Chapter 15: Doctor Patient Communication

What are some barriers to doctor-patient communication from patient side?

-Anxiety/fear -unrealistic patient expectations -language -health literacy -Illness or other injury -Altered mental state -medication effects -gender differences -racial or cultural differences

Why is doctor-patient communication important?

-Communication is an essential route to information -Failed communication can have negative health effects -Effective communication can have a therapeutic effect -Communication can lead to effective behavior change

6 steps of clinical decision-making

-Defining the problem -Defining the outcome goals -Generating alternative solutions -Selecting the best solution -Implementing the solution -Evaluating the outcome

What are some limitations of doctor-patient communication?

-Doctor-patient communication is not always effective -Patients' understanding and memory is limited -Compliance with doctors' advice may be lacking -A substantial proportion of patients' problems remain undisclosed and undetected -The proportion of dissatisfied patients remained surprisingly, and disappointingly, constant over 25 years

Therapeutic Medical Encounter: CARE

-Help patients Cope with stress and illness or with bad news -Activate patients' participation in self care and well being -Increase patients' sense of accountability -Responsibility, self-esteem and confidence -Empower patients' own decision making about their health

What are some good reasons for good doctor/patient communication?

-If patients don't like you they won't follow your instructions - If they don't like you they change doctors - If they don't like you they don't pay their bills as much

What are some ways to become culturally competent?

-Learn about your own culture -learn about other's culture -Identify and retain cultural informants -Attend cultural events in the community -Reserve judgment about behaviors and intentions until you understand the cultural context in which they occur

What are some trends in the role of gender in doctor-patient communication?

-Studies have identified gender differences in doctors' communication -Female doctors use more patient-centered communication styles -Males tend to be more directive and controlling -Both male and females patients seem to feel more empowered by communicating with female doctors -Future research requires exploration of the relationship between physician's gender and communication style and patient communication needs

What are the trends in the role of culture in doctor-patient communication?

-cultural differences may be reflected in the ways health care professionals and patients communicate with each other -Discrepant, culturally specific explanatory models of health and illness may lead to misunderstandings -cultural differences play a role in how patients perceive and evaluate their doctors' conduct -When working with patients from ethnic minorities, doctors have poorer interpersonal skills, provide less information and use a less participatory decision-making style -As western societies are becoming increasingly multicultural, more research is needed about the role communication may play in perpetuating health inequalities

10 principles of cultural competence

1. have an understanding of race, ethnicity, and power 2. understand historical factors about the group 3. understand psycho-social stressors 4. understand cultural differences within minority groups - very heterogeneous 5. understand culture within the family life cycle and in an intergenerational conceptual framework 6.understand the differences between culturally acceptable behaviors vs. psychopathological characteristics 7. understand indigenous healing practices 8. understand cultural beliefs around health 9. understand health service resources for minority patients 10. understand public health policies

culturally competent system

1. recruitment efforts 2. interpreter services 3. training services 4. appropriate materials 5. appropriate health care settings

Most doctors interrupt a patient describing their main concerns within ___ seconds.

18 secs

What is the estimated percentage of patients that do not adhere to medical advice?

50-75%

ILS

A patient-centered communication technique: Invite, Listen, Summarize developed to combat high control techniques of asking yes/no questions

Cultural and linguistic competence

A set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals that enables effective work in cross-cultural situations

What is adherence?

Adherence refers to the extent to which the patient follows the prescribed treatment regimen

Most often lawsuits tend to be based on ________.

Appearances. Mal practice suits are based more on perceived treatment than technical incompetence.

What are some social/macro characteristics of patients associated with non-adherence?

Characteristics of individual's social situation, lack of social support, family instability/disharmony, patient's expectations and attitudes towards treatment, insecure housing, environment that supports non-adherent behavior, competing or conflicting demands, lack of resources

What are some sources of miscommunication from the patient?

Characteristics, knowledge, attitudes towards symptoms

What are some personal characteristics of patients associated with non-adherence?

Demographics, sensory disabilities, type and severity of psychiatric disorder, forgetfulness, lack of understanding

True or False: Patients prefer physicians who do not adopt the more affiliative style.

False

True or False: The search for patient characteristics responsible for non-adherence was successful.

False

True or False: Your doctors knows which medicine you are taking, so you don't need to remind him or her?

False

True or false: It's not the doctor's business to know about your personal life, so he or she shouldn't ask you about anything other than health matters

False

True or false: Its okay to fudge the truth about smoking or dieting when talking to your doctor.

False

True or false: Culture is overt and cultural rules are not discussed until a rule is broken

False. culture is not overt

What is the authoritarian doctor perspective?

Focuses on ways doctors use their authority to control the doctor-patient interaction

What is the most appropriate form of touch?

Handshake

What can lead doctors to the more affiliative style of communication?

Having a positive view of the patient

Competence

Implies having the capacity of function effectively as an individual or organization within the context of cultural beliefs, behaviors, and needs presented by consumers and their communities

What are some advantages of doctor-patient communication?

Improvement can lead to -great patient satisfaction with health-care services -increased patient adherence to treatment regimens -decreases in anxiety and distress on the part of patients -improved health promotion and disease prevention -better mental health in doctors -quicker recovery from surgery -shorter lengths of stay in hospital

What are some health beliefs of patients associated with non-adherence?

Inappropriate or conflicting health beliefs, competing sociocultural and ethnic folk concepts of disease and treatment, implicit model of illness

What is the result of non-adherence?

Increase mortality and hospital cost

What are some characteristics of doctors that are associated with adherence?

Keeping good eye contact, smiling, leaning towards the patient can be interpreted as demonstrating interest and consideration, perceived interpersonal competence, social conversation, being understanding of the patient's belief system

What are some sources of miscommunication from the health care provider?

Not listening, use of jargon, baby talk, non-person, stereotypes

Trends with the role of culture/ethnicity/race in doctor-patient communication

Studies have identified physician bias towards hetero-cultural groups -perceived high substance abuse problems -perceived less likely to be receptive to healthy lifestyle changes -perceived lower educated -lower rates of paint treatment 0higher rates of comments ignored

What are some barriers to doctor-patient communication on the physician or system side?

Training, language, time constraints, system constraints, gender differences, fear of litigations

True or False: Understanding one's own software (or culture) is a first step

True

True or False: there was a link found between patient satisfaction and compliance or adherence

True

True or false: awareness and knowledge increase our choices -leads to greater opportunities for successful encounters

True

True or false: we often misinterpret the actions of others by not understanding their cultural norms

True

What are the major criticism of doctors' traditional communication style?

Used a rigid agenda Little listening to patients' account Little open discussion of treatment options

Doctor-centered style

Uses the doctor's knowledge and skill, for example, through asking questions

Patient-centered style

Uses the patient's knowledge and experience through techniques, such as silence, listening and reflection

Is it sometimes okay to break eye contact?

Yes, you don't want to seem creepy

What is the interactive dyad perspective?

both doctor and patient shape the conversation to achieve interpersonal objectives

Culture

integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious or social groups

A culturally competent physician

those who can provide patient-centered care by adjusting their attitudes and behaviors to the needs and desires of different patients and account for the impact of emotional, cultural, social, and psychological issues on the main biomedical ailment