Module 1.2: What does it mean to be a Patient?

1. Attitude, Ethics & Communication
(AETCOM) competencies
Learning modules for Professional year I
Module 1.2: What does it mean to be a
Patient?
DR. RAJNEE
Assistant Professor
Dept. of Physiology
SNMC, Jodhpur

2. Competencies addressed
Indian Medical Graduates (IMG) should be able
to:
• Enumerate and describe professional qualities
and roles of a physician
• Demonstrate empathy in patient encounters
DR. RAJNEE

3. Introduction
• Professionalism is the basis of medicine’s
social contract with society
• Professionalism demands placing the interests
of patients above those of the physician,
setting and maintaining standards of
competence and integrity, and providing
expert advice to society on matters of health.
• The concepts of empathy and equanimity in
the context of the role of a doctor who helps
patients, who are ill with associated suffering.
DR. RAJNEE

4. Empathy : What it is?
DR. RAJNEE
The word ‘empathy’ originates from the German word
‘Ein-fühlung’ (‘in + feeling’) which in turn was translated
from the Greek word ‘empatheia’ (‘physical affection,
passion’).

5. Status: Look at this Picture
• What is happening ?
• What are you feeling ?
• Are you have any motor responses ?

6. Status: Look at these
Pictures
• What do you think is happening?
• What are you feeling?

7. Empathy: What is it?
• Empathy is the capacity to
recognize and experience
feelings that are being
experienced by another.
• “It is the intrapersonal realization
of another’s plight that illuminates
the potential consequences of
one’s own actions on the lives of
others.” (Hollingsworth, 2003)

8. Empathy: What is it?
• “The essence of empathy is the ability to
stand in another’s shoes, to feel what it’s like
there and to care about making it better if it
hurts.”
– Szalavitz, M. & Perry, B.D. (2010). Born for love: Why
empathy is essential & endangered. New York: William
Morrow, (p. 12)

9. Empathy: What is it?
• Empathy is part of A wider capacity of humans
which can be defined as emotional intelligence
• The capacity to be aware of, control, and express
one's emotions, and to handle interpersonal
relationships judiciously and empathetically.
• Often considered a predictor of success

10. • Empathy is a key component of the patient-
doctor encounter. This enables the doctor to
be able to gauge the environment of the
patient that might help or hinder with the
treatment modalities; this leads to better
accuracy of diagnosis and higher chances of
the effectiveness of treatment.
DR. RAJNEE
Empathy: What is it?

11. Equanimity or stoicism
• Equanimity or stoicism is another quality that
the doctor needs to develop and use
appropriately to enhance the effectiveness of
patient-doctor encounters. Such equanimity
becomes an essential tool for the doctor to be
able to take clinical decisions without getting
bogged down by difficult emotions, either on
the part of the doctor patient or their
caregivers.
DR. RAJNEE

12. A few such cases are described below:
1. Patient's kin attack doctor at Hyderabad
hospital IANS, Hyderabad. Last Updated at May
20, 2019 15:26 IST. Relatives of a patient
attacked a doctor at Nizam' s Institute of
Medical Sciences (NIMS) here in the early
hours of Monday over his alleged negligence.
Weblink:https://www.businessstandard.com/article/news-ians/patient-s-kin-
attack-doctorat-hyderabad-hospital119052000746_1.
DR. RAJNEE

13. 2. Kin of a patient who attacked junior resident doctor at
Kolkata hospital to be charged with attempt to
murder. Updated Jul 11, 2019 / 01: 28 IST / Mirror
Now Digital Close to a month after Dr Paribaha
Mukherjee, a junior resident doctor at Kolkata’s Nil
Ratan Sircar (NRS) Medical College and Hospital, as
attacked by relatives of a 75-year-old patient, a court
in Sealdah city of West Bengal has now given police
officials the permission to include Section 307 of the
IPC which prescribes the Punishment for attempt to
murder.
Weblink: https://www.timesnownews.com/mirror-now/article/kin-of-
patient -who-attacked-Junior-resident-56Aetcom doctor-at-kolkata-
hospita1-to-be-charged-with- attempt-tomurder /451912 4.
DR. RAJNEE

14. 3. Woman of mumbai gets rs 15 lakh payout 9 years after
husband's death in '.Medical negligence' case. Press trust
of india, mumbai. Published: 02nd august 2019 12:21 PM
/ last updated: 02nd august 2019 12:21PM. The state
consumer commission in maharashtra has directed a civic-
run hospital in navi mumbai and a chemburbased hospital
to pay over rs 15 lakh compensation to a woman whose
husband died 9 years ago due to "medical negligence”. In
a recent order, the maharashtra state consumer disputes
redressal commission said while one hospital could not
recognize the illness of her husband, the other did not
provide proper medical treatment to him.
Weblink: http:/ / www. newindianexpress.com / cities/ kolkata / 2019
/aug / 02/ mumbai-woman-gets-rs-15-lakhpayout-nine-years-after
husbands-death-in-medicalnegligence-case-2013051.html
DR. RAJNEE

15. 4. A senior doctor of Bihar suspended for
negligence as encephalitis death toll rises to 109
at Muzaffarpur hospital. India Today Web Desk,
New Delhi. June 23, 2019 UPDATED: June 23,
2019 11:23 IST. A senior doctor from Sri Krishna
Medical College and Hospital (SKMCH) in
Muzaffarpur in Bihar has been suspended for
negligence after 109 children admitted with
acute encephalitis syndrome (AES) or Japanese
encephalitis died due to lack of treatment.
Weblink:https://www.indiatoday.in/india/story/biharsenior doctor-
suspended -f or-negligence-a s-encephalitisdeath toll-rises-to- 109-in-
muzaffarpur-hospital- 1554429-2019-06-23 6.
DR. RAJNEE

16. 5. Too few doctors, too many patients in Calcutta
hospitals. By Kinsuk Basu in Calcutta. Published
29.06.19, 4:37 AM.Updated 29.06.19, 4:37 AM.
The NRS Medical College and Hospital, where
two interns were attacked on the night of June
10 2019 after the death of a 75-year- old
Patients there, has only 1,886 beds. On Friday,
more than 3,500 Patients were in the inpatient
wards. The head injury unit at NRS has 27 beds.
On Friday, the last patient admitted was on
trol1ey and had the serial number 111.
Weblink:
https://www.telegraphindia.com/states/westbengal/too octors-
too-many-patients-in-calcuttahospitals / cid/1693422
DR. RAJNEE

17. Empathy in patient encounters and
student’s role
DR. RAJNEE

18. PATIENTOLOGIST
• Patientologists. They are empathetic; and understand
what the patient's fears and worries are, so that they
can help them to manage them.
• How does a doctor become a good patientologist ?
Unfortunately, these skills are never taught formally in
medical college. Some doctors have a great bedside
manner, because they have a high EQ ( emotional
quotient). Others learn how to improve their patient
skills by emulating their teachers who are good
clinicians

19. PRACTICE LITTLE EMPATHY JUST NOT
SYMPATHY
• Is the ability to understand the patient’s
experiences and feelings accurately as well
as to demonstrate that understanding to
the patient.
• Is an active process.
• Is more than sympathy, or feeling sorry for
someone.
DR. RAJNEE

20. START PRACTICING EMPATHY
DR. RAJNEE
• Empathy requires listening. Remain quiet and let the
patient talk.
• Silence can be helpful, don't be afraid of it. Use open
ended questions.
• Use “continuers” and echoing.

21. Effect model of empathic
communication in the
clinical encounter –
proposed by Neumann et
al.
DR. RAJNEE

22. What we are taught in medical
college is akin to: Alexithymia...
• “When it comes to patients, think
with your head, not with your
heart.”
• “Be objective when dealing with
patients and do not let your own
emotions interfere in the patient-
doctor relationship.”
• “Keep your own emotions at bay
lest you become too involved...”

23. WHAT OUR MEDICAL STUDENTS
NEED
• Medical schools / Colleges must be encouraged to
provide the best possible communication skills
training as part of the core undergraduate
curriculum. This training should have set objectives
and clear methods of assessment.
• More communication skills training programmes
should be developed at postgraduate level. Doctors
could use the appraisal process as a vehicle for
discussing the success of
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24. • Communication skills are
now regarded as a core
competence. Assessment
of communication skills will
be necessary as part of the
doctors appraisal and
personal development
plans. In addition,
revalidation will also take
communication skills into
account
COMMUNICATION SKILLS TO BE INCLUDED
IN STUDENT APPRAISAL
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25. EFFECTIVE COMMUNICATION BENEFITS
DOCTORS AND REDUCES LITIGATIONS
• Effective communication skills may relieve doctors of
some of the pressures of dealing with the difficult
situations encountered in this emotionally demanding
profession. Problematic communication with patients is
thought to contribute to emotional burn-out and low
personal accomplishment in doctors as well as high
psychological morbidity. Being able to communicate
competently may also enhance job satisfaction.
• Patients are less likely to complain if doctors
communicate well. There is, therefore, a reduced
likelihood of doctors being sued

26. • Some people think only
intellect counts:
knowing how to solve
problems, knowing how
to get by, knowing how
to identify an advantage
and seize it. But the
functions of intellect are
insufficient without
courage, love,
friendship, compassion
KNOWLEDGE CAN UNDERSTAND A PROBLEM
BUT CANNOT SOLVE WITHOUT EMPATHY
DR.T.V
a.RA
nO
dMD
empathy. 16