Dr-Patient Communication

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Defining Communication

"To transmit information, thought or feeling so that it is satisfactorily recived or understood"

"Medicine "resides in the interpersonal aspects of patients-physician communication"

Hall, Roter & Rand, 1981

Health Communication

the study and use of communication strategies to inform and influence individual and community decisions that enhance health

"health communication is a communication in any form that contributes to the promotion of health" Marks et al, 2005

"the use of ethical, persuasive means to craft and deliver campaigns and implement strategies that promote good health and prevent disease" Ratzan, 1996

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Different Types of Communication

Verbal Communication                                                       Non Verbal Communication

  • questioning                                                                      Body Language
  • explaining                                                                        Personal Space  
  • jargon language                                                              Clothing
  • the way it is said = speed, tone of voice, um's / er's

Other Factors

  • location - private / community? hospital / waiting room
  • timing - 5 minute appointments might not be enough time to include everything
  • complexity - mutliple problems

Patient Factors

  • anxiety, distress, worry
  • self-efficacy
  • expectations
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Dr Centred VS Patient Centred

Dr Centred

  • Doctor knows best
  • closed questions
  • Dr is in control
  • focus on 1st problem mentioned - no other discussion of other problems
  • Patient is passive - is told what to do and is expected to do it without complaint

Byrne  & Long, 1976

Patient Centred

  • shared decision making
  • open ended questions
  • avoids jargon
  • Patient is active and is included in the discussion and decisions

Elwyn et al, 2000

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Patient Centred

Patient Centered Health Communication is all effective as it is all encompassing

Stewart 1995

  • reflects the reality of the patients every day life
  • gender         age          education          ethnicity            sexual orientation
  • encorporates cultural beliefs / values    health beliefs / attitudes
  • previous experience of healthcare

Five Distinct Dimensions -  Mead & Bower, 2000

  • Biopsychosocial Perspective
  • Patient as a whole person
  • Sharing Power and Responsibility
  • Theraputic Alliance
  • Doctor as a whole person
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Calgary-Cambridge Consultation Communication

Initiating the Consultation

Gathering Information

Building the Relationship

Providing Structure

Explanation and Planning

Ending the Consultation

provides 55 consulation skills

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Sucessful Consultation

establish good relationship

establish nature of problem

gain understanding of patient's perspective

engage patients in decision making process

manage time to avoid rushing consultation

Ford, 2003

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Sources of Health Information - Online Symptom Che

Department of Health 2004 conducted a survey of patients' choices when finding health information and advice

  • over 2000 participants aged 15+
  • GP = 76%
  • Internet = 16%
  • highlighted the importance of one-to-one health information and advice

Semigram, Jefferey, Gidengil & Mehrotra, 2015

  • Internet Usage has grown in the last 10 years
  • conducted an evaluation of online symptom checkers to determine their diagnostic and triage accuracy.
  • Found deficits in both diagnosis and triage

limitations - encourages user to seek health care for conditions where self care is resonable

  • cost to Dr's / resources
  • psychological distress >> hypochondira / anxiety
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Advantages of effective Health Communication

increased adherence to medications & appointments

reduced use of resources

fewer repeat appointments or hospital admissions

social support

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