Copyright ridadagoes@yahoo.com COMMUNICATION IN MEDICINE Should doctors learn to communicate? BHP...

Copyright ridadagoes@yahoo.com

COMMUNICATION COMMUNICATION IN MEDICINE IN MEDICINE

Should doctors learn Should doctors learn to communicate?to communicate?

BHP Lecture series

Author Ridad Agoes

Dept. Bioethic and Humaniora,

Fakultas Kedokteran Universitas Padjadjaran.

Jakarta18 September 1940

MPH, Univ. of California Los Angeles, 1981

ProfessorDepartment Parasitology School of Medicine, FKUP

Jln. Parasitologi 11Bandung

Ph.D. in Basic Medical SciencePadjadjaran Univ. 1997

MD, FK UNPAD, 1968

Email: ridadagoes@yahoo.com

Communication Issue

Breaking bad news“I was 25 years old and working in an

emergency unit. A young lad was brought in with severe head injury following a road accident. We tried to resuscitate him but it was useless. I had to go out and tell his parents. I didn’t have a clue what to say. I didn’t know how to handle the situation. I just said ‘sorry’ and ran out of the room. That was over 30 years ago and things aren’t really much better now.

COMMUNICATION ISSUES

During his life time career of 40 years, a doctor will spend approximately 150.000 to 200.000 patient contacts and communication

Doctors talk to patients and their families more often than performing medical procedures

Unfortunately many doctors are not prepared or ill trained to communicate with patients

COMMUNICATION ISSUE

Many of the complaints received by the hospital are about doctors’ or nurses’ attitudes and miscommunication

- Many medical malpractice claims and patient complaints are caused by emotional and psychological factors due to failed communication.

- Hospital systems can also contribute to communication problems. Clinics that do not provide good information and clinics that run late can result in dissatisfaction and hostility among patients.

•What else ?

Litigation

• More and more patients are not only willing complain, but also prepared to sue

• Poor handling of complaints contribute to increase in litigation

• Most patients want an explanation of what went wrong and an apology and many are forced to take legal action when their doctors are not communicating

COMMUNICATION

What is the definition of COMMUNICATION?

COMMUNICATION- A transactional process involving cognitive sorting, selecting and sharing of symbol in such a way as to help another elicit from his own experiences a meaning or responses similar to that intended by the source

In other word Communication is a process by

which an individual transmitted stimuli (usually verbal) to modify the behavior of other individual.

Elements of

Communication Source

Message Media

Target (Feedback)(Impact)

Effective Communication

• If the communication could create : • Understanding• Satisfaction• Influences the attitude• Good interpersonal relationship• Action

Communication Skill

• communication skills include :• “ ……. the ability talk to patients on

emotional level, to listen, to assess how much information a patient wants to know and to convey information with clarity and sympathy”

The seven C’s of

Communication Credibility

Content Context

Clarity Consistency

ChannelsCapability of the audience

Communication in Medical Context

•Verbal Communication •Non-verbal Communication

Verbal Communication

• Speaking to the person• Look straight in the eye • make eye-ball contact• Clear message • Relevant, interesting• Good listener• Allow them to digest the message

and reply

Non – verbal Communication

• Body language • Gesture• Facial expression. • Head movements. • Touching.

•Why communicate ?

What for ?

• Providing information to patients

• Relieving anxiety and stress• Offering emotional support• Giving instruction to nurse and

patient

•What else ?• (after 10 minutes break)

“When doctors use communication skills effectively, both they and their patients benefit”

Effects of Good Communication skill

• Patients’ problems are identified more accurately

• Patients are more satisfied with their care and can better understand their problems

• Patients are more likely to comply with treatment

• Patients are less likely to complain

•Is there any barrier to effective communication ?

Doctors playing God

• There is a certain attitude that doctors “is basically God”. But with attitude changes, they were asked to put aside their hard earned status and accept questioning from patient

Lack of skill and understandingUndervaluing the importance of

communicating Negative attitude Lack of inclination to

communicate Human failings Inconsistencies in providing

informationLanguage competence

Elements of

Miscommunication Many patients complained of nurses and doctors

saying different things Patients also complained that they had no

opportunity to talk to the doctor They complained about lack of involvement

in decisions about their care They were given no information about

test results

So, why is change needed ?

Cultural reasons There is a major cultural change

within the society where many patients (and their families) are prepared to challenge the way hospital services are providedThis cultural change and

attitude can be difficult for health professionals to manage, and therefore requires changes in communication behavior

Satisfaction and treatment outcome

•Another reason for change is the evidence that improving doctors’ communication skill can increase patient satisfaction and improve treatment outcomes

“Helping doctors improving the way they communicate with patients can also contribute to increasing job satisfaction and improving doctors’ morale”

So, is there room for improvement ?

Room for Improvement

(1) Dealing with difficult

patients : some patients are full of anger, aggressive and hostile and the way doctor manage them will influence the outcome

Room for improvement (2)

•Dealing with different need of patients:

•Some patients have mental health problems, acute sensory impairments, and language barrier

Room for improvement (3)

“Reducing errors and improving treatment approach:

Doctors should review mistakes they have done and improve their approach to handling patients by improving their clinical effectiveness

•What else ?

Ten bad listening habit to avoid

Dismissing patient’s complaints as irrelevant or uninteresting

Resistance to listening to patient becomes more pronounced as doctors get tired or bored

Ten bad listening habit to avoid (2)

“Pretending to listen or acting to look attentive”.

• Feigning attention is risky. Patient usually can sense when a doctor is pretending to listen

“Avoiding complicated subjects”.

• Doctors usually avoid listening to complicated subjects and prefer simple complaints

“Too many distractions”. • Do not allow distraction

interfere during communication with patient.

“Finding fault with the speaker” .

• Avoid finding fault by learning to concentrate more on content rather than on the speaking style

“Listening only on fact” . Learn also to include listening to

the emotional aspects of patient’s complaints

“Becoming too enthusiastic” . • Avoid getting carried away by

patients explanation

“Doctors becoming antagonized by patient’s emotional complaints” .

Certain statement made by patient may trigger negative emotional reaction from the doctor

“Listening is distracted by taking of notes” .

First get the message, and then write down notes

“Doctors did not focus on what is being said” .

If communication is slow, listening becomes bored and the mind may wander somewhere else. Learn to avoid thinking of something other than what patient is trying to communicate

Thank you ….

Copyright ridadagoes@yahoo.com COMMUNICATION IN MEDICINE Should doctors learn to communicate? BHP...

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