Medical professionalism & motivation for doctors- Dr Vijay Sardana

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Medical professionalism & motivation for doctors- Dr Vijay Sardana

  1. 1. Medical Professionalism & Motivation for Doctors Dr Vijay Sardana MD,DM ( Neurology) Professor & Head Deptt. Of Neurology Govt.MedicalCollege, Kota
  2. 2. The Noble Profession of Medicine <ul><li>“ There is no career nobler than that of the physician. The Progress and welfare of society is more intimately bound up with the prevailing tone and influence of the medical profession that with the status of any other class…” </li></ul><ul><li>ElizabethBlackwell,M.D.,1889 </li></ul>
  3. 3. Doctors : Definition of success <ul><li>Having lots of patients </li></ul><ul><li>New car/plot Every year/lots of money </li></ul><ul><li>Publishing papers in journals </li></ul><ul><li>Teaching students </li></ul>
  4. 4. Doctor : Facts <ul><li>One of the every these dissatisfied due to lack of time for themselves or their families </li></ul><ul><li>Average life 10 year less </li></ul><ul><li>Depression 4 times higher than general population </li></ul>
  5. 5. Stages of career <ul><li>Entry </li></ul><ul><li>Establishment </li></ul><ul><li>Exploration </li></ul><ul><li>Specialization </li></ul><ul><li>Mastery </li></ul>
  6. 6. Stages of Professional life <ul><li>No work, No money, lots of time </li></ul><ul><li>Some work, some money, some time </li></ul><ul><li>Plenty of work, Plenty of money, no time </li></ul>
  7. 7. Success <ul><li>Know – How. </li></ul><ul><li>Know - Who. </li></ul><ul><li>Who you know. </li></ul><ul><li>Who knows you. </li></ul>
  8. 8. Today's successful doctor <ul><li>Clinician </li></ul><ul><li>Academician </li></ul><ul><li>Manager </li></ul><ul><li>Financial Expert </li></ul><ul><li>CEO </li></ul><ul><li>Family care Provider </li></ul><ul><li>Self care taker </li></ul>
  9. 9. <ul><li>“ The education of the doctor which goes on after he has his degree is the most important part of his education” </li></ul><ul><li>John Shaw Billings </li></ul>
  10. 10. Patients satisfaction <ul><li>Satisfied patient 3 other people </li></ul><ul><li>Dissatisfied patient 20 others </li></ul><ul><li>Satisfying unhappy patients 50 others </li></ul>
  11. 11. Doctor-Patient Relationship <ul><li>“ The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best pat of your work will having nothing to do with potions and powders…” </li></ul><ul><li>William Oster,M.D.,1925 </li></ul>
  12. 12. Doctor-Patient Relationship <ul><li>Blind trust </li></ul><ul><li>Informed trust with skepticism </li></ul>
  13. 13. Doctor-Patient Relationship <ul><li>Has the Doctor changed?? </li></ul><ul><li>or </li></ul><ul><li>Doctor is facing the changed society? </li></ul>
  14. 14. Trust equation by David Maister <ul><li>T = C + R + I + S , Where </li></ul><ul><li>T = Trustworthiness </li></ul><ul><li>C = Credibility </li></ul><ul><li>R = Reliability </li></ul><ul><li>I = Intimacy </li></ul><ul><li>S = Self-orientation </li></ul><ul><li>Credibility = can your patient trust what you say? </li></ul><ul><li>Reliability = can he trust your actions, confident that you will act honorably? </li></ul><ul><li>Intimacy = Is he comfortable discussing his feeling and emotion with you? </li></ul><ul><li>Self orientation = can he trust your motives, knowing that you care about him, and will act in his best interests? </li></ul>
  15. 15. Doctor-Patient Relationship <ul><li>Patient dissatisfaction </li></ul><ul><li>Mistrust </li></ul><ul><li>Medical litigation </li></ul>
  16. 16. Litigation <ul><li>Professional failure in diagnosis or treatment </li></ul><ul><li>Lack of communication </li></ul><ul><li>Some form of insensitivity by the doctor to upset them emotionally – insult adding to injury. </li></ul>
  17. 17. Doctor-Patient Relationship <ul><li>Excessive workload? </li></ul><ul><li>Attitude Problem? </li></ul>
  18. 18. Attitude formation of a Physician <ul><li>Medical student </li></ul><ul><li>Altruism </li></ul><ul><li>Role models behavior </li></ul><ul><li>Prevailing commercialism </li></ul><ul><li>Work environment </li></ul><ul><li>Social and political environment </li></ul>
  19. 19. Causes of Poor relationship <ul><li>Rising health cost. </li></ul><ul><li>Over specialization. </li></ul><ul><li>Changing patients/community expectation. </li></ul><ul><li>Commercialization. </li></ul><ul><li>Poor Communication </li></ul><ul><li>More awareness about adverse effect. </li></ul>
  20. 20. Medical professionalism : deprofessionalism- cause <ul><li>Technology – Depersonarlise medicine & deprofessionlise a physician </li></ul><ul><li>Corporatization of Medicine </li></ul><ul><li>Specialization – Most patients identified by disease rather than human beings who happens to have disease </li></ul><ul><li>Patients knowing limitation of modern medicine </li></ul><ul><li>Greed </li></ul>
  21. 21. Doctor-Patient Relationship <ul><li>Failure of referral system </li></ul><ul><li>Disproportionate work load </li></ul><ul><li>Unnecessary administrative responsibilities </li></ul>
  22. 22. Doctor-Patient Relationship <ul><li>Overinvestigation/ overtreatment </li></ul><ul><li>Medico-legal Aspect </li></ul><ul><li>“ Defensive Medical Practice” </li></ul>
  23. 23. Doctor-Patient Relationship <ul><li>Commercialization of service </li></ul>
  24. 24. Doctor-Patient Relationship: Informed consent <ul><li>Condition of the patient (Disease) </li></ul><ul><li>Purpose & Nature of intervention. </li></ul><ul><li>Consequences of such intervention. </li></ul><ul><li>Any alternatives available </li></ul><ul><li>Risks involved </li></ul><ul><li>Prognosis in the absence of intervention. </li></ul>
  25. 25. Doctor-Patient Relationship <ul><li>Information given to patient is selected to encourage them to consent to doctor’s decision. </li></ul>
  26. 26. Doctor-Patient Relationship <ul><li>Influence of drug & medical equipment manufacturer </li></ul><ul><li>Pardoned </li></ul><ul><li>Tolerated </li></ul><ul><li>norm </li></ul>
  27. 27. Doctor-Patient Relationship Patients responsibilities <ul><li>Courteous & transparent to health care provider. </li></ul><ul><li>Not carried away by emotion & misinformation. </li></ul><ul><li>Sharing anxiety with doctor to resolve problem </li></ul><ul><li>Never to become violent/act unlawfully. </li></ul>
  28. 28. Doctor-Patient relationship: Politicians <ul><li>Political mileage. </li></ul><ul><li>Instigating patient to raise voice against doctor, at times unjustified. </li></ul>
  29. 29. Pressures <ul><li>Ministers </li></ul><ul><li>Ex ministers </li></ul><ul><li>PAs </li></ul><ul><li>Political party office bearers </li></ul><ul><li>Other parties </li></ul><ul><li>Regional parties </li></ul><ul><li>Media </li></ul><ul><li>others </li></ul>
  30. 30. What constitutes violence? <ul><li>Telephone threats </li></ul><ul><li>Intimidation </li></ul><ul><li>Oral abuses </li></ul><ul><li>Physical manhandling </li></ul>Violence Against Doctors “ incidents where people are abused, threatened or assaulted in circumstances relating to their work, involving an explicit or implicit challenge to their safety, well-being or health”.
  31. 31. UK <ul><li>Half of all doctors – some degree of violence or abuse, 20% of these physical (BMJ, 2003) </li></ul><ul><li>Among GPs, threat of violence at 1 in 500 consultations </li></ul>Violence Against Doctors
  32. 32. Others <ul><li>Kuwait – 86% doctors – verbal insults or imminent violence, 28% physical attacks </li></ul><ul><li>Israel – 54% to 79% rate of violence in physician surveys </li></ul><ul><li>Europe – Intoxicated patients flooding ERs </li></ul><ul><li>Australia – half of doctors physically attacked at least once </li></ul>Violence Against Doctors
  33. 33. Why? <ul><li>More demanding society </li></ul><ul><li>More availability of knowledge </li></ul><ul><li>More aggression in society </li></ul><ul><li>More violence on roads, public places, even schools </li></ul>Violence Against Doctors
  34. 34. How to deal? <ul><li>Not meet anger with anger </li></ul><ul><li>Address the grievances, but also call for help </li></ul><ul><li>Doctors must form groups, which can take over in such instances </li></ul>Violence Against Doctors
  35. 35. Law <ul><li>Non-bailable offence </li></ul><ul><li>Offenders liable to pay up to twice the purchase price of damaged equipment </li></ul>Violence Against Doctors
  36. 36. Doctor-Patient Relationship: police <ul><li>Rajasthan Medicare Service Persons and Medicare Service Institutions (Prevention of Violence and Damage to Property) act 2008 </li></ul><ul><li>304-A </li></ul>
  37. 37. Communication <ul><li>Communication, communication, communication about costs, complications and challenges </li></ul><ul><li>Doctors must make efforts to educate and inform the public at large about diseases and medical problems </li></ul>Violence Against Doctors
  38. 38. Time Barrier to Communication <ul><li>Lack of time can be managed </li></ul><ul><li>Use paramedical staff </li></ul><ul><li>Delegate the work of repeated explanations </li></ul><ul><li>Counselors </li></ul>Violence Against Doctors
  39. 39. Prevention <ul><li>Display information on boards, counters etc. </li></ul><ul><li>Try not to escalate costs later or change plans frequently </li></ul><ul><li>Also display rules regarding consequences of violence in hospital </li></ul>Violence Against Doctors
  40. 40. Doctors’ Expectations <ul><li>From administration - Implement laws by the letter and spirit </li></ul><ul><li>Media – 1. publish both views, avoid sensationalism, seek an expert opinion preferably from another city </li></ul><ul><li>2. more positive </li></ul><ul><li>3. do not ascribe wrongful intentions </li></ul>Violence Against Doctors
  41. 41. Display of Warnings & Other information <ul><li>Display warning in hospital premises mentioning the consequences of violence against doctors in hospital </li></ul><ul><li>Display flow chart/plan in Emergency Room </li></ul>Violence Against Doctors
  42. 42. Trouble Shooting <ul><li>Relatives & attendants Fight Disperse </li></ul><ul><li>10 Min </li></ul><ul><li>1 st degree friends More Attendants </li></ul><ul><li>30 Min </li></ul><ul><li>Hospital Administration </li></ul><ul><li>Police, Media </li></ul><ul><li>30 Min </li></ul><ul><li>Media & Police Strengthening </li></ul><ul><li>2 nd degree friends </li></ul><ul><li> 1 Hour </li></ul>
  43. 43. <ul><li>Strike </li></ul><ul><li>FIRs </li></ul><ul><li>1-2 Days </li></ul><ul><li>Strike Continues </li></ul><ul><li>1-2 Days </li></ul><ul><li>Solution, Often Face saving arrived </li></ul><ul><li>Forgotten, gone with the wind </li></ul>
  44. 44. Medical Students/ Residents/ Doctors <ul><li>Professional Nonprofessional </li></ul><ul><li>Carrier Conscious No carrier so no fear </li></ul><ul><li>Socio-cultural trauma Mostly no Trauma </li></ul><ul><li>Can go to certain extent Can go to any extent </li></ul>Friends
  45. 45. <ul><li> Power </li></ul><ul><li>Vigilance - Negligence </li></ul><ul><li>Silence - Violence </li></ul><ul><li>Tolerance - Intolerance </li></ul><ul><li>Discipline - Indiscipline </li></ul><ul><li>Seriousness - Carelessness </li></ul><ul><li>Good Sense - Nuisance </li></ul>
  46. 46. <ul><li>If too many anxious attendants, send them one or another job. eg. Bringing medicines, arranging blood- Energy utilization </li></ul><ul><li>Never argue with attendants </li></ul><ul><li>Argument will trigger them, at the same time your calmness and promptness will even calm down a triggered person. </li></ul><ul><li>If patient is sick, attend patient periodically and talk to attendants. </li></ul><ul><li>Check emergency tray for drugs. </li></ul><ul><li>Try to solve/resolve crisis immediately </li></ul>Do’s
  47. 47. Do’s <ul><li>Patients should be attended promptly: </li></ul><ul><li>- Error in Decision making is Excusable but not attending patients timely is not. </li></ul><ul><li>Identify a Prominent Person: </li></ul><ul><li>- Important person/relative and explain initial assessment of patient immediately. </li></ul><ul><li>- Explain them management has started. </li></ul><ul><li>Ask if they have any questions </li></ul><ul><li>Call senior consultant as per requirement, talk to them telephonically if possible delay in arrival. </li></ul>
  48. 48. Don’ts <ul><li>Never argue with attendants. this situation teaches you how to remain calm in provocative circumstances. No book in the world can teach this . </li></ul><ul><li>Never overlook a call, especially if call is by a attendant. </li></ul>
  49. 49. DO’S <ul><li>If there is Gang War- call Police force </li></ul>
  50. 50. Codes of ethics and Declaration <ul><li>Duties to patient. </li></ul><ul><li>Duties to public. </li></ul><ul><li>Duties towards law Enforcers. </li></ul><ul><li>Duties not to violate professional ethics. </li></ul><ul><li>Duties not to do anything illegal or hide illegal acts. </li></ul><ul><li>Duties to each other. </li></ul>
  51. 51. Standard Care <ul><li>Standard, suitable, equipment in good repair. </li></ul><ul><li>Standard assistance. </li></ul><ul><li>Non standard drug is a poison by definition. </li></ul><ul><li>Standard procedure and indicated treatment and surgery. </li></ul><ul><li>Standard proper reference to appropriate specialist. </li></ul>
  52. 52. Duty to provide information to patient/attendant <ul><li>Regarding necessity of treatment. </li></ul><ul><li>Regarding duration of treatment. </li></ul><ul><li>Regarding prognosis. Do not exaggerate nor minimize gravity of patients condition. </li></ul><ul><li>Regarding the expenses and break-up thereof. </li></ul>
  53. 53. Emergency care <ul><li>A doctor is bound to provide emergency care on humanitarian grounds, unless he is assumed that other are willing and able to give such care. It may be noted that prior consent is not necessary for giving emergency/first aid treatment. In emergency medico-legal cases condition of first being seen by medical jurist is not essential. </li></ul>
  54. 54. Duties to the public <ul><li>Health Education </li></ul><ul><li>Medical help when natural calamities like drought, flood, earthquakes, etc occur. </li></ul><ul><li>Medical help during train accidents. </li></ul><ul><li>Compulsory notification of births, deaths, infections, disease, food poisoning etc. </li></ul><ul><li>To help victims of house collapse, road accidents, fire, etc </li></ul>
  55. 55. Duties towards Law enforcers, Police Courts, etc <ul><li>To inform the police all cases of poisoning, burns, injury, illegal abortion, suicide, homicide, manslaughter, grievous hurt and its natural complication like tetanus, gas-gangrene, etc. This includes vehicular accidents, fracture, etc </li></ul><ul><li>To call a Magistrate for recording dying declaration. </li></ul>
  56. 56. Duty not to violate Professional ethics <ul><li>Not to indulge in self-advertisement except such as is expressly authorized by the MCI code of Medical Ethics. </li></ul><ul><li>No fee sharing </li></ul><ul><li>Not to attend pts under Alcohol </li></ul><ul><li>Not to issue false certificate and bills. </li></ul><ul><li>not to talk loose with colleagues. </li></ul><ul><li>Patients identity not to be disclosed </li></ul><ul><li>Not to run Medical store </li></ul><ul><li>Recovering any money in connection with service rendered to a patient other than a proper professional fee, even with the knowledge of the patient. </li></ul>
  57. 57. Duty not to do anything illegal or hide illegal acts <ul><li>Perform illegal abortions/sterilizations </li></ul><ul><li>Issue death certificated where cause of death is not known. </li></ul><ul><li>Not informing police a case accident, burns, poisoning, suicide, grievous hurt, gas gangrene. </li></ul><ul><li>Not calling Magistrate for recording dying declaration. </li></ul>
  58. 58. Medical Professionalism <ul><li>“ Contributing those attitude and behaviors that serves to maintain patients’ interest above Physicians’ self interest.” </li></ul>
  59. 59. Professional Responsibilities 1-3 <ul><li>Commitment to Professional competence </li></ul><ul><li>* lifelong learning of medical knowledge and clinical and team skills </li></ul><ul><li>Commitment to honesty with patients </li></ul><ul><li>* Assuring that patient are completely and honestly informed before and after treatment, including disclosure of errors </li></ul><ul><li>Commitment to patient confidentiality </li></ul><ul><li>*Applying safeguards to the disclosure of patient information </li></ul><ul><li>Am Board Int Med Foundation, Am Coll Physician, Eur.Foundation Int Med. Am intern Med & Lancet 2002 </li></ul>
  60. 60. Professional Responsibilities 4-6 <ul><li>Commitment to maintaining appropriate relation with patients </li></ul><ul><li>* Avoiding the exploitation of patients for sexual advantage, personal financial gain, or any other private purpose </li></ul><ul><li>Commitment to improving the quality of care </li></ul><ul><li>* Working collaboratively to create system contributing to continuous quality improvement in health care. </li></ul><ul><li>Commitment to improving access to care </li></ul><ul><li>* Reducing barriers to equitable health care based on education, laws, geography, and social discrimination </li></ul>
  61. 61. Professional Responsibilities 7-9 <ul><li>Commitment to a just distribution of finite resources </li></ul><ul><li>* Providing health care based on wise and cost-effective management of limited resources. </li></ul><ul><li>Commitment to scientific knowledge </li></ul><ul><li>* Uploading current scientific standards and promoting the creation and appropriate use of knowledge </li></ul><ul><li>Commitment to maintaining trust by managing conflicts of interest </li></ul><ul><li>* Compromising professional responsibilities by pursing private or personal gain </li></ul>
  62. 62. Professional Responsibilities 10 <ul><li>Commitment to Professional Responsibilities </li></ul><ul><li>* Working collaboratively and treating one another with respect </li></ul>
  63. 63. Communication skills <ul><li>“ Patients don’t care how much you know them, they know how much you care” </li></ul>
  64. 64. Communication <ul><li>7% - Spoken words </li></ul><ul><li>38% - Voice quality like Tone, Tempo, intonation </li></ul><ul><li>55% - Body language </li></ul>
  65. 65. How to perfect non verbal signal <ul><li>Smile </li></ul><ul><li>Open Posture </li></ul><ul><li>Forward lean </li></ul><ul><li>Touch </li></ul><ul><li>Eye contact </li></ul><ul><li>Nod </li></ul>
  66. 66. Communication skills in clinical practice- Introduction <ul><li>“ Its an art to talk medicine in the language of a non medical men ” </li></ul><ul><li>not an option but a necessity </li></ul><ul><li>separates successful doctors from unsuccessful ones </li></ul><ul><li>include ability to engage with patients at emotional level, to listen, to convey information with clarity & sympathy </li></ul>
  67. 67. What do patients want <ul><li>Patient dissatisfaction with doctors relate to problems of communication rather than clinical competence </li></ul><ul><li>They want </li></ul><ul><li>- quality information about their problems </li></ul><ul><li>- risks & benefits of treatment </li></ul><ul><li>- relief of emotional distress </li></ul><ul><li>- to be active participate in medical decision making </li></ul>
  68. 68. Barriers to communication <ul><li>Work over load on doctors </li></ul><ul><li>Shortage of man power- less time for individual patient </li></ul><ul><li>Lack of training in communication skills during medical education </li></ul><ul><li>Individual attitude & personality traits </li></ul>
  69. 69. Components of clinical communication skills <ul><li>RAPPORT BUILDING </li></ul><ul><li>starts with taking history of patient </li></ul><ul><li>Give adequate time to history taking & clinical examination keeping in mind Bio-Psycho-Social approach </li></ul><ul><li>Do not make false promises regarding prognosis </li></ul><ul><li>Explain the rationality of Lab Investigations prescribed </li></ul><ul><li>Do not criticize previous doctors prescription </li></ul><ul><li>Use patients name whenever possible, it makes rapport building easier </li></ul>
  70. 70. 2. EMPATHIC LISTENING <ul><li>Show empathy & respect – let your patients know that you care & understand their experience </li></ul><ul><li>Putting yourself in patients situation </li></ul><ul><li>Develop listening skills </li></ul><ul><li>Give a 2-4 seconds pause between listening & responding </li></ul><ul><li>Maintain eye to eye contact </li></ul><ul><li>Avoid changing the topic mid way by interrupting </li></ul><ul><li>Empathic listening is most useful in dealing emergency cases </li></ul>
  71. 71. 3. Effective questioning skills <ul><li>elicit maximum information in shortest possible time using purposeful & inoffensive questions </li></ul><ul><li>Ask one question at a time </li></ul><ul><li>Wait until the previous question is fully answered </li></ul>
  72. 72. 5. Answering skills <ul><li>weakest communication skills among Indian Medical Professionals </li></ul><ul><li>In Indian context patient satisfaction is largely decided by the quality of answers & explanation given by doctors </li></ul><ul><li>Understand the question clearly, answer fully, & clearly but briefly </li></ul><ul><li>Avoid major technical terms </li></ul>
  73. 73. 5. Answering skills (contd..) <ul><li>Compliment the patient on asking a good question </li></ul><ul><li>If you can’t give a ready answer give non committal answer like- “ let me observe you for some more time, certain tests are awaited” </li></ul><ul><li>Take feedback whether they have understood answer </li></ul>
  74. 74. Information sharing & decision making <ul><li>Most important when there is life threatening illness </li></ul><ul><li>When different management options exist with varying costs, benefits & when outcome is unpredictable </li></ul><ul><li>Discuss risks & benefits of each option </li></ul><ul><li>It not only increases patient satisfaction but also reduces the chance of litigation if any adverse outcome results </li></ul><ul><li>While prescribing any drug with life threatening side effects- informed consent to be taken </li></ul>
  75. 75. Specific situations <ul><li>Pediatric practice- </li></ul><ul><li>May be more emotionally taxing as you have to manage the parents in addition to the patient </li></ul><ul><li>Adopt a positive attitude in responding to parental concern </li></ul><ul><li>Explain them signs of worsening or severity of illness & explain when they need to seek prompt advice </li></ul><ul><li>Information on OTC medications & antibiotics </li></ul>
  76. 76. Communicating prognosis, hope & risk <ul><li>Misunderstandings in these areas can lead to patient dissatisfaction & litigation </li></ul><ul><li>Prognostication is like weather forecasting uncertain but based on sound scientific principles </li></ul><ul><li>Stage of illness at presentation of patient </li></ul><ul><li>Curability of disease </li></ul><ul><li>In face of uncertainty there is nothing wrong with providing hope </li></ul><ul><li>Provide evidence based risks </li></ul><ul><li>Never create guilt for negligence on part of patient </li></ul>
  77. 77. Dealing with chronic disease & dying <ul><li>Chronic illness/ incurable illness e.g. HIV, Cancer cause stress for patient & attendants </li></ul><ul><li>Counseling plays a big role </li></ul><ul><li>Breaking news can be done in steps- news given too bluntly may lead to denial & psychiatric problems </li></ul><ul><li>Encourage him to hope for the best </li></ul><ul><li>Give example of person who have lived with such illnesses for longer periods with positive attitude & will power </li></ul>
  78. 78. Dealing with relatives during resuscitation <ul><li>Routinely relatives are excluded </li></ul><ul><li>Studies have found no adverse psychological effects if some mature person observes the process </li></ul><ul><li>One of the doctors of team should explain the procedure being done to relatives- it builds better rapport & communication regarding adverse outcome easy </li></ul><ul><li>Remember that bereaved relatives are also your patients- counsel them & give medical help </li></ul>
  79. 79. Anticipate & handle common reactions <ul><li>Disbelief- Is he really gone- for their satisfaction show them proof- eg. ECG </li></ul><ul><li>Guilt- by giving logical & rational explanation & saying that he tried his best </li></ul><ul><li>Offer help to manage transport </li></ul>
  80. 80. Resident Evaluation checklist on Professionalism <ul><li>Marking 0 1 2 3 4 5 6 7 8 9 10 </li></ul><ul><li>Unsatisfactory Satisfactory Exemplary </li></ul><ul><li>Empathy in patient care. </li></ul><ul><li>Appropriate fund of knowledge. </li></ul><ul><li>Soundness of clinical judgment. </li></ul><ul><li>Technical expertise with diagnostic and therapeutic procedures. </li></ul><ul><li>Communication with patients, families and staff. </li></ul><ul><li>Sensitivity and responsiveness to individual patient differences in economic status,ethinicity,age,gender and disabilities. </li></ul><ul><li>Honesty in dealing with patients and colleagues. </li></ul><ul><li>Accountability for action. </li></ul><ul><li>Conflict-resolution skills. </li></ul><ul><li>Adherence to regulatory, institutional and departmental norms. </li></ul>
  81. 81. UCLA PCAT 12-Communication <ul><li>RATE EACH ITEM : </li></ul><ul><li>Strongly agree: Agree: Neutral: Disagree: Strongly disagree </li></ul><ul><li>Not applicable: Not Observed </li></ul><ul><li>The resident: </li></ul><ul><li>Made himself or herself easily accessible to you </li></ul><ul><li>Encourage your input in discussion </li></ul><ul><li>Clarified the objectives, expectations and goals of care </li></ul><ul><li>Listen to your concerns </li></ul><ul><li>Explained and discussed progress and any unforeseen problems. </li></ul>
  82. 82. UCLA PCAT 18 <ul><li>honesty/accountability/Response to Error </li></ul><ul><li>Make up information, tries to cover error, or blames others </li></ul><ul><li>Minimizes error and/or is unable to learn from errors </li></ul><ul><li>Recognizes error, apologizes and alters behavior. </li></ul><ul><li>Recognizes error, apologizes and alters behavior, but takes errors too personally </li></ul><ul><li>Excessive self-criticism/self-doubt interferes with work performance. </li></ul>
  83. 83. Emotional Intelligence (EQ) <ul><li>Def – “The ability to monitor one’s own & other feelings & emotion to discriminate among them, and to use this information to guide one’s thinking and action” </li></ul><ul><li>IQ Average citizen - 100 </li></ul><ul><li>Doctor - 120 </li></ul><ul><li>EQ Average citizen - 100 </li></ul><ul><li>Doctor - 90 </li></ul>
  84. 84. EQ Components <ul><li>Knowing your own emotions (Self awareness) </li></ul><ul><li>Managing your own emotion (Self regulation) </li></ul><ul><li>Motivating yourself </li></ul><ul><li>Recognizing and understand other people’s emotion ( Empathy) </li></ul><ul><li>Managing relationships or social skills- </li></ul><ul><li>Skills in managing emotions in others determines popularity, leadership & interpersonal effectiveness. </li></ul>
  85. 85. EQ <ul><li>Physician cannot perform his job without understanding his emotion & those of patients </li></ul><ul><li>IQ - Technical Competence </li></ul><ul><li>EQ - People’s Competence </li></ul><ul><li>IQ - Gets you job </li></ul><ul><li>EQ - Gets you promoted </li></ul><ul><li>IQ - Gets you higher marks </li></ul><ul><li>EQ - Makes you happy & Productive </li></ul>
  86. 86. Keeping updated : Managing knowledge <ul><li>Medical books -- Become outdated fast </li></ul><ul><li>Medical journals -- Costly </li></ul><ul><li>Conference </li></ul><ul><li>Medical representative </li></ul><ul><li>Internet </li></ul><ul><li>Medical knowledge problem – Mammoth size </li></ul><ul><li>- Short half life </li></ul>
  87. 87. Keeping updated <ul><li>Structure your knowledge around patients </li></ul><ul><li>Learn from your past mistakes </li></ul><ul><li>Master clinical protocols & Flow charts </li></ul><ul><li>Concentrate on carry home massages </li></ul>
  88. 88. Vulnerable times for mistakes <ul><li>Tired, lazy, sleepy </li></ul><ul><li>Angry </li></ul><ul><li>Overconfident </li></ul><ul><li>Patient irritating </li></ul><ul><li>Complex medical Problem </li></ul>
  89. 89. Mistake : Response <ul><li>Blaming the system </li></ul><ul><li>Blaming the colleagues, even patients </li></ul><ul><li>Disconnecting of importance ( No Clinical effectiveness) </li></ul><ul><li>Emotionally Distancing (Everyone makes mistakes) </li></ul>
  90. 90. Dealing with mistake <ul><li>Accept responsibility for the mistake </li></ul><ul><li>Discuss with trusted friend, colleague or spouse </li></ul><ul><li>Disclose & Apologize to the patients </li></ul><ul><li>Error analysis </li></ul><ul><li>Measures to reduce similar mistake in future </li></ul>
  91. 91. Marketing in medicine <ul><li>“ Marketing is Practice building not advertising” </li></ul>
  92. 92. Practice building/Marketing <ul><li>Satisfied patients </li></ul><ul><li>Volunteering at community medical service. </li></ul><ul><li>Organizing an event – like conference </li></ul><ul><li>Attracting Media attention </li></ul><ul><li>Contributing article on health to magazine </li></ul><ul><li>Public lecture </li></ul><ul><li>News letter </li></ul><ul><li>Website </li></ul><ul><li>Marketing to referral base </li></ul>
  93. 93. Informing patient in information age <ul><li>Printed material Broachers </li></ul>
  94. 94. Story of a Doctor Main 12v me Tha Wo 12v me Thi
  95. 95. Main MBBS me Tha Wo BSc me Thi Main MBBS me Tha Wo MSc me Thi
  96. 96. Main MBBS me Tha Wo PHD me Thi Main MBBS me Tha Wo Dr ban gai
  97. 97. Uski Shadi hui Maine PG entrance diya Wo do bachcho ki ma bani Main MD kar raha Tha
  98. 98. Bachche 5 saal ke hoker school jane lage Main post PG karne laga Bachche 10 th pass ho gaye Maine hospital shuru kiya
  99. 99. Afsos bas ye hai ki aaj wo Tubectomy karane aayi hai AUR Aaj meri Sagai hai…….
  100. 100. Marriages <ul><li>Perfectionism, compulsiveness & work holism – good doctor but problematic spouse </li></ul><ul><li>Many married to Profession – no time to cultivate intimacy with spouse </li></ul>
  101. 101. Marriages <ul><li>Stage 1 -- Romance – you are perfect </li></ul><ul><li>Stage 2 -- Fault finding </li></ul><ul><li>Stage 3 -- Blaming </li></ul><ul><li>Stage 4 -- Acceptance </li></ul><ul><li>Transformation – Growing together </li></ul>
  102. 102. Marriages <ul><li>Spend time together </li></ul><ul><li>Respect each other </li></ul><ul><li>Have fun together </li></ul><ul><li>Treat your spouse as your most important VIP patient </li></ul><ul><li>-- A loved spouse is also loving spouse </li></ul>
  103. 103. Marriages <ul><li>A meal together everyday </li></ul><ul><li>Fun together once a week </li></ul><ul><li>One holiday every year together </li></ul><ul><li>Make sure children meet grand parents, relatives periodically </li></ul><ul><li>Help children honor family traditions </li></ul>
  104. 104. Improving Relationship <ul><li>Teaching of ethics & communication skills in UG curriculum. </li></ul><ul><li>Teaching of sociology aimed at creating cultural sensivity,empathy & respect for patients’ dignity. </li></ul><ul><li>Teaching legal aspect of practice. </li></ul><ul><li>Physician has to enter patients world- to see illness through patient’s eye </li></ul>
  105. 105. Take home <ul><li>Fall in love of being a Doctor </li></ul><ul><li>Derive pleasure in work wherever & in whatever capacity you are working. You always have the potential to contribute to patients & society </li></ul><ul><li>Work & practice with Medical professionalism </li></ul><ul><li>Use common sense. Identify local socio-cultural practices & integrate in your working style </li></ul>
  106. 106. Take home <ul><li>If you are a good professional- become trusted advisor to patient-become their friend, philosopher & guide. </li></ul><ul><li>“ Do unto other as you would have them do unto you.” </li></ul><ul><li>Don’t end at result of single Prescription/consultation. Target long lasting patient doctor relationship </li></ul>
  107. 107. Take home message <ul><li>People prefer those doctors with average clinical skills but good communication skills rather than those with excellent clinical but poor communication skills </li></ul><ul><li>Most of the complaints are made against doctors who do not communicate </li></ul>
  108. 108. <ul><li>“ Successful Medical Practice is like successfully driving a car where you not only take care of your own mistakes but others mistakes also.” </li></ul>
  109. 109. Visualised yourself <ul><li>Visualize your funeral with these speakers – A family Member, a Friend, a colleague & a patient. </li></ul>
  110. 110. Thanks

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