Importance of Patient-Centered

Communication in Lifestyle Diseases

Dr Ritu Awasthi-Shukla

Disease Transition

Communicable Diseases

Non Communicable Diseases (Lifestyle Diseases)

Communicable Diseases

Tuberculosis, Malaria, Cholera, Influenza, Measles, Polio etc

Transmitted from one person to another through a causative agent directly or indirectly

Prevalent among lower stratum of the society

Line of treatment and management is simple and easy to follow

Acute diseases

Non Communicable Diseases

Lifestyle Diseases

Changes to the way people live have created new environmental and behavioral risk factors, leading to a rise in lifestyle diseases

start slowly and often asymptomatically but last longer

Type 2 diabetes, Cardiovascular Diseases, Hypertension, Stroke

Management of lifestyle disease requires change in living pattern, attitude and mindset

Improved quality of living and awareness are the only prerequisite of overcoming these diseases

“The diabetic who knows the most, lives the longest”- Elliott P. Joslin, 1929

What Doctors say about patient…..

People are not ready to listen and change so it‟s difficult to bring about positive changes

Patient hide useful information on the first visit

It is easier to change the mindset of the people when somebody has suffered in the family.

What Patients want from Doctors

Make the patient aware that majority of the diseases are preventable and this prevention costs only a minimum of expenditure, if compared to the cost incurred on the treatment.

Awareness of right treatment options for the patient.

In addition to prescribing medicines to the patients, Doctors should also give some time to educate the patients and attendants about the causes of various diseases and what measures should be taken to prevent the common ailments which can be serious at times if neglected

A study published in JAMA found that

72% of the doctors interrupted the

patient‟s opening statement after an

average of 23 seconds

Patients who were allowed to state

their concerns without interruption

spoke for only an average of 6 more

seconds

Patients are at fault too…..

Patients described as “frustrating” by doctors do not trust or agree with the doctor

present too many problems for one visit

do not follow instructions

are demanding or controlling

Traditional Model

Linear/ Unidirectional Communication

Biomedical approach to addressing medical problems

”Prescription followed”

”weight loss”

“Healthy Diet”

Symptomatic Treatment

“Patient as diseases/ organ”

Why is it important?

Compliance with the medical

treatment

Improves Patient‟s satisfaction

Improved health and emotional status

of the patient

Improves Doctor‟s satisfaction

Reduces Malpractices

(Stewart and Roter)

Barriers to effective

communication There may be many barriers to effective

physician-patient communication.

Patients may feel that they are wasting the physician's valuable time;

omit details of their history which they deem unimportant;

be embarrassed to mention things they think will place them in an unfavorable light;

not understand medical terminology;

believe the physician has not really listenedand, therefore, does not have the information needed to make good treatment decisions

Culture and D-P Communication

How illness is discussed and treated

in a culture

Myths and misconceptions already

prevalent in the society

Poor Language skills

Types of doctor–patient

relationship*

Patient Control Doctor’s Control

Low High

Low Default Paternalism

High Consumerist Mutuality

*Stewert and Roter

Default relationship

Patients adopt a passive role even

when the doctor reduces some of his

or her control, with the consultation

therefore lacking sufficient direction

Paternalistic Relationship

Doctor is dominant and acts as a

„parent‟ figure who decides what he or

she believes to be in the patient‟s best

interest

Patient Submissive

Consumerist Relationship

the patient taking the active role and

the doctor adopting a fairly passive

role,

acceding to the patient‟s requests for

a second opinion, referral to hospital,

a sick note, and so on

Relationship of mutuality

active involvement of patients as equal partners in the consultation

meeting between experts‟, in which both parties participate and engage in an exchange of ideas and sharing of belief system

The doctor brings his or her clinical skills and knowledge

Patients bring their expertise in terms of their experiences and explanations of their illness, and knowledge of their particular social circumstances, attitudes to risk, values and preferences

Changing Role of Doctor

Patient-Centered Communication

Biopsychosocialapproach

Facilitator/ Listener

Behavior Change Expert

Negotiating small changes

“Patient as person”

Collective Role of Doctor and

Patient Shared decision making

Patient preferences should be sought

out and validated

Doctor and Patient engage in a

reciprocal relationship

“While the doctor focuses on illness,

the patient may be more interested

in wellness.” Athena du Pre

Thank you