What 3 components create a good dr-patient relationship?
Social relationship: Good manners, using humnour when appropriate, non-judgemental, showing a desire to help
Theraputic relationship: empathy, respect, genuioneness and warmth
Patient-centred communication: communication which allows the patients to express their reasons for coming, including symptoms, thoughts, feelings and expectations
What are the effects of poor communication on the patient?
Patients less likely to adhere to medical regimens - not just because they are dissatisfied, but because they may not understand what is required
Less likely to use health care services or seek medical help in the future
Less likely to attend check-ups, screening or other forms of preventative health care
More likely to experience negaitve health symptoms
Name four behaviours that block patient's disclosure
Not listening or interrupting
Explaining away distress as normal
Attending to physical aspects of illness only
Use of jargon
Jolleing patients along (rushing them)
Name four reasons why a patients may fail to disclose in a consultation
Dr's blocking behaviour
Belief that nothing can be done
Worry that fears will be confirmed
Reluctance to burden healthcare provider
Desire not to seem ungraeful ort critical
Concern that it is not appropriate to disclose some problems
What are the effects of good communication
Increased patient satisfaction, greater recall of adivce, higher adherence to treatment
Improvement in disesae control markers (e.g. bp, HbA1c)
Increased Dr. satisfaction
Which groups of patients are more likely to experience inequalities in communication?
Low socio-economic groups
Providers give less information, are less supportive and less clinically proficient with certain patients
Why do Drs block patient disclosure?
Fear of increasing patient distress, so do not ask probing, more difficult questions
Limited time available
Threat to one's own emotional well-being
Unaware that patients may fail to disclose important information
What interventions can be made to improve communication?
Medical education - teaching communication as a core clinical skill
Modelling - shadowing effective communicators
Ongoing assessment and feedback (peer support./ self-reflection)
Patients preparing and planning questions in advance
Patients having realistic expectations (e.g. chronic conditions)
What psychological processes help explain inequalities in communication in the consultation?
Sterotypes . Once activated, sterotypic knowledge influences behaviour, performance and judgement about other people and interactions with other people subconsciously.
Sterotypes about particular groups of patient may influence Drs behaviour.
What is the purpose of medical communication (consultation)?
Create good interpersonal relationship
Make treatment related decisions
Drs need information to establish correct diagnosis and treatment plan
Patients want to known and understand treatment/disease and feel understood
Name 3 doctor factors and 3 patient factors that may influence the context of a consultation