Doctor Patient Communication

Dainius Jakučionis

Vilnius university, Medicine faculty

Family doctor, Cognitive andbehavioural psychotherapist, Teacher

Disclaimer

Why do You want to be a doctor?

•Family

•Money (₺)

•Wanting to help

•Significance

? @�

What is the

aim/goal of

doctor‘s job ?

? @�

“We come unbidden into this life, and if

we are lucky we find a purpose beyond

starvation, misery, and early death which,

lest we forget, is the common lot. I grew

up and I found my purpose and it was to

become a physician. My intent wasn't to

save the world as much as to heal myself.

Few doctors will admit this, certainly not

young ones, but subconsciously, in

entering the profession, we must believe

that ministering to others will heal our

woundedness. And it can. but it can also

deepen the wound.”

― Abraham Verghese, Cutting for Stone

„A physician is a

professional who

practices medicine,

which is concerned

with promoting,

maintaining or

restoring human

health through the

study, diagnosis, and

treatment of disease,

injury, and other

physical and mental

impairments.“

―Wikipedia.org

„I believe a man for a man

should be a man first

and only then can he be a

doctor“― Ernestukas Blb, Facebook friend

Expectations

? @�

The main determinants of health

(Dahlgren and Whitehead, 1991)

Communication

Sender Receiver

Noise

Patients remember

12,8%

After visit After month

17,1-

60%

Mcguire, L. C., Morian, A., Codding, R. and Smyer, M. A. Older adults' memory for medical information:

Influence of elders peak and note taking. International Journal of Rehabilitation and Health, 2000. 5 (2), pp. 117--128.

Patients sue

doctors…

Why…?

? @�

1Jeffrey Allen and Alice Burkin by Berkeley Rice: “How Plaintiffs’ Lawyers Pick Their Targets,” Medical Economics (April 24,

2000);2Wendy Levinson et al., “Physician-Patient Communication: The Relationship with Malpractice Claims Among Primary

Care Physicians and Surgeons,” Journal of the American Medical Association 277, no. 7 (1997): 553-559

• “People just don’t sue doctors they like”1

• The surgeons who had never been sued spent

more than three minutes longer with each patient

than those who had been sued did (18.3 minutes

versus 15 minutes)2

• They were more likely to make “orienting”

comments, such as “First I’ll examine you, and

then we will talk the problem over” or “I will leave

time for your questions” or “Go on, tell me more

about that”2

Patient-centered approach

MK Czerwiec, http://www.comicnurse.com/

MK Czerwiec, http://www.comicnurse.com/

MK Czerwiec, http://www.comicnurse.com/

MK Czerwiec, http://www.comicnurse.com/

1.exploring the experience and expectations

of disease and illness;

2.understanding the whole person;

3.finding common ground regarding

management (partnership);

4.health promotion;

5.enhancing the doctor-patient relationship;

6.the realistic use of time;

Brown J, Stewart M, Tessier S. Assessing communication between patients and doctors: a manual for scoring patient-

centred communication. London: Thames Valley Family Practice Research Unit; 1995. (Working Paper Series 95-2).

• communication,

• partnership,

• health promotion,

Most patients

strongly want a

patient centered

approach.

Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, et al.

Preferences of patients for patient centred approach to consultation in

primary care: observational study. BMJ. 2001;322:468–472.

Facilitating behaviour(Zandbelt et al, 2006)

• Drop a functional/attentive silence

• Non-verbal encouragement to

continue talking

• Verbal encouragement to continue

talking (echoing included)

• Summarize what the patient has said

• Put an open question or an open

request to the patient

• Put a closed question to the patient

• Educated guess

• Factual reflection (paraphrase

included)

• Emotional reflection

• Process reflection

• Respectful statements/praise

Drop a functional/attentive

silence

you give the patient space to

continue his story;

you do not say a word, but

keep on listening attentively;

This does not include: silence during, for example, writing,

looking at the computer screen, physical examination.

you encourage the patient to

continue his story;

non-verbal encouragement,

for example gesture, nodding

or facial expression;

Nonverbal encouragement

to continue talking

Verbal encouragement to

continue talking

you verbally (explicitly or indirectly)

encourage the patient to continue

his story;

• Explicit encouragement (‘Go on’,

Tell? ‘Yes?’);

• Neutral expressions/to give a sign

of attention (‘Uh-huh’, Mmm’)

• ‘Interjections’: brief conclusion,

brief echo, ‘finish sentence’,

unfinished sentence (‘So you want

eh….’, ‘So you…’): not really

facilitating interventions, but a sign of

attentive listening;

Continued…

Summarize what the

patient has said

To summarize the information that has

previously been discussed in the

conversation, particularly what the

patient has said;

Criterion: to repeat >2 facts or 2

facts with explicit reference to a

summary;

Put an open question or an

open request

• ‘How did it start?’; ‘How do

you feel about this?’; ‘How are

your ankles?’ ‘And how is your

blood pressure?’

• ‘What are you afraid of?’

• ‘What aggravates the

complaints?’

Closed question

for certain information;

can be answered with a ‘yes’ or a

‘no’;

‘Is the pain on the left or the

right side?’; ‘Where do you

feel the pain?’;

Educated guess

you sum up patient thoughts

(which are based by virtue of

knowledge and experience);

’You will probably be

nervous.’ ‘You will probably

be tired?’

Factual reflection

you repeat/reflect the essence of

the actual information that the

patient has given;

‘If I understand it rightly

your bowels in particular are

troubling you.’ ‘You would

like to be a bit fitter’

Emotional reflection

–‘I notice that you are upset’

– ‘I see that it startles you’

– ‘I can imagine that it takes you by surprise’

– ‘A difficult time…’.

– ‘It is quite a lot to take in and all at the

same time’

– ‘This must drive you mad’

– ‘No, that is annoying too…’

Process reflection

you denominate or label an observed

process in the conversation;

‘I think we are talking at cross-

purposes’; ‘I think you become

more and more quiet when we

talk about it in this way’;

Respectful statements or

Praise

• ‘I am impressed by the way you

manage to keep on working.’

• (as the patient takes out of

his/her bag a little booklet with

blood sugar levels): ‘Good, you

took everything with you.’

Empathy

? @�

Everything

mentioned

earlier works

only when

used with

empathy!!!

Link: https://www.youtube.com/watch?v=1Evwgu369Jw

Additional

tip

How react to criticism?

Empathy

Agree with

critique

Feedback and

Negotiation

Ask

questions

Try to

understand

‘I agree with...’, ‘It is possible that...’,

‘It makes sense...’

Express your feelings and

opinions diplomatically. Show

understanding. Apologize, if it’s

your fault. Encourage. D.Burns “Feeling good”, 1980;

Jan Praško lecture, 2014;

Listen

Summary

Good communication helps patients

and doctors

Empathic communication skills

improve outcomes

You can learn and practice it

Questions?

Çok teşekkür

ederim