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Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
Sbh.4.doctor patient+relationship yusuf+misau_2011
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    • 1. Doctor-Patient Relationship (Public Health Specialist –Community Relationship) Dr. Yusuf Abdu Misau MBBS(ABU), MPH(UM), PhD Candidate(UM) Department of Social and Preventive Medicine, University of Malaya
    • 2. Acknowledgement <ul><li>I wish to acknowledge A/P Nabilla Al-Sadat for permission to use her slides in this presentation </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 3. Objectives <ul><li>Appreciate the social roles of doctors and patients </li></ul><ul><li>Understand the Types and Models of Doctor-Patient Relationship (DPR) </li></ul><ul><li>Understand the importance of effective Communication in DPR </li></ul><ul><li>Appreciate the `the changing scenario in DPR </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 4. Contents <ul><li>What is DPR ? </li></ul><ul><li>Person’s model of the sick role and doctor’s role? </li></ul><ul><li>Different factors influencing DPR </li></ul><ul><li>Types of DPR </li></ul><ul><li>Models DPR </li></ul><ul><ul><ul><li>Szasz and Hollender Model </li></ul></ul></ul><ul><ul><ul><li>Transactional Analysis </li></ul></ul></ul><ul><li>Doctors’ Communication skills </li></ul><ul><li>Changes in the Doctor-Patient Relationship </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 5. What is Doctor-Patient Relationship? 03/07/11 Yusuf Misau-Doctor-Patient Relationship <ul><li>It is an emotional association (clinical encounter) between the doctor and a patient which arises when the doctor in a professional capacity ; interact with the patient </li></ul>
    • 6. What is Doctor-Patient Relationship? 03/07/11 Yusuf Misau-Doctor-Patient Relationship <ul><li>It is usually related to clinical events, but it is important to realize the association beyond the clinical premise e.g in the community (non clinical situation) </li></ul><ul><li>Such meetings are a frequent &amp; regular occurrence </li></ul><ul><li>Depends not only on Drs’ clinical knowledge &amp; skills but also the nature of the social relationship that exists between the DR &amp; Patient </li></ul>
    • 7. What is Doctor-Patient Relationship? 03/07/11 Yusuf Misau-Doctor-Patient Relationship <ul><li>The Doctor and The Patient are on two opposite ends </li></ul><ul><li>The Doctor has a high level of knowledge on a problem the patient almost knows nothing about </li></ul><ul><li>The Doctor is often mechanistic (find and fix approach) </li></ul><ul><li>The patient is concern with illness (disruption of life) </li></ul><ul><li>But its entirely different from mechanic-client relationship </li></ul>
    • 8. DPR-Why is it relevant to us? 03/07/11 Yusuf Misau-Doctor-Patient Relationship <ul><li>Because of our understanding of: </li></ul><ul><li>The Clinical Iceberg phenomena </li></ul><ul><li>The decision making process in illness behavior </li></ul><ul><li>The social triggers of decision to seek medical aid </li></ul>
    • 9. PERCEPTIONS OF NEED <ul><li>THE CLINICAL ICEBERG (ICEBERG THEORY, LAST 1963) </li></ul><ul><li>Refers to the gap between the need for medical care and the utilization of professional services. </li></ul><ul><li>Health care professionals only see the tip of the iceberg with respect to the volume of illness in the community </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 10. 03/07/11 Yusuf Misau-Doctor-Patient Relationship Public’s perceived need for care
    • 11. 03/07/11 Yusuf Misau-Doctor-Patient Relationship Public’s perceived need for care Note the difference between actual and perceived need Symptoms Do nothing No symptoms Self-med, Alternative med See GP
    • 12. IMPLICATIONS <ul><li>Treated cases are not representative of sufferers as a whole and that knowledge of disorders obtained by the study of such cases is likely to be biased </li></ul><ul><li>In order to achieve a reduction in the gap: </li></ul><ul><ul><li>Appropriate education of both groups </li></ul></ul><ul><ul><li>Successful Doctor-Patient Consultation </li></ul></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 13. THE DECISION-MAKING PROCESS <ul><li>10 variables important in seeking of professional advice (Mechanic,1968) </li></ul><ul><ul><li>By illness behaviour we mean the way symptoms are perceived, evaluated and acted upon by a person who recognises some pain, discomfort or other signs of organic malfunction </li></ul></ul><ul><li>Social triggers (Zola,1973) </li></ul><ul><li>A model of Health and Illness behaviour in a multi-ethnic society (Jaafar,1995 ) </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 14. THE DECISION-MAKING ROCESS Mechanic (1968) <ul><li>The visibility, recognizability &amp; perceptual salience of the symptoms </li></ul><ul><li>The perceived seriousness of the symptoms </li></ul><ul><li>The extent to which symptoms disrupt work, family &amp; other social activities </li></ul><ul><li>The frequency of the appearance of symptoms &amp; their persistence or recurrence </li></ul><ul><li>The tolerance thresholds of others who are exposed to the symptoms </li></ul><ul><li>The knowledge, cultural assumptions &amp; understanding of the person and relevant others </li></ul><ul><li>Other needs or practical matters competing with the illness response </li></ul><ul><li>Competing possible interactions which can be assigned to symptoms once recognized </li></ul><ul><li>Emotional barriers in the form of fear and anxiety which influence the choice of actions to deal with the problem </li></ul><ul><li>The availability, physical proximity and the financial and/or emotional costs of taking various courses of action </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 15. SOCIAL TRIGGERS (ZOLA, 1973) <ul><ul><ul><li>Non physiological ‘triggers’ to the decision to seek medical aid: </li></ul></ul></ul><ul><ul><ul><li>An interpersonal crisis </li></ul></ul></ul><ul><ul><ul><li>Perceived interference with personal relationships </li></ul></ul></ul><ul><ul><ul><li>‘ Sanctioning’; that is, one individual taking primary responsibility for the decision to seek medical aid for someone else (the patient) </li></ul></ul></ul><ul><ul><ul><li>Perceived interference with work or physical functioning </li></ul></ul></ul><ul><ul><ul><li>The setting of external time criteria (‘If it isn’t better in 3 days…..then I’ll take care of it’) </li></ul></ul></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 16. PARSONS’ MODEL OF SICK ROLE. 03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 17. Parsons’ “Ideal Patient” (Sick Role) <ul><li>Rights (Permitted) to: </li></ul><ul><li>Give up some activities and responsibilities </li></ul><ul><li>Regarded as being in need of care and unable </li></ul><ul><li>to get well by his own decision &amp; will </li></ul><ul><li>Obligations (In Return) : </li></ul><ul><li>Must want to get better quickly </li></ul><ul><li>Seek help from and cooperate with a doctor </li></ul><ul><li>Parsons, 1951 </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 18. <ul><li>Apply a high degree of skill &amp; knowledge to the problems of illness </li></ul><ul><li>Act for welfare of patient and community rather then for own self interest, desire for money, advancement etc </li></ul><ul><li>Be objective and emotionally detached </li></ul><ul><li>Be guided by rules of professional practice </li></ul><ul><li>Parsons, 1951 </li></ul>Parsons’ “Doctor” (Doctors’ Role) 03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 19. Doctor’s Right <ul><li>Granted right to examine patients physically &amp; to enquire into intimate areas of physical &amp; personal life </li></ul><ul><li>Granted considerable autonomy in professional practice </li></ul><ul><li>Occupies position of authority in relation to the patient </li></ul><ul><li>Parsons, 1951 </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 20. Implications of Parsons’ theory <ul><li>Protection for the vulnerable </li></ul><ul><ul><li>From threatening symptoms </li></ul></ul><ul><ul><li>From exploitation </li></ul></ul><ul><ul><li>Doctor-patient relationship unequal </li></ul></ul><ul><li>Correction of societal deviance </li></ul><ul><ul><li>Being sick is ‘social threat’ </li></ul></ul><ul><ul><li>Society may be exploited </li></ul></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 21. Problems with Persons’ model <ul><li>Address acute problems (ignores chronic dx: imagine a cancer patient on medical leave for 10 year!) </li></ul><ul><li>Clinically oriented </li></ul><ul><li>Centered on individuals </li></ul><ul><li>Rights do not always apply </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 22. Factors influencing DPR 03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 23. Factors influencing DPR <ul><li>What could cause an imbalance in DPR? </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 24. Factors influencing DPR 03/07/11 Yusuf Misau-Doctor-Patient Relationship <ul><li>Conflict of Interest </li></ul><ul><ul><li>Interests of patient vs. society </li></ul></ul><ul><ul><li>Interests of patient vs. other patients </li></ul></ul><ul><ul><li>Problems of confidentiality </li></ul></ul>
    • 25. Factors influencing DPR <ul><ul><li>Differences in perspectives </li></ul></ul><ul><ul><ul><li>social class (Rich Doctor-Poor Patient) </li></ul></ul></ul><ul><ul><ul><li>Ethnicity (Foreign Doctor-Orang Asli) </li></ul></ul></ul><ul><ul><ul><li>Gender (Female pt-Male doc) </li></ul></ul></ul><ul><ul><ul><li>clinical-practice style (Over zealous Clinician-Tender Clinician) </li></ul></ul></ul><ul><ul><ul><li>Types and models of doctor-patient relationships (see below) </li></ul></ul></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 26. Recap….. <ul><li>What do you understand by DPR? </li></ul><ul><li>Why do you think it is important? </li></ul><ul><li>What are the factors influencing DPR? </li></ul><ul><li>What are the implications and flaws of Parsons’ Model of Sick role? </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 27. TYPES OF DOCTOR-PATIENT RELATIONSHIP 03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 28. Types of doctor-patient relationships 03/07/11 Yusuf Misau-Doctor-Patient Relationship <ul><li>Default </li></ul><ul><li>Paternalism (Doctor-centered, Disease centered) </li></ul><ul><li>Consumerism (typical in private practice) </li></ul><ul><li>Mutuality (Patient-centered, illness centered) </li></ul><ul><li>conflict </li></ul>
    • 29. Default DPR <ul><li>When patient and physician expectation are at odds, or when the need for change in the relationship cannot be negotiated, the relationship may come to a dysfunction standstill </li></ul>
    • 30. Paternalism: The disease centred DPR <ul><li>The traditional DPR </li></ul><ul><li>Doctor Takes on role of “parent” </li></ul><ul><li>Patient submissive </li></ul><ul><li>Shift towards Mutuality </li></ul>
    • 31. The Paternalistic Approach <ul><li>“ If I’ve told you once I told you 1,000 times, stop smoking!!” </li></ul>
    • 32. Consumerism Patient controlled consultation <ul><li>“ You’re paid to do what I tell you!!” </li></ul>
    • 33. Patients beliefs and expectations <ul><li>Influenced by: </li></ul><ul><li>Previous experience, literature, the media; </li></ul><ul><li>Family and friends; Cultural influences; </li></ul><ul><li>Social significance. </li></ul><ul><li>These beliefs influence outcomes </li></ul>
    • 34. Mutuality: Patient-centered DPR <ul><li>Regarded as optimal DPR </li></ul><ul><li>The Doctor is less authoritarian - encourages patient </li></ul><ul><li>Open questioning, interested in psycho-social aspect of illness </li></ul><ul><li>history &amp; examination investigation results in a diagnosis. Patient – ideas, expectations feelings results in an understanding of patients beliefs </li></ul><ul><li>Hence there is integration </li></ul>
    • 35. Types of doctor-patient relationships 03/07/11 Yusuf Misau-Doctor-Patient Relationship CONFLICT PATIENT CONTROL DOCTOR CONTROL LOW HIGH LOW DEFAULT PATERNALISM HIGH CONSUMERISM MUTUALITY
    • 36. MODELS OF DPR 03/07/11 Yusuf Misau-Doctor-Patient Relationship <ul><li>Szasz and Hollender 1956 - Parson’s concept </li></ul><ul><li>Transactional Analysis- Eric Berne </li></ul>
    • 37. MODELS OF DPR <ul><li>Szasz and Hollender 1956 - Parson’s </li></ul><ul><li>concept </li></ul><ul><li>Activity-passivity Model </li></ul><ul><li>Guidance-cooperation Model </li></ul><ul><li>Mutual Participation Model </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 38. MODELS OF DPR <ul><li>Szasz and Hollender 1956 - Parson’s concept </li></ul><ul><li>Activity-passivity Model </li></ul><ul><li>Doctor assumes complete responsibility </li></ul><ul><li>for the pt’s treatment ( Pt on the operating table ) </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 39. MODELS OF DPR <ul><li>Szasz and Hollender 1956 - Parson’s concept </li></ul><ul><li>GUIDANCE-COOPERATION MODEL </li></ul><ul><ul><li>Paternalistic relationship (high physician control &amp; low patient control) </li></ul></ul><ul><ul><li>Dr is dominant &amp; acts as a parent figure </li></ul></ul><ul><ul><li>Decides for patient’s best interest </li></ul></ul><ul><ul><li>Traditional medical consultation </li></ul></ul><ul><ul><li>Reliance on doctors for decision making </li></ul></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 40. MODELS OF DPR <ul><li>Szasz and Hollender 1956 - Parson’s Concept </li></ul><ul><li>MUTUAL PARTICIPATION MODEL </li></ul><ul><li>Active involvement of patients as more equal partners (‘meeting of experts’) </li></ul><ul><li>Both parties share power and responsibility, exchange of ideas &amp; sharing of belief systems, need each other and will work towards choices and actions satisfying to them both </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 41. MODELS OF DPR Transactional Analysis or TA (Eric Berne 1986) <ul><li>Describes and explains how we relate to each </li></ul><ul><li>other by looking at 3 ego states. </li></ul><ul><ul><li>Ego states: </li></ul></ul><ul><ul><ul><li>Parent </li></ul></ul></ul><ul><ul><ul><li>Adult </li></ul></ul></ul><ul><ul><ul><li>Child </li></ul></ul></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 42. Transactional Analysis <ul><li>Adult </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship Parent Child Parent Adult Child Doctor Patient reciprocal crossed
    • 43. SZASZ and HOLLENDER’S MODEL Vs. TRANSACTIONAL ANALYSIS <ul><li>ACTIVITY-PASSIVITY MODEL (Parent &amp; child) </li></ul><ul><li>Dr assumes complete responsibility for the pt’s treatment </li></ul><ul><li>GUIDANCE-COOPERATION MODEL ( Parent &amp; adult) </li></ul><ul><li>Instructions given by the doctors and patients cooperate by following this advice. Most common model used </li></ul><ul><li>MUTUAL PARTICIPATION MODEL (Adult-Adult) </li></ul><ul><li>Both parties share power and responsibility, need each other and will work towards choices and actions satisfying to them both </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 44. 03/07/11 Yusuf Misau-Doctor-Patient Relationship COMMUNICATION SKILLS
    • 45. A MODEL OF THE COMMUNICATION PROCESS 03/07/11 Yusuf Misau-Doctor-Patient Relationship SENDER RECEIVER E NCODI NG D ECODIN G CHANNEL Transmit Message Receive Message
    • 46. COMMUNICATION <ul><li>Between doctor and patient </li></ul><ul><li>Foundation for diagnosis and treatment (elicit &amp; convey information) </li></ul><ul><li>Relationship has a therapeutic effect placebo effect of drug </li></ul><ul><li>Doctor-centred consultation (Paternalistic style) </li></ul><ul><ul><li>‘ Closed’ nature questions e.g. “How long have you had the pain? &amp; is it sharp or dull?” Diseased centred model talk </li></ul></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 47. COMMUNICATION <ul><li>Between doctor and patient </li></ul><ul><li>‘ Patient-centered’ approach (Mutuality) </li></ul><ul><ul><li>Encourage &amp; facilitate their patients to participate </li></ul></ul><ul><ul><li>Use of ‘open’ questions e.g. ‘tell me about your pain’, ‘how do you feel? &amp; ‘what do you think is the cause of the problem?’ </li></ul></ul><ul><ul><li>Active listening skills, requires more time (participative style) </li></ul></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 48. COMMUNICATION STUDIES <ul><li>Studies on medical practitioners: </li></ul><ul><li>1.Kincey et al (1975) </li></ul><ul><ul><li>In US only 56% felt that they had been fully informed of dx, aetiology, tt and prognosis of their condition </li></ul></ul><ul><li>2. Cartwright &amp; Anderson (1981) </li></ul><ul><ul><li>In UK 23% felt their Dr was not good at explaining things to them </li></ul></ul><ul><li>Studies on dentists: </li></ul><ul><li>Collet (1969) </li></ul><ul><li>About 25% of pts left a dental practice over a 5-yr period because of poor dentist-pt communication </li></ul><ul><li>2. Corah (1974) </li></ul><ul><ul><li>Reported loss of pts as high as 50% </li></ul></ul><ul><li>Schouten et al (2002) </li></ul><ul><ul><li>Pts’ satisfaction is positively related to the communicative behaviour of dentists </li></ul></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 49. COMMUNICATION STUDIES <ul><li>Influence on time : </li></ul><ul><li>Howey et al (1992) </li></ul><ul><ul><li>Pressure on time result in fewer psychological problem are identified &amp; more prescriptions are issued (2-20 min, average 6 minutes) </li></ul></ul><ul><li>Ridsdale et al, 1992 </li></ul><ul><ul><li>Increase to 10 minutes resulting in all Drs asking more questions. </li></ul></ul><ul><li>Patient characteristics &amp; behaviours </li></ul><ul><ul><li>Mutual participation more among younger than elderly people </li></ul></ul><ul><ul><li>Pts with high SES ask more Qs &amp; explanation than pts from lower SES </li></ul></ul><ul><ul><li>Social class difference 27% working class compared to 45% middle-class pts sought clarification (Tuckett, 1985) </li></ul></ul><ul><ul><li>Drs offer more explanations to some groups eg educated pts nad male pts (Street, 1991) </li></ul></ul><ul><li>Influence of structural context </li></ul><ul><li>Hospital situation discourage personal continuity of care compared to general practice </li></ul><ul><li>Financing of health care </li></ul><ul><ul><li>Fee-for-service encourage longer consultation and increase pt satisfaction compared to per capita or salaried basis </li></ul></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 50. Why is there poor communication? <ul><li>The influence of class and status </li></ul><ul><li>Cognitive failure </li></ul><ul><li>Professional attitudes and interviewing styles </li></ul><ul><li>Professional power </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 51. Good Communication Skills In Consultation <ul><li>Initiating the session ( initial rapport ) </li></ul><ul><li>Gathering information (exploring the problem, understanding the patients views) </li></ul><ul><li>Building the relationship (involving the patient) </li></ul><ul><li>Explanation and planning (providing the appropriate amount &amp; type of information, aiding accurate recall and understanding, achieving a shared understanding and planning) </li></ul><ul><li>Closing the session </li></ul><ul><li>Silverman et al, 1998 </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 52. <ul><li>Non-verbal (Body language ) Verbal </li></ul><ul><li>Greet patient, SMILE, polite and gentle - Social exchanges </li></ul><ul><li>Forewarn patient of your next action - Address the patient accordingly </li></ul><ul><li>Facial expression - Avoid compound question </li></ul><ul><li>Listening - Open and focused questions </li></ul><ul><li>Eye contact - Facilitate talking: “Go on…” </li></ul><ul><li>Posture - Restating: repeat what patient </li></ul><ul><li>say in your own words. </li></ul><ul><li>Proximity </li></ul><ul><li>Position - Simple words and speak clearly </li></ul><ul><li>Body contact </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 53. Advantages of improved communication <ul><li>Compliance with medical instructions and advice </li></ul><ul><ul><li>Low compliance Dr who do not seek pts’ active participation in the interview, are formal and distant in their mx of the pt by providing little in the way of feedback </li></ul></ul><ul><li>2. Satisfaction with health care </li></ul><ul><ul><li>Goals of pt – dx and tt of any oral problems, relief of fear &amp; anxiety </li></ul></ul><ul><li>3. The social dimensions of healing </li></ul><ul><ul><li>Benefits of improved DPR – satisfactory recovery </li></ul></ul><ul><ul><li>Significance of EMPOWERMENT </li></ul></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 54. <ul><li>Wersch &amp; Eccles, 2001 (Development of clinical guidelines for practice) </li></ul><ul><ul><li>Philosophy of patient-centred care </li></ul></ul><ul><ul><li>Shift towards shared treatment decisions </li></ul></ul><ul><ul><li>Greater access to high quality medical information on the internet will increase the no. of ‘information-rich’ pts </li></ul></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship Changes in the DPR
    • 55. <ul><li>Ridsdale &amp; Hudd, 1994 </li></ul><ul><ul><li>The widespread use of computers in the consultation </li></ul></ul><ul><ul><ul><li>Position of pt from the screen </li></ul></ul></ul><ul><ul><ul><li>Drs’ ability to maintain their personal touch through verbal skills and eye contact </li></ul></ul></ul><ul><ul><ul><li>Confidentiality of data maintain TRUST </li></ul></ul></ul><ul><li>The use of telemedicine as a means of delivering health care </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship Changes in the DPR
    • 56. Strategies for improvement of DPR <ul><li>1. Understanding illness </li></ul><ul><ul><li>How pts and those around him view origin, significance &amp; prognosis of the condition &amp; how it affects other aspects of life </li></ul></ul><ul><ul><li>Info about pts’ cultural, religious, social &amp; economic background, his previous experience of ill-health, &amp; if possible his view of misfortune in general </li></ul></ul><ul><li>2. Improving communication </li></ul><ul><ul><li>“ Language of distress” - culturally specific folk illnesses (Mechanic) </li></ul></ul><ul><li>Helman, 2000 </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 57. Strategies for improvement of DPR <ul><li>3. Increasing reflexivity (self-awareness) </li></ul><ul><li>4. Treating ‘illness’ and ‘disease’ </li></ul><ul><ul><li>Do not deal with physical abnormalities/malfunctions </li></ul></ul><ul><ul><li>The many dimensions of “ILLNESS” </li></ul></ul><ul><li>5. Respecting diversity – health beliefs and practices </li></ul><ul><li>6. Assessing role of context (social, economic, environmental factors - focus on who?) </li></ul><ul><li>Helman, 2000 </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 58. The proposed conceptual model: Patients preferences in dentist communication skills in the Malaysian Army 03/07/11 Yusuf Misau-Doctor-Patient Relationship DPR SOCIOEMOTIONAL BEHAVIOUR TECHNICAL COMPETENCY INTERPERSONAL COMPETENCY <ul><li>GOOD TREATMENT </li></ul><ul><li>FRIENDLY </li></ul><ul><li>COMPETENT &amp; SKILFUL </li></ul><ul><li>CAREFUL &amp; DON’T RUSH ++ </li></ul><ul><li>Accurate ++ decision </li></ul>COGNITIVE &amp; INFORMATION GIVING CONFLICT RESOLUTION &amp; NEGOTIATION Ref: Zainal Abidin Z. MCD 1997
    • 59. CONCLUSION <ul><li>Goal of consultation is not only to arrive at diagnosis and formulating a treatment plan </li></ul><ul><li>But also, to develop common understanding between patient and doctor </li></ul><ul><li>To help patients develop self control over their illness and its course </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 60. You may wish to have my contact: <ul><li>[email_address] </li></ul><ul><li>Or visit my Journal </li></ul><ul><li>www.publichealthinafrica.com </li></ul><ul><li>www.publichealthinafrica.org </li></ul><ul><li>Your papers will of course be highly welcomed!!! </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 61. REFERENCES <ul><li>Cecil G Helman. Culture, Health and Illness. Wright 2000 </li></ul><ul><li>David Armstrong. Outline of Sociology as Applied to Medicine. Butterworth Heinemann. 1994. </li></ul><ul><li>Graham Scambler (ed). Sociology as Applied to Medicine. Saunders 2003. </li></ul><ul><li>David Tuckett (ed). An introduction to Medical Sociology. Tavistock Publications. 1976. </li></ul><ul><li>Fredric D. Wolinsky. The sociology of Health: Principles, Professions and Issues. Little, Brown and Company Ltd. 1980. n CG. Culture, Health and Illness. 4th ed. 2001; Butterworth Heinemann, London. Chapter, pp. 79-107. </li></ul>03/07/11 Yusuf Misau-Doctor-Patient Relationship
    • 62. Terima kasih Nagode Thank you 03/07/11 Yusuf Misau-Doctor-Patient Relationship                                                                                             

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