Patient doctor relationshipprof .Dr Elham Aljammas

MAY2015l14

Physician’s ResponsibilitiesFreedom of choiceResponsibility to improve communityResponsibility to patient is paramountMust support access to medical care for all peopleHuman dignityHonestyResponsibility to societyConfidentialityContinued study

Patients rights

•Right to give informed consent•Right to privacy

•Right to be informed of advantages and potential risks of treatment

•Right to refuse treatment•Right to confidentiality–Privileged communication

Patient expects from doctor....»A cure•Medication•To be listened to

•Sympathy•Advice- he understands

•The ‘answer’•A sick note•What they want (agenda)

•Comfort•A chat•No harm

•Professionalism & Respect•To be told what to do

•To feel better•The truth

They feel ill physicallyThey feel ill mentallyThey are lonelyThey want time off workNeed adviseDon’t know who to turn toMarital/family problemsLegal reasons

Why a patient goes to doctor..

Expectations

Doctor expects from patient...

•Trust•Compliance to treatment

•Agreement•The truth•Respect

•They want to get better•To be listened to•To obey the ‘Rules!’

Doctor Patient Contacts

The nature of the relationship determines the success or otherwise of the contact

Communication and Diagnosis

Patients who feel at ease and who are encouraged to talk freely are more likely to disclose the real reason for consultion

Communication and Treatment

Advice ,reassurance and support from the doctor can have a significant effect on recovery

(The placebo effect)

•clinical competence used to include the medical technical knowledge, physical

examination, and medical problem solving. •while the Communication was missing from

the list .•It is clear from the literature that better

physician communication skills improve patient satisfaction and clinical outcomes and that good communication skill can be taught and learned

Patient controlled consultation“You’re paid to do what I tell

you”!!

The Paternalistic Approach

“If I’ve told you once I told you 1,000 times, stop

smoking”!!

Paternalism

The traditional D-P relationship

Doctor Takes on role of “parent”

Patient submissive

Doctor centred consultation style:

Paternalistic - doctor is the expert and patient expected to cooperateTightly controlled interviewing style aimed at reaching an organic diagnosis.

Patient Centred consultation style

Less authoritarian - encourages patient to their own feelings and concernsOpen questioning, interested in psycho-social aspect of illness

Consultation Styles

It’s serious isn’t it doctor?

Patient centred clinical interview

Doctor– history examination investigation

results in a differential diagnosisPatient –

ideas, expectations, feelings,results in an understanding of patients beliefs

Length of ConsultationAverage 8 minutes

Makes patient centred consultation styles more

difficult.

Goals of Communication Teaching and Learning

•Doctors with good communication skills identify patients' problems more accurately

•patients are more satisfied with their care and can better understand their problems, investigations, and treatment options

•patients are more likely to adhere to treatment and to follow advice on behaviour change

•In ConclusionCommunication techniques are a learned skill.

Unfortunately, many health care providers discover this after an adverse event occurs. If this

is the case in your facility, turn that negative experience into a positive teaching tool by asking

these questions :•What can we learn from this ?•How can we prevent a recurrence ?•Is there anything we can do now to alleviate the

situation ?

General communication skills:

0 1 2 3 4

(1)Greeting the patient (2)Using patient name (3)Self introduction (4)Role & nature of interview (5)Obtaining consent (6)Empathy & respect (7)Eye contact (8)Posture of student (9)Position of student (10)Facial expression Information giving skills:

0 1 2 3 4

(11)Simple, clear & no jargons (12)Assess education of patient (13)Putting important thing first (14)Chunk & check (15) Summarizing (16)Giving request (17)Asking what else (18)Getting feedback (19)Safety netting (20)Arrange for next visit Closing skills:

0 1 2 3 4

(21) End summary (22) closure & thanks to patient

Thank you