28-11-13 Ridad BHP Doctor-Patient Communication

BHP Lecture series
COMMUNICATION
IN MEDICINE
Should doctors learn to
communicate?
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ridadagoes@yahoo.com
Author
Ridad Agoes
Dept. Bioethic and Humaniora,
Fakultas Kedokteran Universitas Padjadjaran.
Copyright
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
Copyright
Email: ridadagoes@yahoo.com ridadagoes@yahoo.com
Bandung
Caveat
Half of what you are taught as
medical students will in 10 years
have been shown to be wrong. And
the trouble is, none of your
teachers knows which half.
Dr. Sidney Burwell
Dean, Harvard Medical School
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Breaking bad news
I was working in an emergency
department. A young lad was brought
in with severe head injuries. We
tried to resuscitate him but it was
useless. I had to go out and tell his
parents that their child was dead but
didnt have a clue what to say. I just
blurted it out and said sorry and run
out of the room. I didnt know how to
handle the situation. I didnt know to
communicate properly.
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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
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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-Many medical malpractice claims
and patient complaints are caused
by emotional and psychological
factors due to failed
communication.
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- 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
to complain, but also prepared to sue
Poor handling of complaints contribute to
increase in litigation/lawsuits
Most patients want a simple explanation of
what went wrong and an honest apology.
But many are forced to take legal action
when their doctors are not communicating
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Doctors playing God
Formerly there is a certain
attitude that doctors is basically
God. They work to save life.
But nowadays attitude changes,
they were asked to put aside
their hard earned status and
accept questioning from patient.
But manytimes they failed to
communicate with their patients
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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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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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Skill
Communication
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 Cs 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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Body language
communication
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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 ?
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When doctors use
communication skills
effectively, both they
and their patients
benefit
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Communication by showing example
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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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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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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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When I
understand
what the
doctor
said
I smile big
!!!
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 patients complaints
as irrelevant or uninteresting
Resistance to listening to patient becomes
more pronounced as doctors get tired
or bored
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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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avoid (3)
Avoiding complicated subjects.

Doctors usually avoid listening to
complicated subjects and prefer
simple complaints
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avoid (4)
Too many distractions.

Do not allow distraction interfere
during communication with patient.
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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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avoid (6)
Listening only on fact .

Learn also to include listening to the
emotional aspects of patients
complaints
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avoid (7)
Becoming too enthusiastic .

Avoid getting carried away by
patients explanation
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avoid (8)
Doctors becoming antagonized by

patients emotional complaints .
Certain statement made by patient
may trigger negative emotional
reaction from the doctor
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avoid (9)
Listening is distracted by taking

of notes .
First get the message, and then
write down notes
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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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Parting Comment
Communicate Thank you .

Copyright

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BHP Lecture series

MD, FK UNPAD, 1968

MPH, Univ. of California

Ph.D. in Basic Medical Science

Many of the complaints

Reducing errors and improving

Pretending to listen or acting to

Avoiding complicated subjects.

Too many distractions.

Finding fault with the speaker .

Listening only on fact .

Becoming too enthusiastic .

Doctors becoming antagonized by

Listening is distracted by taking

Communicate Thank you .

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