1. Patient doctor relationship prof.Dr Elham Aljammas MAY2015 l14

2. Physician’s Responsibilities Freedom of choice Responsibility to improve community Responsibility to patient is paramount Must support access to medical care for all people Human dignity Honesty Responsibility to society Confidentiality Continued study

3. Patients rights Right to give informed consent Right to privacy Right to be informed of advantages and potential risks of treatment Right to refuse treatment Right to confidentiality – Privileged communication

4. Patient expects from doctor.... » A cure Medication To be listened to Sympathy Advice- he understands The ‘answer’ A sick note What they want (agenda) Comfort A chat No harm Professionalism & Respect To be told what to do To feel better The truth They feel ill physically They feel ill mentally They are lonely They want time off work Need advise Don’t know who to turn to Marital/family problems Legal reasons Why a patient goes to doctor.. Expectations

5. Doctor expects from patient... Trust Compliance to treatment Agreement The truth Respect They want to get better To be listened to To obey the ‘Rules’!

6. Doctor Patient Contacts The nature of the relationship determines the success or otherwise of the contact

7. Communication and Diagnosis Patients who feel at ease and who are encouraged to talk freely are more likely to disclose the real reason for consultion

8. Communication and Treatment Advice,reassurance and support from the doctor can have a significant effect on recovery (The placebo effect)

9. clinical competence used to include the medical technical knowledge, physical examination, and medical problem solving. while the Communication was missing from the list. It is clear from the literature that better physician communication skills improve patient satisfaction and clinical outcomes and that good communication skill can be taught and learned

10. Patient controlled consultation “You’re paid to do what I tell you!!”

11. The Paternalistic Approach “If I’ve told you once I told you 1,000 times, stop smoking!!”

12. Paternalism The traditional D-P relationship Doctor Takes on role of “parent” Patient submissive

13. Doctor centred consultation style: Paternalistic - doctor is the expert and patient expected to cooperate Tightly controlled interviewing style aimed at reaching an organic diagnosis.

14. Patient Centred consultation style Less authoritarian - encourages patient to their own feelings and concerns Open questioning, interested in psycho- social aspect of illness

15. Consultation Styles It’s serious isn’t it doctor?

16. Patient centred clinical interview Doctor – history examination investigation results in a differential diagnosis Patient – ideas, expectations, feelings, results in an understanding of patients beliefs

17. Length of Consultation Average 8 minutes Makes patient centred consultation styles more difficult.

18. Goals of Communication Teaching and Learning Doctors with good communication skills identify patients' problems more accurately patients are more satisfied with their care and can better understand their problems, investigations, and treatment options patients are more likely to adhere to treatment and to follow advice on behaviour change

19. In Conclusion Communication techniques are a learned skill. Unfortunately, many health care providers discover this after an adverse event occurs. If this is the case in your facility, turn that negative experience into a positive teaching tool by asking these questions: What can we learn from this? How can we prevent a recurrence? Is there anything we can do now to alleviate the situation?

21. Thank you