• The doctor’s (personal) experience with the antibiotic
When you prescribe an antibiotic…

Advise patient on:

• Dose
• Duration of antibiotic course
• If any side effects advise to notify the doctor
Provide information about :
• Antibiotic resistance
• Importance of taking an antibiotic correctly
Ref: https://antibiotic.ecdc.europa.eu/sites/default/files/media/en/eaad/Documents/antibiotics-patient-dialogue-primary-care-prescribers.pdf
Questions