importance of patient centered communication in lifestyle diseases
TRANSCRIPT
Communicable Diseases
Tuberculosis, Malaria, Cholera, Influenza, Measles, Polio etc
Transmitted from one person to another through a causative agent directly or indirectly
Prevalent among lower stratum of the society
Line of treatment and management is simple and easy to follow
Acute diseases
Non Communicable Diseases
Lifestyle Diseases
Changes to the way people live have created new environmental and behavioral risk factors, leading to a rise in lifestyle diseases
start slowly and often asymptomatically but last longer
Type 2 diabetes, Cardiovascular Diseases, Hypertension, Stroke
Management of lifestyle disease requires change in living pattern, attitude and mindset
Improved quality of living and awareness are the only prerequisite of overcoming these diseases
“The diabetic who knows the most, lives the longest”- Elliott P. Joslin, 1929
What Doctors say about patient…..
People are not ready to listen and change so it‟s difficult to bring about positive changes
Patient hide useful information on the first visit
It is easier to change the mindset of the people when somebody has suffered in the family.
What Patients want from Doctors
Make the patient aware that majority of the diseases are preventable and this prevention costs only a minimum of expenditure, if compared to the cost incurred on the treatment.
Awareness of right treatment options for the patient.
In addition to prescribing medicines to the patients, Doctors should also give some time to educate the patients and attendants about the causes of various diseases and what measures should be taken to prevent the common ailments which can be serious at times if neglected
A study published in JAMA found that
72% of the doctors interrupted the
patient‟s opening statement after an
average of 23 seconds
Patients who were allowed to state
their concerns without interruption
spoke for only an average of 6 more
seconds
Patients are at fault too…..
Patients described as “frustrating” by doctors do not trust or agree with the doctor
present too many problems for one visit
do not follow instructions
are demanding or controlling
Traditional Model
Linear/ Unidirectional Communication
Biomedical approach to addressing medical problems
”Prescription followed”
”weight loss”
“Healthy Diet”
Symptomatic Treatment
“Patient as diseases/ organ”
Why is it important?
Compliance with the medical
treatment
Improves Patient‟s satisfaction
Improved health and emotional status
of the patient
Improves Doctor‟s satisfaction
Reduces Malpractices
(Stewart and Roter)
Barriers to effective
communication There may be many barriers to effective
physician-patient communication.
Patients may feel that they are wasting the physician's valuable time;
omit details of their history which they deem unimportant;
be embarrassed to mention things they think will place them in an unfavorable light;
not understand medical terminology;
believe the physician has not really listenedand, therefore, does not have the information needed to make good treatment decisions
Culture and D-P Communication
How illness is discussed and treated
in a culture
Myths and misconceptions already
prevalent in the society
Poor Language skills
Types of doctor–patient
relationship*
Patient Control Doctor’s Control
Low High
Low Default Paternalism
High Consumerist Mutuality
*Stewert and Roter
Default relationship
Patients adopt a passive role even
when the doctor reduces some of his
or her control, with the consultation
therefore lacking sufficient direction
Paternalistic Relationship
Doctor is dominant and acts as a
„parent‟ figure who decides what he or
she believes to be in the patient‟s best
interest
Patient Submissive
Consumerist Relationship
the patient taking the active role and
the doctor adopting a fairly passive
role,
acceding to the patient‟s requests for
a second opinion, referral to hospital,
a sick note, and so on
Relationship of mutuality
active involvement of patients as equal partners in the consultation
meeting between experts‟, in which both parties participate and engage in an exchange of ideas and sharing of belief system
The doctor brings his or her clinical skills and knowledge
Patients bring their expertise in terms of their experiences and explanations of their illness, and knowledge of their particular social circumstances, attitudes to risk, values and preferences
Changing Role of Doctor
Patient-Centered Communication
Biopsychosocialapproach
Facilitator/ Listener
Behavior Change Expert
Negotiating small changes
“Patient as person”
Collective Role of Doctor and
Patient Shared decision making
Patient preferences should be sought
out and validated
Doctor and Patient engage in a
reciprocal relationship
“While the doctor focuses on illness,
the patient may be more interested
in wellness.” Athena du Pre