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COMMUNICATION IN COMMUNICATION IN HEALTHCAREHEALTHCARE
Datuk Dr. Ahmad Tajudin JaafarDatuk Dr. Ahmad Tajudin Jaafar
Allianze College of Medical SciencesAllianze College of Medical Sciences
Subject of communication has become Subject of communication has become prominent in healthcare for the last 50 prominent in healthcare for the last 50 yearsyears
It is now an established subject in most It is now an established subject in most medical curriculummedical curriculum
Evidence is that healthcare fails without a Evidence is that healthcare fails without a conscious informed effort of conscious informed effort of communication which is the personal and communication which is the personal and professional responsibilities of all care professional responsibilities of all care giversgivers
It is a major issue in the strategies of all It is a major issue in the strategies of all health organisationhealth organisation
Healthcare is a complex intervention of Healthcare is a complex intervention of at least four elementsat least four elements
1)1) Physical carePhysical care
2)2) Cognitive careCognitive care
3)3) Behavioral careBehavioral care
4)4) Psychological carePsychological care
The aim and mission is to provide care The aim and mission is to provide care that is evidence-based, patient-centred that is evidence-based, patient-centred and in collaborative partnership with the and in collaborative partnership with the patientpatient
Effective communication is an absolute Effective communication is an absolute necessity at every stage of the clinical necessity at every stage of the clinical interviewinterview
Communication whether good or bad Communication whether good or bad affects everyone of the four aspects of affects everyone of the four aspects of carecare
Health Outcome
Effect of communication on case and its Effect of communication on case and its outcomeoutcome
The best outcome depend on accurate The best outcome depend on accurate diagnosis and appropriate treatmentdiagnosis and appropriate treatment
Communication styles that are ‘Patient Communication styles that are ‘Patient Centred’ provide a more complete Centred’ provide a more complete picture which lead to improvement in picture which lead to improvement in health outcome e.g.health outcome e.g.
i.i. Symptom resolutionSymptom resolution
ii.ii. Psychological distress reducedPsychological distress reduced
(cont’)(cont’)
iii.iii. Health and functional states Health and functional states improvedimproved
iv.iv. Pain control improvedPain control improved
v.v. Patient anxiety reducedPatient anxiety reduced
Patient also describe several Patient also describe several consisted failure of communicationconsisted failure of communication
i.i. 5454% of complaint not elicited% of complaint not elicited
ii.ii. 45% of their concerns not elicited45% of their concerns not elicited
iii.iii. 50% of psychological problem not 50% of psychological problem not elicitedelicited
(cont’)(cont’)iv.iv. In 50In 50% visits, patient and doctors % visits, patient and doctors
disagreed on main presently disagreed on main presently problemproblem
v.v. In 50% cases, their history was In 50% cases, their history was blocked by interruption within 24 blocked by interruption within 24 secondsseconds
vi.vi. These lead to an incomplete history These lead to an incomplete history and poor professional relationshipand poor professional relationship
Adherence To Treatment
Health outcome also depend on the extent Health outcome also depend on the extent to which patient adhere to their clinical to which patient adhere to their clinical adviceadvice
Adherence and clinical advice is Adherence and clinical advice is dependent on effective communicationdependent on effective communication
Factors in communication which Factors in communication which improved patient adherence and clinical improved patient adherence and clinical advice are:advice are:
i.i. Clinicians understands the patientClinicians understands the patient
ii.ii. Clinician’s tone of voiceClinician’s tone of voice
(cont’)(cont’)• Clinicians elicits all the patient’s Clinicians elicits all the patient’s
health concernshealth concerns• Patient is comfortable asking Patient is comfortable asking
questionsquestions• Patient perceived that sufficient Patient perceived that sufficient
time is spent with the cliniciantime is spent with the clinician
Social Outcome
Patient satisfaction is the result of their;Patient satisfaction is the result of their;knowing that they are getting the best knowing that they are getting the best
appropriate careappropriate care
knowing that they are being treated knowing that they are being treated as individuals and not items on a as individuals and not items on a conveyor beltconveyor belt
being treated in a humane mannerbeing treated in a humane manner
These are all related to good These are all related to good communicationcommunication
Discord Between Patient And Clinician
An increasing number of complaints An increasing number of complaints and lawsuits due to poor and lawsuits due to poor communicationcommunication
Factors cited by 75Factors cited by 75% of complaining % of complaining patients as the cause of their complaint patients as the cause of their complaint against their doctor:against their doctor:
(cont’)(cont’) feeling desertedfeeling deserted feeling devaluedfeeling devalued information poorly deliveredinformation poorly delivered lack of understandinglack of understanding
In contrast, the qualities that patient In contrast, the qualities that patient described in interviews with primacy described in interviews with primacy care physician arecare physician are oriented patient to the process of the oriented patient to the process of the
visitvisit use of facilitative commentsuse of facilitative comments
ask patients their opinionsask patients their opinions use active listeninguse active listening use humor and laughteruse humor and laughter conducted slightly longer visitsconducted slightly longer visits
Clinician Satisfaction
It is the quality of their relationships with It is the quality of their relationships with their patients and colleagues which bring their patients and colleagues which bring about clinician satisfaction and happinessabout clinician satisfaction and happiness
Poor Communication Between Doctors And Patients
Difficulties clinician have in Difficulties clinician have in communicating with patientscommunicating with patients
1)1) Lack of knowledgeLack of knowledge
- - Concentrate on biomedical model Concentrate on biomedical model rather than psychosocial model of rather than psychosocial model of clinical practiceclinical practice
• illness have physical symptoms illness have physical symptoms without organic basiswithout organic basis
• physical illness prolonged by physical illness prolonged by psychological factorspsychological factors
• 2020% of patients have psychiatric % of patients have psychiatric diseasedisease
2)2) AttitudeAttitude
-- authoritarian role = paternalisticauthoritarian role = paternalistic
-- negative attitude to shared carenegative attitude to shared care
3)3) Lack of SkillLack of Skill
-- due to time constrains and due to time constrains and uncomfortable topics to patientsuncomfortable topics to patients
4)4) Failure of EmpathyFailure of Empathy -- empathy is described as empathy is described as
‘imagination for others’‘imagination for others’ -- demonstrate genuine interest in demonstrate genuine interest in
patient experiencepatient experience -- key skill in building key skill in building doctor-patient doctor-patient
relationshiprelationship
5)5) Personal FailurePersonal Failure -- unhappiness, short tempered, unhappiness, short tempered,
rushed and interrupted on the rushed and interrupted on the part of the doctor can affect part of the doctor can affect effective communication effective communication building between doctor and building between doctor and patientpatient
Difficulties For Patients In Communicating With Doctors
• InferiorityInferiority• Anxiety and its consequencesAnxiety and its consequences• MisconceptionsMisconceptions• Conflicting informationConflicting information• ForgetfulnessForgetfulness• Disinclinations to disclose their concernsDisinclinations to disclose their concerns• Impaired faculties of communicationImpaired faculties of communication
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