COMMUNICATION IN HEALTHCARE, DOCTOR-PATIENT

INTERACTION

"Doctor, I have an ear ache."2000 B.C. - "Here, eat this root."1000 B.C. - "That root is heathen, say

this prayer."1850 A.D. - "That prayer is superstition,

drink thispotion."1920 A.D. - "That potion is snake oil,

swallow this pill."1975 A.D. - "That pill is ineffective, take

this antibiotic."2006 A.D. - "That antibiotic is artificial.

Here, eat this root!"

Basic document

• Deontological code (greek deon = obligation, something you must follow; doctrine of duty)

• What is the most important deontological code in medicine?

Hippocratic oath

I swear by Apollo Physician and Asclepius and Hygeia and Panaceia and all the gods and goddess, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:

Hippocratic oathI hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money, to give him a share of mine, and regard his offspring as equal to my brothers in male lineage, and to teach his art – if they desire to learn it – without fee and covenant,; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and the pupils who have signed the covenant and have taken this oath according to the medical law, but to no one else.

Hippocratic oathI will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

Hippocratic oathI will not use the knife, nor even on sufferers of stone, but will withdraw in favour of such men as are engaged in this work.

Whatever houses I visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

Hippocratic oathWhat I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about.

If it fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

Summary of the Hippocratic tradition

• Open, friendly and supportive attitude between students and their teachers;

• Application of measures according to the skills and abilities and for the good of patients;

• Protecting patients from harm and injustice .

Summary of the Hippocratic tradition

• Protection of human life;• Avoiding sexual relations with patients;• Confidentiality;• Sanctity and inviolability of the medical

profession.

Current principles of medical ethics

1. The principle of nonmaleficence - it is a well-known principle of (non)harm a patient. If the doctor is not able to heal well, at least he/she does not hurt either.

2. The principle of beneficence - this imperative commands to make (the patient) good. If there is any risk in the patients healing, the doctor must be sure that the final benefit will be guaranteed and will be greater than the risk.

Current principles of medical ethics

3. The principle of autonomy - the doctor respects the patient's human nature, and of course, respects his/her essential designation, autonomy, the possibility of freedom. Doctor must respect all patients decisions.

4. The principle of justice – all patients of all physicians are entitled to equal, fair health care without any difference.

Task 1

1 noun _____________2 adjectives __________ __________3 verbs ________ ________ ________4 words sent. ______ ______ ______ ______1 synonym ____________

Communication in healthcare

„Healing arts has three components:A disease, a patient and a physician.The physician is a servant of healing arts.The patient must face to the disease togetherwith the physician.“(Hippocrates)

Communication in healthcare

• To communicate in healthcare means to communicate and obtain information, on which depend the patient´s health.

Communication in healthcare

• What is the difference between „normal“ communicative act and communicative act between a physician and a patient? Why?

Communication in healthcare

Do you think this communication model changes in patient-physician communication?

Communication in healthcare

• Who and what is a sender?• Who and what is a receiver?• What is a code?• What is a message?• What is a noise?

Communication in healthcare

In healthcare the normal communication boundaries move along:

• Baring of intimate body parts;• Touching of different parts of the body;• Implementation of painful procedures.

Communication in healthcare

Communication skills in healthcare include:• Explanations of diagnosis, investigation and

treatment.• Patient involvement in decision making.• Communication with relatives. • Communication with other health professionals. • Saying bad news. • Searching for the informed consent, obtaining

consent for post-mortem.• Providing advice on lifestyle, health, or risk factors.

Communication in healthcareOur physician had to go to ER with a child because of scarlet fever. In a waiting room, a nurse welcomed them and told them to sit on a chair. Twenty minutes nothing happened although the child was really sick. Doors were opened after the second third of hockey game which could be heard in the waiting room. A physician came out all sweaty, unshaven, in a coat which was once white, with oily hair and undone zipper (at trousers). He neither say Hallo nor looked at us. He just asked the nurse „What is it?“ She replied kindly. The physician nasty appealed to child to open the mouth. Then he uttered with the same nasty voice to the nurse: „This is going to be a scarlet fever. Send it to the lab,“….and he vanished without greeting by side doors behind which the third period began.

Communication in healthcare

Types of patients:• Patients with special needs (mentally unstable

patients, aggressive patients, anxious patients, depressive patients, socially disadvantaged patients, patients with permanent damage/disability, patients with impaired speech);

• Sensorial/sense handicapped patient (blind patients, deaf patients, deaf blind patients)

Communication in healthcareEmpathy indicates understanding emotions and motives of other person. But it is no compassion or regret.Empathy can be inborn (which is very rare), we can have a special talent for empathy or we can study it or learn how to use it.

Empathy is required in communication with a patient but only 1 % of physicianscan express empathy. Physicians deal more with treatment and they are not able to understand to the patient as an individual and holistic personality.

Emphatic skills – non-verbal listening

• Facial expression;• Posture;• Postural habits;• Gestures.

Empathic skills

Emphatic skill – verbal paraphrasing

To repeat the sense of what a patient has said,using different words in a way how weunderstand to the information.Sentences:• I can understand… • I think I understand…• I´m sorry…

Communication in healthcare

What he/she feels.

What he/she wants.

Who he/she is.

The patient usually tells to the physician: