As a physician how to communicate effectively with patients.

1. Communication with
patients
Dr. Zubair Ahmad Bhat
Junior Resident,
Pharmacology, Govt. Medical College,
Baramulla, J&K.

2. No greater opportunity, responsibility, or
obligation can fall to the lot of a human
being than to become a physician. In the
care of suffering, the physician needs
technical skill, scientific knowledge, and
human understanding……. Tact, sympathy,
and understanding are expected of the
physician, for the patient is no more
collection of symptoms, signs, disordered
functions, damaged organs, and disturbed
emotions. The patient is human, fearful,
and hopeful, seeking relief, help and
reassurance.

3. Definition…
Communication is the process of sharing information
or messages for the purpose of common
understanding.
Effective communication with patients on various
aspects is important
‘Patient –centered care’ recommended also by WHO
Following features are important in communication
in medical profession:
Sympathy – it is an effort to understand another
person’s feelings or behavior with kindness and
compassion.

4. Definitions…
Empathy: Empathy is the ability to feel other people's
emotions, coupled with the ability to imagine what
someone else might be thinking or feeling, suffering by
ability to imagine oneself in another’s situation.
Ethics: Ethics is the study of morality – careful and
systematic analysis of moral decisions and behaviors and
practicing those decisions in day today life.
Medical ethics is application of fundamental moral
principles of ethics that apply values and judgments to the
practice of clinical medicine and in scientific research.

5. Principle of Medical Ethics:
• Beneficence: A physician must act in the best
interest of the patient
• Non maleficence: Physician must not harm a
patient through careless, malice or dislike or even
through treatment.
• Autonomy: This principle is focused on the
patient's independence or liberty.
• Justice: Justice refers to fairness with respect to
the distribution of medical resources without
considering their economical , social or any other
status.

6. What is purpose of doctor-patient communication?
•Creating good inter-personal relationship:
The doctor must show empathy, respect,
genuineness and warmth.
• Exchanging information:
The doctor should seek information about the
clinical problem from the patient by being a good
listener and then giving information.
• Making treatment related decision:
He/she should provide information about the
disease, drugs, life-style and dietary changes etc.

7. Doctor -patient interaction:
Non-verbal communication
• Offering seat, touching the patient, nodding head, eye to
eye contact.
Verbal communication
• Patient complaints
• Prescriber’s questioning about complaints: length, severity
• Prescriber’s explanation about diagnosis/ diseases
• Prescriber’s explanation to patient’s question
• Prescriber’s explanation about treatment particularly drugs

8. Coding of ideas :
1. Language (verbal, written)
2. Para-language (tone, pitch, accent of voice)
3.Non-verbal or body language (face, eye, other
gesture, body positioning, appearance)
Approx.% of meaning conveyed by the three codes:
1. Language-7%
2. Para-language-38%
3. Non verbal or body language-55%

9. Active listening
• Listening is a communication skill every doctor
should cultivate.
• It is the foundation of all communication and
relationship skills.
• A doctor must:
• Commit time to listen without interruption
• Absorb what patient want to convey
• Be open-minded, sensitive, empathetic
• Be able to concentrate without distractions (mobile/
laptop)…. or interruptions

10. Explanations on the following:
• Name of drug: generic name & brand name
• Therapeutic effects, side effects
• How to take the drug, when to stop
• Patient’s question about treatment
• How to prevent the disease / exacerbation
•Other information about diet/exercise
Effective communication results into accurate
diagnosis, more effective treatment or medical
intervention, more speedy recovery & better
realization of quality of life

11. Steps to Good communication skills with patient
• Initial greeting (friendly & helpful), building rapport with
the patient
• Offer Seat make comfortable
• Body posture -non threatening (warmth in questioning
style)
• Maintain eye contact, listen complaints actively ,sensitively
• Interruption and facilitation, when needed use of silence at
times
• Discuss personal and psychosocial issues of relevance
• Explain treatment available/given, directions for follow up
with clarity of expression
• End of interview with solving doubts to satisfy patient .

12. Avoid / Don’ts of communication
– Cynical or pessimistic talk
– Misleading false hope
– Creating guilt complex
– Losing temper

13. GATHER - in family practice
• G = Greet patient in a friendly way
• A = Ask about complaints
• T = Tell them about methods available
• H = Help the patient to decide
• E = Explain use
• R = Plan return visit

15. Drug Adherence:
• Medication adherence also known as drug
compliance or adherence refers to the
degree to which the person follows a
treatment regimen. It involves taking
medication on time and follow schedule as
directed by the health care provider to
achieve desired benefits.

16. Guidelines for ensuring adherence to drug treatment:
It is essential to provide step by step guidance on how
to use/ administer different medical devices/dosage
forms.
Information should be provided in a simple language,
that the patient/caretaker can understand.
Make sure the patient has understood the instructions.
Written instructions too may be provided in patient’s
vernacular language

17. Drug adherence….
– Whenever possible, involve patients in decision
making regarding their treatment so that they
have a sense of ownership in the treatment plan.
– Address key information about the drugs (what,
why, when, how, and how long)
– Check adherence on follow up visits….by various
means can ask to bring empty blisters of
medicine to cheque..intake of tablets…etc…

18. Drug adherence….
– Inform the common side effects and those that
patient should necessarily know.
– Provide medication calendars or schedules that
specify the time to take medications, medicine
related information sheets or specific packaging
such as pill boxes indicating the time of dose
– Motivate & Monitor adherence on follow up
visits

19. The most common reasons for non-adherence are:
• Frequent dosing
• Denial of illness
• Poor comprehension of the benefits of taking the
drug.
• Cost

20. Good communication about prescriptions to the patients
can avoid irrationality to some extent. Irrationality can
also be due to the patient's part because of the following
reason:
• Patients ask for a quick cure (asking for an injection in
place of oral treatment)
• Poor health education and wrong beliefs (taking too
much dose for quick relief)
• Self-medication of other drugs without prescription
• Misinterpretation of information given on prescription
• Non-compliance (not taking a complete course of
therapy).

21. Thank you