Patient-Doctor Communication

Relationship Building

***Crucial at the START of the contact, but must CONTINUE/BE INTEGRATED with data gathering & patient education -->Characteristics of Relationship Building: 1) Non-verbal behavior (ATTENTIVENESS, RESPONSIVENESS, & WARMTH) 2)Explicit Comments & Questions that show a CARING interest in the person (not just the medical condition) -->Works best when they reflect your GENUINE THOUGHTS & FEELINGS -->Should be moderated by one's awareness of one's own biases & emotional reactions in responding to patient's personal / emotional issues

Empathy

-->Ability to put yourself in another person's shoes by attempting to try to understand what their situation might be like -->You feel FOR, ***NOT WITH -->Offer non-judgemental support ***NOT SYMPATHY

Respect

-->Acknowledge effort of patient during their experience (Ex. I'm impressed by how well your doing; You're doing a great job of managing you diabetes; Despite this chronic pain, you're still able to carry on at home & at work. That is quite an accomplishment)

Reflection

-->Acknowledges patients statements (Ex "You look sad right now"; "I can see this is upsettting to you"; "This is hard to talk about"

Goal of Patient-Doctor Communications

-->Asking specific questions in order to gain information from patient in doctor's terminology

Key for Attentiveness & Warmth Questions

-->Look for "I Can see..."(attentivenes & "Please tell me more..."(invitation to open up; warmth)

Key for Partnership Questions

-->Look for answer that has "Lets work together" -->Also usually is a "We" in the Answer

Support

-->Statements to the patient the make their experience as PERSONAL as possible (Ex. I want to help in any way I can; No matter what happens, I will be doing whatever I can to assist you; The reason I'm here is b/c I am concerned about your health, & I want to do whatever is needed to ensure that you stay healthy)

Legitmization

-->Validate the validity/authenticity of the patients statement (Ex. I can certainly understand why you'd be upset; Anyone would find this difficult; Your reactions are perfectly normal; This would be anxiety evoking for anyone; I can understan why you're so angry)

PEARLS Statements

1) "P": Partnership 2) "E": Empathy 3) "A": Apology 4) "L": Legitimization 5) "S": Supporting -->Use these statements to respond to EMOTION instead of redirecting or pursing clinical detail

5 Factors In order to demonstrate appropiate non-verbal behaviors ("Attentiveness & Warmth)

1) Eye Contact: Direct Most of the Time 2)Tone of Voice: Demonstrates concern & interest 3)Pace of Interview: Not too fast or too slow 4)Posture:General forward lean of head & body towards patient 5)Attentive Silence

Fundamental Skills to maintain uring a patient-doctor relationship

1) Use relationship building skills by: -->Allow patient to express themselves -->Be attentive & empathetic NON-VERBALLY -->Use appropieate language -->Communicate non-judgemental, respectful, and supportive enviornment -->Accurately recognize emotion & feelings -->Use ***PEARLS statements*** 2)Manage Flow -->Be organized & logical -->Manage time effectively in the interview

Specialties where effective communication with your patient is not critical to providing care

1)Pathology 2)Noninterventional Radiology 3)Some surgical specialities

Sample Question of Respect

5 Renata Bowen, an 80 year old widow and retired antiques dealer was brought to the hospital for a hip fracture. Her rehabilitation is going more slowly than usual, and she will clearly need long-term care for an uncertain period. Ms. Bowen has maintained her independence throughout life, and the idea of going to a nursing home (even temporarily) seems unacceptable. Her mood has been depressed, and her social worker reported that Ms. Bowen cried when he brought up the issue. After greeting her, what statement would best demonstrate Respect, as you begin today's conversation?

2nd Practice Question for Attractiveness & Warmth

7 Ken Fortek is a 40 year old divorced Caucasian book keeper who complains of persistent headaches. You've done a careful history, physical exam, and ordered laboratory tests. Your exam and lab results are normal. You convey this good news but your patient continues to look worried. He asks, "How can you be sure that these headaches are not related to a brain tumor?" Which of the following responses would best illustrate Attentiveness and Warmth?

2nd Sample Question for Support

8 Juanita Perez, 21, is a single college student of Hispanic descent. Juanita came in with gastrointestinal symptoms, you suspected pregnancy, and confirmed the diagnosis by lab test. You noticed arm bruises consistent with physical abuse. When you told Juanita she was pregnant, she started to cry. Which of the following responses would best convey Support?

2nd Sample Question for Respect

9 Israel Wasserman, a 50 year old Caucasian teacher, was brought to the hospital after experiencing a seizure while shopping. You found that he has a benign brain tumor and recommended that he start treatment immediately to prevent further seizures. Israel has trouble accepting the diagnosis and wants to postpone treatment because he fears that any delay in launching a big project at school may derail the entire project. Which of the following statements best conveys Respect?

Answer to Practice Questions for Partnership

A. State "Many people in your situation would feel hesitant to stay longer in the hospital. Let's work together to make sure that you are stable enough to return home."

Answer to 2nd Support Question

A. State: "I can see that being pregnant is very upsetting to you. How can I help you?"

Answer for Respect Question

B. State: "I am so impressed with your ability to lead a remarkably independent life until now."

Answer to Question for Attractiveness & Warmth

B. State: "I can see that you are anxious about going into hospital without having your regular physician at your side. Please tell me more about your concerns."

Answer to Practice Question for Empathy

C. State: "You seem uncomfortable with our conversation, so far."

Sample Practice Question for Partnership

Carlos Rodriguez is 60, Hispanic, owns a neighborhood grocery store, and is in the hospital with a heart attack. His condition has improved and he wants to be released immediately, even contemplating signing out against medical advice. Mr. Rodriguez is in bed, with IV's running. He tells you he is concerned that his store is his wife's responsibility while he is in the hospital, and she is undergoing outpatient treatment for breast cancer. Which of the following responses would best convey Partnership?

Answer to Question about Attentiveness & Warmth

D. State "I can see that you are still worried about the possibility of a brain tumor. Help me understand why that is the case."

Answer to Practice Questions for Partnership

D. State "You are coping with a lot of challenges. Let's see if we can devise a new plan that won't add to your stress levels."

Answer to Respect Question

E. State: "I admire your devotion to your work, and I'm sure your students appreciate all you do for them."

Answer to Support Question

E. State: "There are many situations that can result in someone driving while they are drunk. I would like to help you figure out what led to your accident so that you can avoid it in the future."

2nd Practice Question for Partnership

Francine Bacon is a single mother of 3 school-aged children. She is 38, African American, overweight and has hypertension. She is an office manager and some of her supervisees are performing poorly. Balancing home and work demands is difficult. You have discussed weight loss strategies and she agreed to start a medication for her blood pressure. When you tell her that today neither her blood pressure nor her weight has changed, she responds "I have been following your instructions and made a lot of changes. But this plan clearly does not work for me." Which of the following responses would best illustrate Partnership?

1st Practice Question for Attractiveness & Warmth

James King, 70, is a patient of your colleague on vacation and a retired African American postal worker. His daughter brings him in today because of difficulty breathing and a fever. You recommend hospitalization, but Mr. King wants to wait until his regular physician returns in a few days. Which of the following responses would best convey Attentiveness and Warmth?

Sample Question for Support

Peter Erman is 18, a Caucasian high school student admitted to the hospital for internal injuries after driving a car into a tree. He was driving while intoxicated, and luckily no one else was injured. It is your responsibility now to address the drunk driving issue with him. Which of the following responses would best convey Support?

Practice Question for Empathy

This is your first encounter with Margot Gwen, a 20 year old single Caucasian collegian with Crohn's disease whose previous physician just moved out of town. Her responses to your open-ended questions ("Tell me a little about yourself;" or "I've looked at your medical record, how can I help you today;" etc.) are consistently one or two word answers, and she looks down at her hands and twists her fingers during the interview. Which of the following responses would best illustrate Empathy?