THE HUBERT KAIRUKI MEMORIAL UNIVERSITY

DEPARTMENT OF BEHAVIORAL SCIENCESTOPIC: DOCTOR PATIENT COMMUNICATIONFACILITATORS: DR. A. J. LIWAGROUP NO: 32

MEMBERS:

⦁ JANATH AZIZ⦁ DAUDI GEORGE⦁ MARTHA MLAY⦁ IRENE JEROME⦁ CASIAN AMOR

CONTENTS

⦁ INTRODUCTION⦁ OBJECTIVES⦁ DEFINITION OF TERMS⦁ MAIN PRESENTANTION⦁ SUMMARY ⦁ CONCLUSION⦁ RECOMMENDATION ⦁ REFERENCES

INTRODUCTIONThe first visit for a patient is crucial encounter that can either lead to development of a therapeutic patient to doctor relationship or end in dissatisfaction on both sides and search for another care provider. The medical interview goes well beyond the capture of medical information in order to make a diagnosis. It is the building block upon which the physician’s relationship with the patient is constructed. The interview is filled with the opportunity of the patient to share the information about themselves and for the physician to get to know the patient, so that a patient becomes a person and not just a medical problem. By understanding the patient who, they are, and the expectations that they have of the doctor the doctor can formulate medical judgments for that particular patient as well as derive satisfaction from health patient doctor relationship

OBJECTIVES

At the end of this presentation everyone should be able to;1) Understand and explain the meaning of DOCTOR TO PATIENT COMMUNICATION2) Produce effective communication between a doctor and a patient.3) Understand and explain communication difficulties4) Explain communication failures5) Practice effective methods of doctor to patient communication

DEFINITION OF VARIOUS TERMS

⦁ COMMUNICATION. This is the process of exchanging information and feelings from one person /group to another⦁ VERBAL COMMUNICATION. It refers to a process of exchanging information through the words of mouth that is spoken rather than written words⦁ NON-VERBAL COMMUNICATION. This is sending information by the use of unspoken language like gestures, facial expression, body language, sounds and postures⦁ DOCTOR. A person who maintains human health through the practice of medicine.⦁ PATIENT. Is a person who receives a medical care.⦁ DOCTOR TO PATIENT COMMUNICATION. This verbal or non verbal process through which a doctor obtain and share information with patient there by developing a therapeutic relationship

MAIN PRESENTATION

Here are the seven traits listed by a patients, along with the patients definition of these traits:Confident: The doctor's confidence gives me confidence.Empathetic: The doctor tries to understand what I am feeling and experiencing, physically and emotionally, and communicates that understanding to me.Humane: The doctor is caring, compassionate, and kind.Personal: The doctor is interested in me more than just as a patient, interacts with me, and remembers me as an individual.Forthright: The doctor tells me what I need to know in plain language and in a forthright manner.Respectful: The doctor takes my input seriously and works with me.Thorough: The doctor is conscientious and persistent.

Common expectations patients have for their physicians are: Primary Expectations- • Clinical CompetenceSecondary Expectations- • Professional • Respectful • Polite • Sincere • Interested • Effective Communication Skills-Verbal and Non-Verbal

EVIDENCE FOR COMMUNICATION DIFFICULTIESIn listening to a doctor, we hear frequent reports of communication difficulties. Relevant evidence comes from two main sources: from patients’ point of view, how satisfied they are with the medical communication; and from doctor’s point of view, how successfully the patients remember and carry out instructions.

Patient satisfactionAlthough most patient express overall satisfaction with the medical care they receive, the one notable exception is their satisfaction with the communication. Between10 and 60% of discharged patients report being dissatisfied and having wanted more information. Further insight into patient’s satisfaction is provided by a study of 800 consultations at a walk-in-children’s clinic in America. On average only 5% of doctors’ conversation was personal or friendly and yet the amount of non-medical or sociable conversation was directly related to mothers’ satisfaction with the visit. The more satisfied the mothers were the more they were to carry out prescribed treatment. It is interesting to note that most doctors think that they have been friendly but less than a half the patient shared this impression. In the study satisfaction was also related to another of the patients’ major goals: the feeling that their main concern was dealt with.

Remembering and following adviceIn the study at the children’s clinic it was found that when interview was done after the consultation nearly half of the women were unclear about what could be the cause of their child’s illness. Moreover less than a half of them carried out doctor’s advice in full. These discouraging findings are not all typical however. About 45%of medical information is likely to be forgotten and roughly one half of all patients can be expected not to follow doctor’s instructions.

EXPLAINING COMMUNICATION FAILURES

Explanation for communication failures have been divided into three which are⦁ Patient characteristics⦁ Cognitive process⦁ Motivational process

Patient characteristicsDoctors say that some patients complain or are uncooperative no matter the efforts made on their behalf. That is to say their behavior is directly attributed to their personality. Although this may be true in some individual cases, no consistent personality differences have been found to distinguish between dissatisfied and noncompliant patients, similarly they do not differ systematically by age, sex, race, marital status, social class or intelligenceThis is not to say the variables are irrelevant, but they do not provide general understanding of a problem. Moreover most patients appear to be dissatisfied just with the communication but perfectly satisfied with other aspects of medical care.

Cognitive processCommunication problem may as well occur because patients do not understand or do not remember what they are told. This may be due to lack of primary medical knowledge or complexity of information presented by doctors.It has been shown that most people do not know the location of some organs and may have misleading theories on how the body works. This lack of information may lead to misinterpretation of explanations given by a doctor to patient.Also many doctors use technical terms in which patients are not familiar, and provide the information in too complex form. Leaflets produced by doctors may be too difficult for as much as a half of a population to read and understand the information.

It is seen that the failure of memory is a big problem and the more the information is given the more likely to be forgotten. The following are the suggestion on how to improve the cognitive process.⦁ Increasing the comprehensibility of written material by using shorter words and sentences.⦁ Explicit categorization. Doctors should categorize the material for patients and announcing and repeating the categories by names. Example I will tell you: what is wrong with you, what test are needed, what will happen to you, what treatment you need and what you should do to yourself.⦁ Repeat the most important bits of information.⦁ Use of concrete rather than general statements. Example` you need two weeks full holiday’ instead of `you must take proper holidays’

Motivational processesCognitive explanations assumed that doctor and patient had common goal but communication problem arises due to technical reasons. This part explains that communication problem arises because most doctors do not recognize goals of their patient or because goals are in conflict with doctor’s wishes.Lack of doctor’s recognition is also seen in assumption made by doctors that compliance is always the best. In some conditions where the patients may be aware of their conditions and may be placed better to make decision than doctors. Their decision not to take a certain medication may be good grounds but may be labeled as a non compliant behavior.Motivational conflicts are inevitable sometimes but can be minimized if doctors could recognize patients’ goals even those which may not be explicit. They should also improve their interview skills. The doctor must appear relaxed and unhurried and anxious to know the patient’s point of view. The doctor must use appropriate eye contacts and not simultaneous writing and reading medical notes. The distance between doctor and patient should be kept to minimum and some rapport established with non medical conversation.

COMMUNICATION SKILLS

Basic Elements found in the medical interview/interaction with the patient. Initial Encounter- The First Impression-the most important one that occurs! The patient, in the first few moments, will decide if he/she will feel comfortable with the doctor and most of this first impression is made not on what the doctor says, but how he/she says it and how he/she interacts with the patient

Be Prepared-know who the patient is before you walk through the door

Don’t fumble for a name after you are in the room. Never call a patient over the pediatric age group by their first name without permission, it is disrespectful

Make eye contact with the patient, shake hands, and introduce yourself

Indicate your role to the patient. If you are a medical student, make sure the patient knows that and does not assume you are the one in charge of their care. You cannot assume that the patient will know who you are.

Set the patient at ease and build rapport Most patients will be nervous meeting the doctor for the fist time. If appropriate, you can consider an initial inquiry into nonmedical areas of lift to assist in developing a relationship with them as a person.

Have a seat Where you are positioned relative to the patient is important. It is intimidating to the patient for you to stand over them. The patient should not have to look up to you to make eye contact.

Let the patient tell their story Ask the patient to explain why there are here.

CONDUCTING THE INTERVIEW

As the patient explains the chief complaint and the history of the present illness, you can question the patient using the following skills and techniques Use open-ended questions Direct/closed-ended questions Avoid leading questions Ask one question at a time Keep the interview organized and use transition

statements Learn about the patient and his/her family Encourage the patient to ask questions Listen Accurately to the Patient

SUMMARY

Communication difficulties can be explained from two main points of view; from patient point of view on how they are satisfies with the medical communication and from doctors’ point of view on how patients are able to carry out medical instructions.Explanations for communication failures are divided into three: patient’s characteristics cognitive process and motivational processesMotivational conflicts can be reduced if doctors could recognize the goals of the patients and use appropriate interview skills.

CONCLUSION

All patients to doctor communication are influenced by expectations of both sides. If doctors have unfair expectations patient then effective relationship will not develop. Likewise if the patient’s expectations are not met a patient will not be able to follow doctor’s instructions properly. So effective communication is needed for proper medication

RECOMMENDATION

It is important for doctors to ensure good communication with their patients since good communication is the building block upon which the physician’s relationship is constructed

REFFERENCES

⦁ A. C. P. Sims. &W. I. Hume: lecture notes on behavioral science Haftel, Lypson, Page August, 2008