The Relationship Between the Doctor and the Patient Partner like cooperation Rational as well as emotional influence

“ …a person becomes a personality at the very moment when he understands himself, can evaluate himself and is able correctly to find his place among others. Only a person who can be his own man can also make a contribution to other people. Thus I think that the relationship of one human being to another is the greatest life value which must be daily fought for.” J.Peskova, philosopher

“ Every education is a kind of inward journey” Vaclav Havel “…profoundly human attitude to the other person forms the basis of communication between doctor and the patient ….” J. Beran, MD

Basic communicative skills Predominantly verbal -questions and appeals -explanation -summaries -interpretation -demonstration of understanding Predominantly non-verbal -observation -listening -empathy -demonstration of interest -respect

Listening Perceiving person actively – not only what he is saying , but the way in which he is saying it, movements, facial expressions / hidden message Information in patient`s verbal message: What happened to the patient What the patient has done What he has gone through Monitor our feelings and thoughts during dialogue to avoid misrepresentation of the message Respect – attitude, appreciation of another person as a human being “I am here for you”

Empathy Projecting oneself into mental condition of the other person, ability to recognize and understand the mental condition of the other person, his mood, and what he is going through. X sympathy= experiencing the same feeling together with the other person Development of empathy -pay full attention [Amelie] -follow our own feelings during dialogue -be tolerant, accept and don`t judge the patient

Tests – complete a sentence, how our reactions stimulate flow of information from patient 1. Identification – willingness and desire to understand a fellow human being 2. Knowledge

Demonstration of understanding Assurance, that we understood patient, his opinions, information he gives, his thoughts and feelings – motivation to cooperation Nodding, agreement Repeating the last couple of words Challenging – presenting alternative views Summary Clarification- explaining connections by reminder Emphasizing particular statements Suggesting an interpretation of relations Does not mean agreement! Relieves the distress [ when the prognosis is bad]

Interpretation Explanation of connections and relationships, which the patient has not been aware of = better understanding of situation and himself, based on good knowledge of the patient`s life, events, influence of others Disease in context of the patient`s whole life, his inner world, his contribution Doctor`s support, compassion Not I formulations / we are not judges/ Suitable moment – not too early! interpretation must correspond to his own view, don`t press , don`t persuade / Iatropsychopathogenic effect of incorrect i./ Evokes further questions and doubts on previous “certainties” Point out the positive aspects of situation, sense of hope

Interest and support Nodding, leaning towards p., looking at him “I am here for you and with you, I am trying to understand you” Remind him of positive aspects in his life and in present situation, reinforce balance Mutual silence x empty silence [ “ try to say aloud, what is in your mind,… what are you thinking about…, never mind if your words are confused…]

Advice and Counselling Diet, daily routine, taking medicine… Not at psychological problems Help the patient to find his own orientation in a life situation so that he himself can find a solution and take his decision [ no other people can make it for him] Direct advice only in situations where patient can be harmed by any delay, provide information about optimal strategies for solving the crises [ marriage guidance]

Non-verbal Communication Between Doctor and Patient More than 65% of all human exchange of information, mostly is transmitted and evaluated unconsciously Incongruity between verbal and nonverbal, between what we say and what we feel [Unwelcome guests] Para-verbal: intonation, speed, loudness, pauses, tone of voice

Description and Classification of Non-verbal Behaviour Proxemic patterns/ physical distance between people/ -intimate /touch/ 15-30cm -personal /hand-shake/ 45-70cm -social / dialogue/ 120-350cm -public / in the street/ 500cm or more Breaking zones. Vertical dimension. Naked patients Haptic patterns – touching Postural patterns – carriage of body / leaning towards patient/ Movements

Psychobiology – the science of biological basis of behaviour, dominant hemisphere – verbal, written, solving math problems, non-dominant – non-verbal, emotions…comprehension happens unconsciously [receive, evaluate, transmit] Ethology - studies patterns in behaviour in animal and human world. Individuals, social systems.Human behaviour is pre-structured and it displays certain patterns that, under certain circumstances regularly occur.[collective unconscious- Jung]

Desmond Morris – “The Naked Ape” Visual behaviour- not sitting opposite Mirror movements- the same body posture as a patient=tuning in Territorial behaviour –” bubble”,chairs with wheels,beds not too close Barrier signals - folding of hands, crossing of legs, table / across the corner / Physical barrier – respect distance or come closer Metasignals – clarify a context / facial expressions /

Application of the Study of Non-verbal Behaviour in Doctor – Patient Interaction Spatial arrangement: “triangular”- helps to stimulate informal and relaxed atmosphere,not sitting with one`s back to an open space,soft armchairs on wheels Interest conveyance: verbally, body posture/inclining body,than changing the direction of the sightline, legs and hands should not be crossed

Non-verbal behaviour Gestures, movements, body posture Facial expressions/ laughter, raised eye-brows/ Para-verbal signals /loudness, tempo, pauses, silence, tone/ Physiological processes/ accelerated breathing, flushing, pallor, sweating, pupils dilatation../ General appearance / clothing, choice of colors /

Psychological approaches to various groups of patients Undressed patients Dominant patient Submissive patient Surgery Painful treatment Amputation and other permanent consequences / abortion, abnormal fetus/ Obstetrics Sight disorders Orthopedics and neurological diseases Hospitalism bribe