Patient-Practitioner Communication Flashcards
Why do we need good relationships in the medical setting?
Decrease experience of negative emotions such as fear or anger
Establish and maintain a positive trusting relationship with patients and their families
Get and give accurate and relevant information
Use time and opportunity effectively
Improve patient satisfaction
Improve adherence
Increase changes of successful assessment & treatment
What is the doctor-centred communication style?
Ask yes/ no questions
Focus on first presenting problem only
Focus on establishing link between problem and organic process
Ignore patient attempts to discuss other problems
What is the patient-centred communication style?
Ask open-ended questions
Encourage patients to introduce other information
Avoid use of medical jargon
More encouragement of patient participation
Mutual participation
Doctor and patient pursue common goals
What are the three factors that influence provider communication style?
- Decision-making (hypothesis testing)
- Errors in information gathering
Premature closure/ jumping to conclusions
Primacy and Recency effects
Stereotypes
Time pressure
Individual difference in tolerance of uncertainty
Other biases eg should statements - Jargon
What influences patient communication style?
Express criticism or anger towards doctor
Do not listen to doctors explanations
Insist on certain tests, medications or procedures
Request certification when condition is unfounded
Make sexually suggestive remarks or behaviours
Do not convey their distress / feelings about health
Inappropriately describe their symptoms
Ask few questions
What is adherence?
The degree to which patients carry out the behaviours and treatments that their practitioners recommend
What is non-adherence
Non-adherence can be defined as degree to not following recommendations or as “point below which the desired preventative or therapeutic result is unlikely to be achieved with the medication prescribed”
What are the three types of factors that contribute to non-adherence?
Treatment and illness factors
Sociocultural factors
Psychological factors
How might you increase adherence?
Give clear instructions eg take 1 pill with breakfast and 1 with dinner rather than take 2 pills a day
Explain rationale for instructions
Use simple verbal or written language
Ask pt to repeat instructions in their own words
Ask pt to explicitly state that he or she will comply: “Will you promise me that you will…”
Positive reinforcement by carers, family, self-help groups
Behavioural strategies e.g. self-monitoring, prompts, reinforcement schedule, contextual adaptations e.g. take medication at certain times
What are the socio-cultural factors that contribute to non-adherence?
- kids affected by parents
- adolescents fail to adhere LT
- elderly - mood, eyesight etc
- gender - depends on type
- social support increases
- SES lowers
- ethnicity varies
What are some treatment and illness factors that may affect compliance?
Positively: - medication adherence better than habit change - patient-rated severity - short term better than LT Negatively: - complex instructions - cost - side effects - negative affect reduces
What are the psychological factors that influence non-adherence?
- high illness threat
- benefits vs. cost
- ‘rational’ non-adherence
- high SE and optimism
- memory (present info early, small statements, anxiety increases)
Why don’t people change?
- secondary gain
- familiar devils
- fear of changing
- fear of failing
- reactance - may be a threat to our personal freedom
- function of behaviour e.g. substance use
- faulty beliefs
- fear of negative emotion
What are the four types of resistance?
Reluctance
Rebellion
Resignation
Rationalisation
How should you respond to resistance?
Roll with it Reflective statements Change topic Reframe Emphasise autonomy Cautiously acknowledge truth
