Download communication issues

BHP Lecture series
COMMUNICATION
IN MEDICINE
Should doctors learn to
communicate?
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Author
Ridad Agoes
Dept. Bioethic and Humaniora,
Fakultas Kedokteran Universitas Padjadjaran.
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Jakarta
18 September 1940
MD, FK UNPAD, 1968
MPH, Univ. of California
Los Angeles, 1981
Ph.D. in Basic Medical Science
Padjadjaran Univ. 1997
Professor
Department Parasitology
School of Medicine, FKUP
Jln. Parasitologi 11
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Bandung
Communication Issue
Breaking bad news
“I was 25 years old and working in an
emergency unit. A young lad was brought
in with severe head injury following a road
accident. We tried to resuscitate him but
it was useless. I had to go out and tell his
parents. I didn’t have a clue what to say.
I didn’t know how to handle the situation.
I just said ‘sorry’ and ran out of the
room. That was over 30 years ago and
things aren’t really much better now.
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COMMUNICATION ISSUES
 During his life time career of 40 years, a
doctor will spend approximately 150.000
to 200.000 patient contacts and
communication
 Doctors talk to patients and their
families more often than performing
medical procedures
 Unfortunately many doctors are not
prepared or ill trained to communicate
with patients
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COMMUNICATION ISSUE
Many of the complaints
received by the hospital are
about doctors’ or nurses’
attitudes and
miscommunication
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COMMUNICATION ISSUES
Many medical malpractice claims
and patient complaints are caused
by emotional and psychological
factors due to failed
communication.
-
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COMMUNICATION ISSUES
- Hospital systems can also contribute
to communication problems. Clinics
that do not provide good information
and clinics that run late can result in
dissatisfaction and hostility among
patients.
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• What else ?
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Litigation
• More and more patients are not only willing
complain, but also prepared to sue
• Poor handling of complaints contribute to
increase in litigation
• Most patients want an explanation of what
went wrong and an apology and many are
forced to take legal action when their doctors
are not communicating
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COMMUNICATION
 What is the definition of
COMMUNICATION?
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COMMUNICATION
- A transactional process involving
cognitive sorting, selecting and
sharing of symbol in such a way as to
help another elicit from his own
experiences a meaning or responses
similar to that intended by the
source
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In other word

Communication is a process by
which an individual transmitted
stimuli (usually verbal) to modify
the behavior of other individual.

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Elements of Communication
Source
Message
Media
Target
(Feedback)
(Impact)
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Effective
Communication
•
•
•
•
•
•
If the communication could create :
Understanding
Satisfaction
Influences the attitude
Good interpersonal relationship
Action
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Communication
Skill
• communication skills include :
• “ ……. the ability talk to patients on
emotional level, to listen, to assess
how much information a patient wants
to know and to convey information
with clarity and sympathy”
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The seven C’s of
Communication
Credibility
Content
 Context
Clarity
Consistency
Channels
Capability of the audience
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Communication in
Medical Context
• Verbal Communication
• Non-verbal Communication
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Verbal Communication
•
•
•
•
•
•
•
Speaking to the person
Look straight in the eye
make eye-ball contact
Clear message
Relevant, interesting
Good listener
Allow them to digest the message
and reply
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Non – verbal Communication
•
•
•
•
•
Body language
Gesture
Facial expression.
Head movements.
Touching.
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• Why communicate ?
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What for ?
•
•
•
•
Providing information to patients
Relieving anxiety and stress
Offering emotional support
Giving instruction to nurse and
patient
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• What else ?
• (after 10 minutes break)
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“When doctors use
communication skills
effectively, both they
and their patients
benefit”
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Effects of Good
Communication skill
• Patients’ problems are identified more
accurately
• Patients are more satisfied with their care
and can better understand their problems
• Patients are more likely to comply with
treatment
• Patients are less likely to complain
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• Is there any
barrier to
effective
communication ?
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Doctors playing God
• There is a certain attitude that
doctors “is basically God”. But
with attitude changes, they were
asked to put aside their hard
earned status and accept
questioning from patient
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Lack of skill and understanding
Undervaluing the importance of
communicating
Negative attitude
Lack of inclination to communicate
Human failings
Inconsistencies in providing
information
Language competence
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Elements of Miscommunication
 Many patients complained of nurses and doctors
saying different things
 Patients also complained that they had no
opportunity to talk to the doctor
They complained about lack of involvement in
decisions about their care
They were given no information about test
results
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So, why is change needed
?
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Cultural reasons
There is a major cultural change
within the society where many
patients (and their families) are
prepared to challenge the way
hospital services are provided
This cultural change and attitude
can be difficult for health
professionals to manage, and
therefore requires changes in
communication behavior
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Satisfaction and
treatment outcome
• Another reason for change is
the evidence that improving
doctors’ communication skill
can increase patient
satisfaction and improve
treatment outcomes
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“Helping doctors improving
the way they
communicate with patients
can also contribute to
increasing job satisfaction
and improving doctors’
morale”
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So, is there room for
improvement ?
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Room for Improvement (1)
Dealing with difficult patients :
some patients are full of anger,
aggressive and hostile and the
way doctor manage them will
influence the outcome
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Room for improvement (2)
• Dealing with different need
of patients:
• Some patients have mental
health problems, acute
sensory impairments, and
language barrier
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Room for improvement (3)
“Reducing errors and improving
treatment approach:
Doctors should review mistakes they have
done and improve their approach to
handling patients by improving their
clinical effectiveness
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• What else ?
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Ten bad listening habit to
avoid
(1)
Dismissing patient’s complaints
as irrelevant or uninteresting
Resistance to listening to patient becomes
more pronounced as doctors get tired
or bored
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Ten bad listening habit to
avoid (2)
“Pretending to listen or acting to
look attentive”.
• Feigning attention is risky. Patient
usually can sense when a doctor is
pretending to listen
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Ten bad listening habit to
avoid (3)
“Avoiding complicated subjects”.
• Doctors usually avoid listening to
complicated subjects and prefer
simple complaints
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Ten bad listening habit to
avoid (4)
“Too many distractions”.
• Do not allow distraction interfere
during communication with patient.
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Ten bad listening habit to
avoid (5)
“Finding fault with the speaker” .
• Avoid finding fault by learning to
concentrate more on content
rather than on the speaking style
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Ten bad listening habit to
avoid (6)
“Listening only on fact” .
Learn also to include listening to the
emotional aspects of patient’s
complaints
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Ten bad listening habit to
avoid (7)
“Becoming too enthusiastic” .
• Avoid getting carried away by
patients explanation
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Ten bad listening habit to
avoid (8)
“Doctors becoming antagonized by
patient’s emotional complaints” .
Certain statement made by patient
may trigger negative emotional
reaction from the doctor
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Ten bad listening habit to
avoid (9)
“Listening is distracted by taking
of notes” .
First get the message, and then
write down notes
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Ten bad listening habit to
avoid (10)
“Doctors did not focus on what is
being said” .
If communication is slow, listening
becomes bored and the mind may
wander somewhere else. Learn to
avoid thinking of something other
than what patient is trying to
communicate
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Thank you ….
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