Consultation

Question 1

What 3 components create a good dr-patient relationship?

Answer 1

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

Question 2

What are the effects of poor communication on the patient?

Answer 2

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

Question 3

Name four behaviours that block patient’s disclosure

Answer 3

Not listening or interrupting

Depersonalisation

Explaining away distress as normal

Attending to physical aspects of illness only

Use of jargon

Jolleing patients along (rushing them)

Question 4

Name four reasons why a patients may fail to disclose in a consultation

Answer 4

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

Question 5

What are the effects of good communication

Answer 5

Increased patient satisfaction, greater recall of adivce, higher adherence to treatment

Improvement in disesae control markers (e.g. bp, HbA1c)

Increased Dr. satisfaction

Question 6

Which groups of patients are more likely to experience inequalities in communication?

Answer 6

Ethnic minorities

Low socio-economic groups

Elderly

Females

Chronic illness

Psychological symptoms

Providers give less information, are less supportive and less clinically proficient with certain patients

Question 7

Why do Drs block patient disclosure?

Answer 7

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

Question 8

What interventions can be made to improve communication?

Answer 8

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)

Question 9

What psychological processes help explain inequalities in communication in the consultation?

Answer 9

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.

Question 10

What is the purpose of medical communication (consultation)?

Answer 10

Create good interpersonal relationship

Exchange information

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

Question 11

Name 3 doctor factors and 3 patient factors that may influence the context of a consultation

Answer 11

Doctor:
Experience
Personality
Training
Targets
Last patient

Patient:
Healthcare experience
Health status
Personality
Beliefs/fears
Social network
Consulting motivation