Download Who is the patient?!

Illness Behavior &
Dr - Pt Relationship
Illness Behavior
• 20% of the
patients neglect
their illness
I am a patient
I am weak
I need help
Causes of Denial of Illness
It is not
easy for
the
patient to
show his
weakness
Doctor’s authority
Illness Behavior
Factors Affecting Illness Behavior
 Gender
 Symptom presentation
 Age
 Lay beliefs
 Race
 Social Class
 Learned behavior
 Previous experience
 Accessibility to health
services
 Trigger factors
 Locus of control
Factors Affecting Illness
Behavior
Symptoms :
• severity of the symptom
• Patient ideas & understanding about
the symptom
• Patient previous experience with this
symptom
Factors Affecting Illness Behavior
Accessibility to Medical services
Physical barriers can make health
facilities difficult to reach
H
Factors Affecting Illness Behavior
Previous experience with health services
???
Bureaucratic barrier can make
health services difficult to obtain
H
Illness Behavior
Learned behavior
Somatic
complain
Somatic
fixation
Inappropriate reaction
(Pt. Family & Dr.)
Trigger Factors
Another Interpersonal Crisis
Trigger Factors
Effect of the Problem on Pt. Activity
Trigger Factors
Pressure from Family or Friends
Trigger Factors
The setting
of arbitrary
deadline
or putting limit
Illness Behavior
Final Message & Conclusions
 Doctors need to understand illness behavior
for proper understanding of their patients
 Doctors need to explore & acknowledge
patient’s believes & worries
Communication Skills
Communication Skills
Objectives:
 To improve your skills in exploring and
acknowledgement of patient’s thoughts and
feelings.
 To increase your awareness about your
patients’ verbal and nonverbal cues.
 To help you to develop new communication
skills in order to deal with your patients’ cues.
Exercise 4
• Write down three words that best describe the
way you want to be perceived by your patients:
1)………
2) …………
3)……….
• Write how can you use your communication
skills to convey this message?
1)
……………..........
2)
……………..........
2)
……………..........
Awareness of Patients’ verbal
and Nonverbal Cues
Who is
the
patient?!
Classification of
Communication Skills
 Verbal communications
 Nonverbal communications
Communication Skills
Verbal communications
• How to formulate questions
• Discussion , explanation & Advice
• Understanding pt. verbal cues
Verbal communications
How to formulate questions
• Direct Qs (Yes or No)
• Suggestive Qs
• Why Qs
• Many Qs at a time
• Indirect Qs (Open-ended Qs)
Communication Skills
Nonverbal communications
1 - Body language &
Facial expression
2 - Appearance
3 - Touch
4 - Paralanguage
5 - Body bubble
6 - Environment
Verbal communication for tilling
information , but nonverbal
communication for negotiation
• Verbal communication
• 10% of
communications
• nonverbal communication
• 90% of
communications
Reference: (McCaskey 1979 )Rakel
Nonverbal Communication
is an universal language
Mind & Body
Body Language
Facial Expression
Appearance
Body Language
Hand to face Expression
Body Language
Hand Expression
Body Language
Hand Expression
Body Language
Body Posture
Body Posture
Body Language
Touch
The effect of touch
Communications
Paralanguage
•
•
•
•
•
Velocity
Volume
Tone
Pause
Others
Body Language
Body Bubble
????
Body Bubble
Intimate
zone
15 - 46 cm
Private
zone
46 cm - 1.2 m
zone Social
1.2 m - 3.6 m
Public zone
More then 3.6
Communications
Environment
Dr.
Pt.
Couch
Communications
Environment
Communications
Environment
Discuss the advantage of this style of
communications
???
Doctor - Patient Relationship
Doctor - Patient Relationship
Doctors - Patient Relationship
 Why doctors need to have a
positive relationship with their pt.
???
 How dose this relationship start &
how it progress ???
 What are the skill needed to build
a positive relationship ???
Doctors - Patient Relationship
Why ???
• For the patient care &
satisfaction
• For doctor satisfaction
• For effective use of
resources
Doctors - Patient
Relationship
Doctors - Patient
Relationship
Patient positive role
Doctors - Patient
Relationship
How ???
• Professional relationship
• personal relationship
• Intimate relationship
To Establish & To Maintain
Dr-Pt Relationship
• Welcoming the Patient
• Showing respect
To Establish & To Maintain
Dr-Pt Relationship
The ability
to listen
“ Don’t waste my time , just say yes or no”
Doctor - Patient Relationship
Understanding
& Empathy
Review of
Consultation
Models
Hospital Model of Consultation
Computerized
chick lest of
history taking
A case of 2
weeks
headache
Complete history, physical
Examination & Investigations ?!
Psychosocial component of the
physical problems
.
Byrne & Long 1976
Patient Centered
Consultation
Doctor Centered
Consultation
Use of pt’s knowledge and
experience
Use of doctor’s
special skills and knowledge
Silence
Clarification Analyzing
Listening Interpretation Probing
Reflection
Gathering
Information
The Real Reason for
Consultation
Failure to explore
the real reason of
patient problem is
the main reason of
consultation failure
(Byrne & Long 1976)
The Expanded Model of
Consultation
Management of
Presenting Problem
Modification of Help
Seeking Behavior
Management of
Continuous Problem
Opportunistic health
Promotion
(Stott & Davis 1979)
Modification of Help Seeking
Behavior
• The child as the presenting complain
• Frequent attender
• Somatic patient
Modification of Help
Seeking Behavior
• Sick Role
• Secondary gain
Modification of Help
Seeking Behavior
• Denial
• Poor Compliance
Modification of Help Seeking
Behavior
• Hidden agenda
• Displacement
Pendleton 7 Tasks
1. To define the real reasons for pt attendance
2. To consider other problems
3. To choose with the pt. appropriate action for
each problem
4. To achieve a share understanding
5. To involve pt. in the management
6. To use time & resources effectively
7. To establish & maintain Dr.-pt. relationship
Patient’s Ideas :
Patient’s Concern :
Patient’s Expectation
Explanation
Skills Needed To Explore the
Real Reasons for Pt. Attendance
• Open ended questions
• Confrontation
• Indirect questions
• Reflection
• Use of silence
• Probing
• Recognition of pt cues
• Summarization
• Immediate response to
pt. cues
Pendleton Third Task
With the patient to choose an
appropriate action for each problem.
Why
With the patient to choose an
appropriate action for each problem
• Patient responsibility
• Patient compliance
Pendleton Fourth Task
With the patient to achieve shared
understanding of the problem
Doctor
Patient
Knowledge
Questions
Doubts
Theories
Experience
Knowledge
Questions
Doubts
Theories
Experience
Pendleton Fourth Task
With the patient to reach Shared
Understanding of the Problem
The
patient
has the
right to
know all
important
details
Pendleton Fifth Task
To involve patient in the
management
Pendleton Sixth Task
To use time & resources
appropriately
Pendleton Seventh Task
To Establish & Maintain Dr.-Pt.
Relationship
Final Message & Conclusions
• A lot of practice is needed to be able adopt
the proper consultation model