Doctor Patient Relationship

Prepared by

Dr Sirwan K Ali

2012-2013

Doctor Patient Relationship

Prepared by

Dr Sirwan K Ali

2012-2013

Good physician treats the disease; the great physician treats the patient who has the disease ~ William Osler (Canadian Physician, 1849-1919)

Good physician treats the disease; the great physician treats the patient who has the disease ~ William Osler (Canadian Physician, 1849-1919)

Content of the lecture:

•Introduction

•Parson ideal patient and doctor

•What do patients want from a doctor

•Styles of Dr-patient relationship

•Communication skill

•Conclusion

Content of the lecture:

•Introduction

•Parson ideal patient and doctor

•What do patients want from a doctor

•Styles of Dr-patient relationship

•Communication skill

•Conclusion

The Doctor-Patient RelationshipThe Doctor-Patient Relationship

At the core of the practice of medicineAt the core of the practice of medicine The patient expects a good relationship as The patient expects a good relationship as

much as a curemuch as a cure Dr-patient relationship itself becomes part of Dr-patient relationship itself becomes part of

the therapeutic processthe therapeutic process

IntroductionThese two people have just met, but within seconds one has begun to tell the other intimate personal details about his health. What is more, it is likely that, in a few minutes, he will be prepared to remove some of his clothes and submit to a physical examination.The interaction is shaped by their differing social roles and their different needs.

IntroductionThese two people have just met, but within seconds one has begun to tell the other intimate personal details about his health. What is more, it is likely that, in a few minutes, he will be prepared to remove some of his clothes and submit to a physical examination.The interaction is shaped by their differing social roles and their different needs.

Parsons’ “Ideal PatientParsons’ “Ideal Patient””

Permitted toPermitted to::

Give up some activities and responsibilitiesGive up some activities and responsibilities

Regarded as being in need of careRegarded as being in need of care

In ReturnIn Return: :

Must want to get better quicklyMust want to get better quickly

Seek help from and cooperate with a doctorSeek help from and cooperate with a doctor

Parsons’ “ Ideal DoctorParsons’ “ Ideal Doctor””

Apply a high degree of skill and knowledgeApply a high degree of skill and knowledge

Act for the good of the patientAct for the good of the patient

Remain objective and emotionally detachedRemain objective and emotionally detached

What do patients want from a physician?

Patients want to be able to trust the competence and efficacy of their caregivers.

Patients want to be able to negotiate the health care system effectively and to be treated with dignity and respect.

Patients want to understand how their sickness or treatment will affect their lives, and they often fear that their doctors are not telling them everything they want to know.

What do patients want from a physician?

Patients want to be able to trust the competence and efficacy of their caregivers.

Patients want to be able to negotiate the health care system effectively and to be treated with dignity and respect.

Patients want to understand how their sickness or treatment will affect their lives, and they often fear that their doctors are not telling them everything they want to know.

Patients want to discuss the effect their illness will have on their family, friends, and finances.

Patients worry about the future. Patients worry about and want to learn how

to care for themselves away from the clinical setting.

The four different styles of Dr/patient relations

Paternalistic: The paternalistic approach is typified by a doctor centered style. It relies on closed questions designed to elicit yes or no answers. The doctor will tend to use a disease centered model and be focused on reaching a diagnosis, rather than the patients unique experience of illness.

The Paternalistic ApproachThe Paternalistic Approach

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

stop smokingstop smoking”!!”!!

Patient controlled consultationPatient controlled consultation

ConsumeristicConsumeristic : Here the : Here the patient knows exactly patient knows exactly what they want and forces what they want and forces the doctor into a the doctor into a patient centered approachpatient centered approach

““You’re paid to do what I tell You’re paid to do what I tell youyou”!!”!!

Default: This is where the patient centered style fails. The doctor is trying to relinquish control but the patient is unwilling to accept it, The result

is an impasse. Mutuality:

The doctor uses open questions to encourage the patient to talk about his

complaint. This approach relies on taking time to listen and trying to understand the patients

point of view.

Mutual StylesMutual Styles

It’s serious isn’t it It’s serious isn’t it doctordoctor??

Factors which influence Factors which influence Dr-Patient CommunicationDr-Patient Communication

Patient-related factorsPatient-related factors Dr-related factorsDr-related factors The interview settingThe interview setting

Patient-related factorsPatient-related factors

Physical symptomsPhysical symptoms Psychological factorsPsychological factors Previous experiencePrevious experience Current experienceCurrent experience

Dr-related factorsDr-related factors

Training in communication skillsTraining in communication skills Self-confidence in ability to communicateSelf-confidence in ability to communicate PersonalityPersonality Physical factorsPhysical factors Psychological factorsPsychological factors

The interview settingThe interview setting

PrivacyPrivacy Comfortable surroundingsComfortable surroundings An appropriate seating arrangementAn appropriate seating arrangement

Importance of Effective Importance of Effective Doctor-patient CommunicationDoctor-patient Communication

1.1. Accurate diagnosis. Accurate diagnosis.

2.2. Enhancing patient compliance to treatment Enhancing patient compliance to treatment plans. plans.

3.3. Contributing to doctor clinical competence Contributing to doctor clinical competence and self assurance.and self assurance.

4.4. Contributing to patient satisfaction. Contributing to patient satisfaction.

Importance of Effective Importance of Effective Doctor-patient CommunicationDoctor-patient Communication

5.5. Contributing to cost and resource Contributing to cost and resource

effectiveness by preventing unnecessary effectiveness by preventing unnecessary

prescriptions for medication that are either prescriptions for medication that are either

wrongly prescribed or not properly used by wrongly prescribed or not properly used by

patients.patients.

Physician need To AcquirePhysician need To Acquire

A) Core communication skills:A) Core communication skills:

Doctor-patient interpersonal skills. Doctor-patient interpersonal skills.

Information gathering skills. Information gathering skills.

Information giving skills.Information giving skills.

Physician need To AcquirePhysician need To Acquire

B) Advanced communication skills:B) Advanced communication skills:

Skills for motivating patient adherence to Skills for motivating patient adherence to

treatment plans. treatment plans.

Skills for specific situations. Skills for specific situations.

Core Communication SkillsCore Communication Skills

1- Doctor-patient interpersonal skills:1- Doctor-patient interpersonal skills: Creating an appropriate physical environment.Creating an appropriate physical environment. Greeting others.Greeting others. Empathy.Empathy. Showing respect and interest.Showing respect and interest. Showing warmth and support.Showing warmth and support. Using appropriate language.Using appropriate language. Developing a collaborative relationship.Developing a collaborative relationship. Closing the interview.Closing the interview.

Core Communication SkillsCore Communication Skills

2- Information gathering skills:2- Information gathering skills:

a) Using an appropriate balance of open to closed a) Using an appropriate balance of open to closed questions:questions:

* * Open question:Open question: To achieve information.To achieve information. To allow patients the freedom of response.To allow patients the freedom of response. To establish an atmosphere of two-way communication.To establish an atmosphere of two-way communication. To assess the type and level of patient vocabulary.To assess the type and level of patient vocabulary.

**Closed questions:Closed questions: To achieve specific information.To achieve specific information. To allow a limited choice of response.To allow a limited choice of response.

Core Communication SkillsCore Communication Skills

2- Information gathering skills:2- Information gathering skills:

b) Silence:b) Silence:

To allow time for the patient to collect his To allow time for the patient to collect his

thoughts.thoughts.

To assess levels of anxiety.To assess levels of anxiety.

Core Communication SkillsCore Communication Skills

2- Information gathering skills:2- Information gathering skills:

Clarifying the information given to the patient. Clarifying the information given to the patient.

Active listening:Active listening: To show that the therapist is To show that the therapist is

attending closely the patient.attending closely the patient.

Sequencing of events. Sequencing of events.

Directing the flow of information. Directing the flow of information.

Summarizing. Summarizing.

Core Communication SkillsCore Communication Skills

3. Information giving skills: 3. Information giving skills:

They include: They include:

1.1. Providing clear and simple information. Providing clear and simple information.

2.2. Using specific advice with concrete Using specific advice with concrete

examples. examples.

3.3. Pushing important things first. Pushing important things first.

4.4. Using repetition (restatement). Using repetition (restatement).

Core Communication SkillsCore Communication Skills

3. Information giving skills: 3. Information giving skills: 5.5. Summarizing. Summarizing. 6.6. Categorizing information to reduce complexity Categorizing information to reduce complexity

and aid recall. and aid recall. 7.7. Using tools such as diagrams, written Using tools such as diagrams, written

instruction and technical aids to explain the instruction and technical aids to explain the information being given. information being given.

8.8. Checking patient understanding of what has Checking patient understanding of what has been said. been said.

9.9. Asking patients to repeat back what they had Asking patients to repeat back what they had heard and understood. heard and understood.

SummarySummary

An intigrated approach to information An intigrated approach to information gatheringgathering..

Seeking to identify physical psychological Seeking to identify physical psychological and social factorsand social factors

Is likely to produce a better outcomeIs likely to produce a better outcome..

Thank you…