The role of an effective physician;A psychological perspective

Mr. R.M.G. Karunarathne,Clinical Psychologist & Lecturer in Psychology

Department of Psychiatry,Faculty of Medicine,University of Jaffna.

19.03.2016

Structure of the Talk

1. Importance of effective communication2. Teaching/Practice of effective coping

strategies for stress/anxiety/worries etc. of the patients

3. Involvement with a multidisciplinary team

4. Referrals for the consultations

Good physician treats the disease; the great physician treats the patient who has the disease ~ William Osler (Canadian Physician, 1849-1919)

1. Importance of effective communication

What is Communication?

What does it mean to you?• The process of communication is what allows

us to interact with other people; without it, we would be unable to share knowledge or experiences with anything outside of ourselves. Common forms of communication include speaking, writing, gestures, touch and broadcasting.

• Wikipedia definition

The Communication Equation• What you hear• Tone of voice• Vocal clarity• Verbal expressiveness 40% of the message

• What you see or feel• Facial expression• Dress and grooming • Posture• Eye contact 50% of the message• Touch• Gesture

• WORDS … 10% of the message!

Effective Communication Skills

Effective Communication skills

Eye contact & visible mouth

Body language

Silence

Checking for understanding

Smiling face

Summarising what has been said

Encouragement to continue

Some questions

Importance of Effective Doctor-patient Communication

1. Accurate diagnosis. 2. Enhancing patient compliance to treatment

plans. 3. Contributing to doctor’s clinical competence

and self assurance.4. Contributing to patient satisfaction.

Importance of Effective Doctor-patient Communication

5. Contributing to cost and resource effectiveness

by preventing unnecessary prescriptions for

medication that are either wrongly prescribed

or not properly used by patients.

Physician need To Acquire

Core communication skills:• Doctor-patient interpersonal skills.

• Information gathering skills.

• Information giving skills.

Core communication skills:1- Doctor-patient interpersonal skills:• Creating an appropriate physical environment.• Greeting others.• Empathy.• Showing respect and interest.• Showing warmth and support.• Using appropriate language.• Developing a collaborative relationship.• Closing the interview.

Core communication skills:

2- Information gathering skills:a) Using an appropriate balance of open to closed questions:* Open question:• To achieve information.• To allow patients the freedom of response.• To establish an atmosphere of two-way communication.• To assess the type and level of patient vocabulary.*Closed questions:• To achieve specific information.• To allow a limited choice of response.

b) Silence:• To allow time for the patient to collect his

thoughts.• To assess levels of anxiety.

c) Clarifying the information given to the patient.

d) Active listening: To show that the therapist is

attending closely the patient.

e) Sequencing of events.

f) Directing the flow of information.

g) Summarizing.

Core communication skills:

3. Information giving skills: 1. Providing clear and simple information.

2. Using specific advice with concrete examples.

3. Pushing important things first.

4. Using repetition (restatement).

5. Summarizing. 6. Categorizing information to reduce

complexity and aid recall. 7. Using tools such as diagrams, written

instruction and technical aids to explain the information being given.

8. Checking patient understanding of what has been said.

9. Asking patients to repeat back what they had heard and understood.

2. Teaching/Practicing of effective coping strategies for

stress/anxiety/worries etc. of the patients

Effect of Prolong Stress

• Thoughts:– I’m sick – I can’t cope – I have no enough time– It will never end– Difficult to forget, ……..

• Emotions– Irritable– Bad tempered– Angry– Anxious– Sad– Hopeless– Helpless– Intolerant– worry

• Physical sensation– Hear racing– Breathing fast– Pain in muscles – neck, shoulder, back pain,

abdomen etc.– Hot, sweaty– Restless– Bladder or bowel problems– Headache……

• Behaviour– Unable to settle– Sleep disturbances– Crying– Smoking more– Using drugs– Alcohol usage– Eating more or less– Shouting and arguing frequently– Criticizing ……………

Possible coping strategies in you clinic

• Groups- – Alcohol/ drugs addiction group– Somatoform/ stress group

• Home visit• Arranging peer groups in villages (eg. Geriatric

groups)• Introducing worry or worry free zones• Laughter groups

3. Involvement with a multidisciplinary team

Case scenario

• Mr. Pradeepan is a 45 years old, single, farmer who is living alone in a rural area in Jaffna.

• He came to your clinic for the consultation and complains that he feels suddenly breathless, a tightness of the chest, and fear that he will collapse.

• He has met few medical doctors including a cardiologist too before he comes to your clinic.

• The cardiologist has not found anything medically wrong with him.

• In questioning further, you have found that there are certain circumstances in which he gets these symptoms.

In Psychotherapy (CBT) • Formulation

Protective factors

(Modifying factors

Perpetuating factors(Maintaining factors

Predisposing factors

(Vulnerability factors

Problem/s(Presenting problems

Precipitating factors(Trigger)

Protective factors

(Modifying factors

Perpetuating factors(Maintaining factors

Example

Genetics, Family history, psychiatric history, major life

event……

Depression, Stress, panic, substance misused, anxiety, sleeping issues….

Argument, death, relationship breakdown, loss of job …….

Supportive family, friends, healthy life style, spirituality ….

Unhelpful behaviours,Unhelpful thoughts,Somatic symptoms

The Psychological Treatment plan

• Explore the vicious cycle• Exploring safety behaviours• Providing formulation to the patient• Examining evidence for maladaptive belief and

creating alternative belief (thought records)• Doing some behavioral experiments

(Situation/prediction/behavioural experiment/outcome/what was learnt)

The patients you can work out with a multidisciplinary team

• Panic attacks• OCD• Depression• Anxiety• Somatoform• Sexual dysfunctions• Children with difficult behaviours• Personality disorders• Family issues• Substance misused/drugs addiction

4. Referrals for the consultations

You can refer all the Psychotic Patients to consultant psychiatrists

in the peninsula

Thank You for

Listening