HLTH 366 - Exam 3: Doctor Patient Communication

Competence

"Implies having the CAPACITY TO FUNCTION EFFECTIVELY as an individual or organization within the context of cultural beliefs, behaviors, and needs presented by consumers and their communities."

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"

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 crosscultural situations."

According to the 'Deviant Patient' Perspective, in the 60's, it was assumed patients routinely masked the ________ problem.

'real'

What occurred during the Byme and Long (1976) study?

(Under the 'Authoritarian Doctor Perspective') Identified different communication styles among doctors; These constitute a continuum from 'patient-centered' to 'doctor-centered' styles

Doctor-Centered Style

(Under the 'Authoritarian Doctor Perspective') Uses the doctor's knowledge and skill, for example, through asking questions

Patient-Centered Style

(Under the 'Authoritarian Doctor Perspective') Uses the patient's knowledge and experience through techniques such as silence, listening and reflection

Recent Trends: The Role of Culture

1. Cultural differences may be reflected in the ways health care professionals and patients communicate with each other. 2. Discrepant, culturally specific explanatory models of health and illness may lead to misunderstandings 3. Cultural differences play a role in how patients perceive and evaluate their doctors' conduct. 4. When working with patients from ethnic minorities, doctors have poorer interpersonal skills, provide less information and use a less participatory decision-making style. 5. As Western societies are becoming increasingly multicultural, more research is needed about the role communication may play in perpetuating health inequalities.

What are the 6 steps of clinical decision making?

1. Defining the problem 2. Defining the outcome goals 3. Generating alternative solutions 4. Selecting the best solution 5. Implementing the solution 6. Evaluating the outcome

What are the 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

How do you become more culturally competent?

1. Learn about your OWN culture 2. Learn about OTHER'S cultures 3. Identify and retain CULTURAL INFORMANTS (Ask questions about their culture and verify your perceptions) 4. Attend CULTURAL EVENTS in the community (Learn about rituals and values, Demonstrates your sincere interest, Be flexible in your intercultural interactions) 5. RESERVE JUDGEMENT about behaviors and intentions until you understand the cultural context in which they occur

What are some physician biases that were identified towards hetero-cultural groups?

1. Perceived higher substance abuse problems 2. Perceived less likely to be receptive to healthy lifestyle changes 3. Perceived lower educated 4. Lower rates of pain treatment 5. Higher rates of comments ignored

What are the factors of a 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

A recent review article estimated _________ of patients do not adhere to medical advice

50-75%

Culturally Competent Physician

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." (AMA)

Partnership

Assumes a more active patient

In the interactive dyad perspective, who shapes the conversation to achieve interpersonal objectives?

Both doctor and patient

What does CARE stand for (Therapeutic Medical Encounter: CARE)

Cope Activate Responsibility Empower

Which of the following are good reasons for good doctor/patient communication? A. If patients don't like you they wont follow your instructions B. If they don't like you they change doctors C. If they don't like you they don't pay their bills as much D. All are good reasons for good patient/doctor communication

D. All are good reasons for good patient/doctor communication

What was the purpose of the three steps of the patient-centered communication technique (invite, listen, summarize)?

Developed to combat high control techniques of asking yes/no questions

What are the three doctor-patient communication approaches?

Deviant Patient Perspective, Authoritarian Doctor Perspective; Interactive Dyad Perspective

What does Radley, 1994 say about why doctor-patient communication is important?

Effective communication can have a therapeutic effect

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

Its ok to fudge the truth about smoking or dieting when talking to your doctor.

False

Your doctor knows which medicine you are taking, so you don't need to remind him or her?

False

(As a limitation of doctor-patient communication), true or false: The proportion of satisfied patients remained surprisingly, and disappointingly, constant over 25 years

False; The proportion of DISSATISFIED patients remained surprisingly, and disappointingly, constant over 25 years

Who tends to use more patient-centered communication styles? Female doctors or their male counterparts?

Female doctors

Authoritarian Doctor Perspective

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

What are the three steps of the patient-centered communication technique?

I (invite) L (listen) S (summarize)

Patient Characteristics Associated with Non-Adherence: HEALTH BELIEFS

Inappropriate or conflicting health beliefs and competing sociocultural and ethnic folk concepts of disease and treatment (see chart for more)

Is doctor-patient communication always effective?

No

Does the extent of adherence stay the same across the different forms of recommended behaviors?

No, the extent of adherence varies across the different forms of recommended behaviors.

Later studies of the Authoritarian Doctor Perspective advocate for ______________________.

Patient activation and advocacy.

True or false: If a patients' understanding and memory is limited, this can be a LIMITATION of doctor-patient communication

True

True or false: Studies have identified gender differences in doctors' communication.

True

True or false: with the Authoritarian Doctor Perspective, there are conflicting findings regarding patient-centered styles and patient satisfaction

True

What was a common question in the Deviant Patient Perspective?

What is it about the patient that makes him/her a defaulter?'

In patient doctor communication, Is it sometimes okay to break eye contact?

Yes-- you don't want to seem creepy

According to Buller and Buller, 1987, patients prefer physicians who adopt the more ______________style

affiliative

In patient doctor communication, do lawsuits most often tend to be based on actions or appearances?

appearances; Malpractice suits are based more on perceived treatment than technical incompetence.

Interactive Dyad Perspective

communicative event to which both doctor and patient contribute; researchers started looking into it during the 1990s

Oftentimes, if ____________ with doctors' advice is lacking, this can be a limitation of doctor-patient communication.

compliance

With the interactive dyad perspective, a focus on the communicative event also allows the role of ________________ in doctor-patient interactions to be explored.

culture specificity

Both male and female patients seem to feel more _____________ by communicating with female doctors.

empowered

In patient doctor communication, what is the most appropriate form of touch?

handshake

What leads to a physician adopting a much more affiliative style of communication?

having a positive view of the patient

Studies have identified physician bias towards ____________-cultural groups

hetero

Physician _________________ have been associated with adherence.

interaction styles; • 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

Patient Characteristics Associated with Non-Adherence: SOCIAL/MACRO CHARACTERISTICS

lack of social support, insecure housing, competing or conflicting demands, lack of resources (see chart for more)

Patient Characteristics Associated with Non-Adherence: PERSONAL CHARACTERISTICS

lack of understanding (see chart for more)

Which doctors tend to be more directive and controlling, men or women doctors?

men

What does non-adherence increase?

mortality and hospital cost

Future research requires exploration of the relationship between physician's gender and communication style and patient communication ________.

needs

Do all patients want an active role?

no

A patient-centered communication technique emphasizes ___________ inquiry, empathy, and engagement to gather data

open-ended

Early studies via the 'Deviant Patient' Perspective focused on ______________ to understand failed patient communication

patient characteristics

With the Deviant Patient Perspective, the search for _______________ responsible for non-adherence was unsuccessful, instead they found a link between patient satisfaction and ____________________.

patient characteristics; compliance or adherence

In the Deviant Patient Perspective, with the newfound link between patient satisfaction and compliance/adherence, this led to traditional concepts of authority being challenged, leading to a shift of focus onto the ____________________.

role of the doctor

With partnership, what two factors play in between the patient and the physician?

supportive role of the physician and discussion of treatment options

Adherence

the extent to which the patient follows the prescribed treatment regimen

Who is inadherence mostly blamed on?

the patient

Who's treatment plan does adherence follow?

the treatment plan of the physician

What are some PATIENT characteristics of barriers to doctor-patient communication?

• Anxiety/ fear • Unrealistic patient expectations • Language • Health literacy • Illness or other injury • Altered mental state • Medication effects • Gender differences • Racial or cultural differences

What are some sources of miscommunication on the patient's side?

• Characteristics • Knowledge • Attitudes towards symptoms

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 (e.g. Radley, 1994). • Communication can lead to effective behavior change

Health Practitioners as Agents of Change

• Credible source with KNOWLEDGE • Can SIMPLIFY and TAILOR messages • Can help the patient DECIDE by highlighting advantages and disadvantages • Private face-to-face nature of interaction provides EFFECTIVE setting for communication • Can communicate warmth and caring • Can ENLIST THE COOPERATION of other family members • Patient under partial SURVEILLANCE and CAN MONITOR progress

Raising Self Awareness

• Culture is not OVERT and "cultural rules are not discussed until a rule is broken." • WE OBSERVE, INTERPRET, THEN ACT --> we often misinterpret the actions of others by not understanding their cultural norms • We may not know that we are offending others • AWARENESS and KNOWLEDGE increase our choices --> leads to greater opportunities for successful encounters • Understanding one's OWN "SOFTWARE" (or culture) is a first step --> value systems and potential for bias

What are some advantages of improvements to doctor-patient communication?

• Greater 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 the four goals of the 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 sources of miscommunication on the health care provider's side?

• Not listening • Use of jargon • Baby talk • Stereotypes

What are some PHYSICIAN OR SYSTEM characteristics of barriers to doctor-patient communication?

• Training • Language • Time constraints • System constraints • Gender differences • Racial or cultural differences • Fear of litigation

Under the 'Authoritarian Doctor' Perspective, what are some major criticisms of doctors' traditional communication style

• Used a rigid agenda • Little listening to patients' accounts and • Little open discussion of treatment options.