Post on 17-Jan-2016
Illness Behavior &
Dr - Pt Relationship
Illness Behavior
• 20% of the
patients neglect
their illness
I am a patient
I am weak
I need help
Causes of Denial of Illness
It is not
easy for
the
patient to
show his
weakness
Doctor’s authority
Illness BehaviorFactors Affecting Illness Behavior
Gender
Age
Race
Learned behavior
Accessibility to health services
Symptom presentation
Lay beliefs
Social Class
Previous experience
Trigger factors Locus of control
Factors Affecting Illness
Behavior
Symptoms :
• severity of the symptom
• Patient ideas & understanding about the symptom
• Patient previous experience with this symptom
Factors Affecting Illness Behavior
Accessibility to Medical services
Physical barriers can make health
facilities difficult to reach
H
Factors Affecting Illness Behavior
Previous experience with health services
???
Bureaucratic barrier can make
health services difficult to obtainH
Illness BehaviorLearned behavior
Somatic
complain
Inappropriate reaction (Pt. Family & Dr.)
Somatic fixation
Trigger Factors
Another Interpersonal Crisis
Trigger FactorsEffect of the Problem on Pt. Activity
Trigger Factors
Pressure from Family or Friends
The setting
of arbitrary
deadline
or putting limit
Trigger Factors
Illness Behavior Final Message & Conclusions
Doctors need to understand illness behavior
for proper understanding of their patients
Doctors need to explore & acknowledge
patient’s believes & worries
Communication Skills
Objectives:Objectives: To improve your skills in exploring and
acknowledgement of patient’s thoughts and
feelings.
To increase your awareness about your
patients’ verbal and nonverbal cues.
To help you to develop new communication
skills in order to deal with your patients’ cues.
Communication Skills
Exercise 4
• Write down three words that best describe the way you want to be perceived by your patients:
1)……… 2) ………… 3)……….
• Write how can you use your communication
skills to convey this message?
1) ……………..........
2) ……………..........
2) ……………..........
Who is Who is the the
patientpatient?!?!
Awareness of Patients’ verbal and Nonverbal
Cues
Classification of
Communication Skills
Verbal communications
Nonverbal communications
Communication Skills
Verbal communications
• How to formulate questions
• Discussion , explanation & Advice
• Understanding pt. verbal cues
Verbal communications
How to formulate questions
• Direct Qs (Yes or No)
• Suggestive Qs
• Why Qs
• Many Qs at a time
• Indirect Qs (Open-ended Qs)
Communication Skills Nonverbal communications
1 - Body language &
Facial expression
2 - Appearance
3 - Touch
4 - Paralanguage
5 - Body bubble
6 - Environment
Verbal communication for tilling
information , but nonverbal
communication for negotiation
• Verbal communication
• nonverbal communication
Reference: (McCaskey 1979 )Rakel
• 10% of communications
• 90% of communications
Nonverbal Communication is an universal language
Mind & Body
Body Language
Facial Expression
Appearance
Body Language
Hand to face Expression
Body Language
Hand Expression
Body Language
Hand Expression
Body Language
Body Posture
Body Posture
Body Language
Touch
The effect of touchThe effect of touch
CommunicationsParalanguage
• Velocity
• Volume
• Tone
• Pause
• Others
Body Language
Body Bubble
????
Body Bubble
15 - 46 cm 46 cm - 1.2 m 1.2 m - 3.6 m More then 3.6
Public zoneSocial zonePrivate
zone
Intimatezone
Communications
Environment
Dr.
Pt.
Couch
CommunicationsEnvironment
CommunicationsEnvironment
Discuss the advantage of this style of
communications
???
Doctor - Patient Relationship
Doctor - Patient Relationship
Doctors - Patient Relationship
Why doctors need to have a positive relationship with their pt. ???
How dose this relationship start & how it progress ???
What are the skill needed to build a positive relationship ???
Doctors - Patient Relationship
Why ???
• For the patient care &
satisfaction
• For doctor satisfaction
• For effective use of
resources
Doctors - Patient Relationship
Doctors - Patient Relationship
Patient positive role
Doctors - Patient Relationship
How ???
• Professional relationship
• personal relationship
• Intimate relationship
To Establish & To Maintain Dr-Pt Relationship
• Welcoming the Patient
• Showing respect
To Establish & To Maintain Dr-Pt Relationship
“ Don’t waste my time , just say yes or no”
The ability The ability
toto listenlisten
Doctor - Patient Relationship
Understanding
&Empathy
Review of
Consultation
Models
Hospital Model of Consultation
Computerized chick lest of history taking
A case of 2
weeks headache
Complete history, physical Examination & Investigations ?!
Psychosocial component of the
physical problems
.
Byrne & Long 1976
Patient Centered Doctor CenteredConsultation Consultation
Use of pt’s knowledge and experience
SilenceClarification
Listening Interpretation
Reflection
Use of doctor’s special skills and knowledge
Analyzing Gathering
Probing Information
The Real Reason for Consultation
Failure to explore the
real reason of
patient problem is
the main
reason of
consultation failure
(Byrne & Long 1976)
The Expanded Model of Consultation
Management of
Presenting Problem
Management of
Continuous Problem
Modification of Help
Seeking Behavior
Opportunistic health
Promotion
(Stott & Davis 1979)
Modification of Help
Seeking
Behavior
• The child as the presenting complain
• Frequent attender
• Somatic patient
Modification of Help
Seeking Behavior
• Sick Role
• Secondary gain
Modification of Help Seeking Behavior
• Denial
• Poor Compliance
Modification of Help Seeking
Behavior
• Hidden agenda
• Displacement
Pendleton 7 Tasks
1. To define the real reasons for pt attendance
2. To consider other problems
3. To choose with the pt. appropriate action for
each problem
4. To achieve a share understanding
5. To involve pt. in the management
6. To use time & resources effectively
7. To establish & maintain Dr.-pt. relationship
Patient’s Ideas :
Patient’s Concern :
Patient’s Expectation
Explanation
Skills Needed To Explore the Real Reasons for Pt. Attendance
• Open ended questions
• Indirect questions
• Use of silence
• Recognition of pt cues
• Immediate response to
pt. cues
• Confrontation
• Reflection
• Probing
• Summarization
Pendleton Third Task
With the patient to choose an
appropriate action for each problem.
Why
With the patient to choose an
appropriate action for each problem
• Patient responsibility
• Patient compliance
Pendleton Fourth Task With the patient to achieve shared
understanding of the problem
Doctor Patient
Knowledge Questions
Doubts Theories
Experience
KnowledgeQuestions
DoubtsTheories
Experience
Pendleton Fourth TaskWith the patient to reach Shared
Understanding of the Problem
The patient has the right to
know all important
details
Pendleton Fifth TaskTo involve patient in the
management
Pendleton Sixth TaskTo use time & resources
appropriately
Pendleton Seventh
Task
To Establish & Maintain Dr.-Pt.
Relationship
Final Message & Conclusions
• A lot of practice is needed to be able adopt
the proper consultation model