COMMUNICATION IN COMMUNICATION IN HEALTHCAREHEALTHCARE

Datuk Dr. Ahmad Tajudin JaafarDatuk Dr. Ahmad Tajudin Jaafar

Allianze College of Medical SciencesAllianze College of Medical Sciences

Subject of communication has become Subject of communication has become prominent in healthcare for the last 50 prominent in healthcare for the last 50 yearsyears

It is now an established subject in most It is now an established subject in most medical curriculummedical curriculum

Evidence is that healthcare fails without a Evidence is that healthcare fails without a conscious informed effort of conscious informed effort of communication which is the personal and communication which is the personal and professional responsibilities of all care professional responsibilities of all care giversgivers

It is a major issue in the strategies of all It is a major issue in the strategies of all health organisationhealth organisation

Healthcare is a complex intervention of Healthcare is a complex intervention of at least four elementsat least four elements

1)1) Physical carePhysical care

2)2) Cognitive careCognitive care

3)3) Behavioral careBehavioral care

4)4) Psychological carePsychological care

The aim and mission is to provide care The aim and mission is to provide care that is evidence-based, patient-centred that is evidence-based, patient-centred and in collaborative partnership with the and in collaborative partnership with the patientpatient

Effective communication is an absolute Effective communication is an absolute necessity at every stage of the clinical necessity at every stage of the clinical interviewinterview

Communication whether good or bad Communication whether good or bad affects everyone of the four aspects of affects everyone of the four aspects of carecare

Health Outcome

Effect of communication on case and its Effect of communication on case and its outcomeoutcome

The best outcome depend on accurate The best outcome depend on accurate diagnosis and appropriate treatmentdiagnosis and appropriate treatment

Communication styles that are ‘Patient Communication styles that are ‘Patient Centred’ provide a more complete Centred’ provide a more complete picture which lead to improvement in picture which lead to improvement in health outcome e.g.health outcome e.g.

i.i. Symptom resolutionSymptom resolution

ii.ii. Psychological distress reducedPsychological distress reduced

(cont’)(cont’)

iii.iii. Health and functional states Health and functional states improvedimproved

iv.iv. Pain control improvedPain control improved

v.v. Patient anxiety reducedPatient anxiety reduced

Patient also describe several Patient also describe several consisted failure of communicationconsisted failure of communication

i.i. 5454% of complaint not elicited% of complaint not elicited

ii.ii. 45% of their concerns not elicited45% of their concerns not elicited

iii.iii. 50% of psychological problem not 50% of psychological problem not elicitedelicited

(cont’)(cont’)iv.iv. In 50In 50% visits, patient and doctors % visits, patient and doctors

disagreed on main presently disagreed on main presently problemproblem

v.v. In 50% cases, their history was In 50% cases, their history was blocked by interruption within 24 blocked by interruption within 24 secondsseconds

vi.vi. These lead to an incomplete history These lead to an incomplete history and poor professional relationshipand poor professional relationship

Adherence To Treatment

Health outcome also depend on the extent Health outcome also depend on the extent to which patient adhere to their clinical to which patient adhere to their clinical adviceadvice

Adherence and clinical advice is Adherence and clinical advice is dependent on effective communicationdependent on effective communication

Factors in communication which Factors in communication which improved patient adherence and clinical improved patient adherence and clinical advice are:advice are:

i.i. Clinicians understands the patientClinicians understands the patient

ii.ii. Clinician’s tone of voiceClinician’s tone of voice

(cont’)(cont’)• Clinicians elicits all the patient’s Clinicians elicits all the patient’s

health concernshealth concerns• Patient is comfortable asking Patient is comfortable asking

questionsquestions• Patient perceived that sufficient Patient perceived that sufficient

time is spent with the cliniciantime is spent with the clinician

Social Outcome

Patient satisfaction is the result of their;Patient satisfaction is the result of their;knowing that they are getting the best knowing that they are getting the best

appropriate careappropriate care

knowing that they are being treated knowing that they are being treated as individuals and not items on a as individuals and not items on a conveyor beltconveyor belt

being treated in a humane mannerbeing treated in a humane manner

These are all related to good These are all related to good communicationcommunication

Discord Between Patient And Clinician

An increasing number of complaints An increasing number of complaints and lawsuits due to poor and lawsuits due to poor communicationcommunication

Factors cited by 75Factors cited by 75% of complaining % of complaining patients as the cause of their complaint patients as the cause of their complaint against their doctor:against their doctor:

(cont’)(cont’) feeling desertedfeeling deserted feeling devaluedfeeling devalued information poorly deliveredinformation poorly delivered lack of understandinglack of understanding

In contrast, the qualities that patient In contrast, the qualities that patient described in interviews with primacy described in interviews with primacy care physician arecare physician are oriented patient to the process of the oriented patient to the process of the

visitvisit use of facilitative commentsuse of facilitative comments

ask patients their opinionsask patients their opinions use active listeninguse active listening use humor and laughteruse humor and laughter conducted slightly longer visitsconducted slightly longer visits

Clinician Satisfaction

It is the quality of their relationships with It is the quality of their relationships with their patients and colleagues which bring their patients and colleagues which bring about clinician satisfaction and happinessabout clinician satisfaction and happiness

Poor Communication Between Doctors And Patients

Difficulties clinician have in Difficulties clinician have in communicating with patientscommunicating with patients

1)1) Lack of knowledgeLack of knowledge

- - Concentrate on biomedical model Concentrate on biomedical model rather than psychosocial model of rather than psychosocial model of clinical practiceclinical practice

• illness have physical symptoms illness have physical symptoms without organic basiswithout organic basis

• physical illness prolonged by physical illness prolonged by psychological factorspsychological factors

• 2020% of patients have psychiatric % of patients have psychiatric diseasedisease

2)2) AttitudeAttitude

-- authoritarian role = paternalisticauthoritarian role = paternalistic

-- negative attitude to shared carenegative attitude to shared care

3)3) Lack of SkillLack of Skill

-- due to time constrains and due to time constrains and uncomfortable topics to patientsuncomfortable topics to patients

4)4) Failure of EmpathyFailure of Empathy -- empathy is described as empathy is described as

‘imagination for others’‘imagination for others’ -- demonstrate genuine interest in demonstrate genuine interest in

patient experiencepatient experience -- key skill in building key skill in building doctor-patient doctor-patient

relationshiprelationship

5)5) Personal FailurePersonal Failure -- unhappiness, short tempered, unhappiness, short tempered,

rushed and interrupted on the rushed and interrupted on the part of the doctor can affect part of the doctor can affect effective communication effective communication building between doctor and building between doctor and patientpatient

Difficulties For Patients In Communicating With Doctors

• InferiorityInferiority• Anxiety and its consequencesAnxiety and its consequences• MisconceptionsMisconceptions• Conflicting informationConflicting information• ForgetfulnessForgetfulness• Disinclinations to disclose their concernsDisinclinations to disclose their concerns• Impaired faculties of communicationImpaired faculties of communication