Communication In Healthcare New


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Communication In Healthcare New

  1. 1. COMMUNICATION IN HEALTHCARE Datuk Dr. Ahmad Tajudin Jaafar Allianze College of Medical Sciences
  2. 2. <ul><li>Subject of communication has become prominent in healthcare for the last 50 years </li></ul><ul><li>It is now an established subject in most medical curriculum </li></ul>
  3. 3. <ul><li>Evidence is that healthcare fails without a conscious informed effort of communication which is the personal and professional responsibilities of all care givers </li></ul><ul><li>It is a major issue in the strategies of all health organisation </li></ul>
  4. 4. <ul><li>Healthcare is a complex intervention of at least four elements </li></ul><ul><ul><li>Physical care </li></ul></ul><ul><ul><li>Cognitive care </li></ul></ul><ul><ul><li>Behavioral care </li></ul></ul><ul><ul><li>Psychological care </li></ul></ul>
  5. 5. <ul><li>The aim and mission is to provide care that is evidence-based, patient-centred and in collaborative partnership with the patient </li></ul>
  6. 6. <ul><li>Effective communication is an absolute necessity at every stage of the clinical interview </li></ul><ul><li>Communication whether good or bad affects everyone of the four aspects of care </li></ul>
  7. 7. Health Outcome <ul><li>Effect of communication on case and its outcome </li></ul><ul><li>The best outcome depend on accurate diagnosis and appropriate treatment </li></ul>
  8. 8. <ul><li>Communication styles that are ‘Patient Centred’ provide a more complete picture which lead to improvement in health outcome e.g. </li></ul><ul><ul><li>Symptom resolution </li></ul></ul><ul><ul><li>Psychological distress reduced </li></ul></ul>
  9. 9. <ul><li>(cont’) </li></ul><ul><ul><li>Health and functional states improved </li></ul></ul><ul><ul><li>Pain control improved </li></ul></ul><ul><ul><li>Patient anxiety reduced </li></ul></ul>
  10. 10. <ul><li>Patient also describe several consisted failure of communication </li></ul><ul><ul><li>54 % of complaint not elicited </li></ul></ul><ul><ul><li>45% of their concerns not elicited </li></ul></ul><ul><ul><li>50% of psychological problem not elicited </li></ul></ul>
  11. 11. <ul><li>(cont’) </li></ul><ul><ul><ul><li>In 50 % visits, patient and doctors disagreed on main presently problem </li></ul></ul></ul><ul><ul><ul><li>In 50% cases, their history was blocked by interruption within 24 seconds </li></ul></ul></ul><ul><ul><ul><li>These lead to an incomplete history and poor professional relationship </li></ul></ul></ul>
  12. 12. Adherence To Treatment <ul><li>Health outcome also depend on the extent to which patient adhere to their clinical advice </li></ul><ul><li>Adherence and clinical advice is dependent on effective communication </li></ul>
  13. 13. <ul><li>Factors in communication which improved patient adherence and clinical advice are: </li></ul><ul><ul><ul><li>Clinicians understands the patient </li></ul></ul></ul><ul><ul><ul><li>Clinician’s tone of voice </li></ul></ul></ul>
  14. 14. <ul><ul><ul><li>(cont’) </li></ul></ul></ul><ul><ul><ul><li>Clinicians elicits all the patient’s health concerns </li></ul></ul></ul><ul><ul><ul><li>Patient is comfortable asking questions </li></ul></ul></ul><ul><ul><ul><li>Patient perceived that sufficient time is spent with the clinician </li></ul></ul></ul>
  15. 15. Social Outcome <ul><li>Patient satisfaction is the result of their; </li></ul><ul><ul><li>knowing that they are getting the best appropriate care </li></ul></ul>
  16. 16. <ul><ul><li>knowing that they are being treated as individuals and not items on a conveyor belt </li></ul></ul><ul><ul><li>being treated in a humane manner </li></ul></ul><ul><ul><li>These are all related to good communication </li></ul></ul>
  17. 17. Discord Between Patient And Clinician <ul><li>An increasing number of complaints and lawsuits due to poor communication </li></ul><ul><li>Factors cited by 75 % of complaining patients as the cause of their complaint against their doctor: </li></ul>
  18. 18. <ul><li>(cont’) </li></ul><ul><ul><li>feeling deserted </li></ul></ul><ul><ul><li>feeling devalued </li></ul></ul><ul><ul><li>information poorly delivered </li></ul></ul><ul><ul><li>lack of understanding </li></ul></ul>
  19. 19. <ul><li>In contrast, the qualities that patient described in interviews with primacy care physician are </li></ul><ul><ul><li>oriented patient to the process of the visit </li></ul></ul><ul><ul><li>use of facilitative comments </li></ul></ul>
  20. 20. <ul><ul><ul><li>ask patients their opinions </li></ul></ul></ul><ul><ul><ul><li>use active listening </li></ul></ul></ul><ul><ul><ul><li>use humor and laughter </li></ul></ul></ul><ul><ul><ul><li>conducted slightly longer visits </li></ul></ul></ul>
  21. 21. Clinician Satisfaction <ul><li>It is the quality of their relationships with their patients and colleagues which bring about clinician satisfaction and happiness </li></ul>
  22. 22. Poor Communication Between Doctors And Patients <ul><li>Difficulties clinician have in communicating with patients </li></ul><ul><ul><li>Lack of knowledge </li></ul></ul><ul><ul><li>- Concentrate on biomedical model rather than psychosocial model of clinical practice </li></ul></ul>
  23. 23. <ul><li>illness have physical symptoms without organic basis </li></ul><ul><li>physical illness prolonged by psychological factors </li></ul><ul><li>20 % of patients have psychiatric disease </li></ul>
  24. 24. <ul><ul><li>Attitude </li></ul></ul><ul><ul><li>- authoritarian role = paternalistic </li></ul></ul><ul><ul><li>- negative attitude to shared care </li></ul></ul><ul><ul><li>Lack of Skill </li></ul></ul><ul><ul><li>- due to time constrains and uncomfortable topics to patients </li></ul></ul>
  25. 25. <ul><ul><ul><li>Failure of Empathy </li></ul></ul></ul><ul><ul><ul><li>- empathy is described as ‘imagination for others’ </li></ul></ul></ul><ul><ul><ul><li>- demonstrate genuine interest in patient experience </li></ul></ul></ul><ul><ul><ul><li>- key skill in building doctor-patient relationship </li></ul></ul></ul>
  26. 26. <ul><ul><ul><li>Personal Failure </li></ul></ul></ul><ul><ul><ul><li>- unhappiness, short tempered, rushed and interrupted on the part of the doctor can affect effective communication building between doctor and patient </li></ul></ul></ul>
  27. 27. Difficulties For Patients In Communicating With Doctors <ul><li>Inferiority </li></ul><ul><li>Anxiety and its consequences </li></ul><ul><li>Misconceptions </li></ul><ul><li>Conflicting information </li></ul><ul><li>Forgetfulness </li></ul><ul><li>Disinclinations to disclose their concerns </li></ul><ul><li>Impaired faculties of communication </li></ul>