Staff Patient Interaction Chap10

Question 1

Consumers

Answer 1

Consumers are lay people who are aware of their knowledge, making choices and influencing the distribution and use of power. Think of informed people selecting providers and insurance companies in competitive health care markets (Chapter 7). In the consumerist view, people are seen as customers of health services.

Question 2

Why is staff-patient interaction important?

Answer 2

Poor communication between staff and patients is a major reason for dissatisfaction and poor outcome of care. One study in the UK in the early 1990s found the commonest criticisms of general practitioners were: inadequate clinical treatment (27%), practitioner not responding or cooperating (27%), personal attributes of health professional (25%), organization of practice/staff (10%), financial issues (7%) and mistakes by practitioner (4%). The authors concluded that the doctor’s ‘ability to dispense pills is not in question but his manner – abrupt and abrasive – calls into question his ability as a general practitioner’ (Nettleton and Harding 1994).

The impact of communication between staff and patients on outcomes of care is well documented. For example, instruction and encouragement of patients can reduce post-operative pain (Egbert 1964). Patients who received extra visits from anaesthetists were able to leave hospital three days earlier.

Question 3

What are failure to communicate with patients related to?

Answer 3

Failure to communicate with patients is related to three areas:

• Failure to assess the full spectrum of patient concerns. In a study of routine encounters, patients were typically interrupted after 18 seconds.
• Failure to develop and maintain therapeutic relations – empathy, a response demonstrating an accurate understanding and acceptance of a patient’s feelings. Developing empathy reduces negative emotions such as anger, anxiety and depression, which are common reactions to illness.
• Failure in delivering information to patients. Levels of distress are reduced when patients perceive themselves to have received adequate information on diagnostic procedures and treatment plans. Most challenging for staff is communicating bad news to patients and their families.

Question 4

Patients

Answer 4

Patients are people expressing a felt need for better health in an interpersonal relationship with health workers.

Question 5

What impacts compliance?

Answer 5

Compliance has been defined as the extent to which patients follow professional advice. Though socioeconomic and cultural factors play an important role, staff–patient interaction also influences compliance with treatment. Notwithstanding the logistical difficulties of case detection in low income countries, failure of compliance with treatment is considered a global problem. High proportions of patients discontinue medication when they feel better but stay infectious and communicate the disease. Hopes are directed towards the development of even shorter treatment regimes, but effective interaction of health workers with patients forms a central part of any control strategy. As an example from Bangladesh demonstrates, specially trained village health workers who are trusted by local communities achieve high rates of case detection and treatment compliance (Chowdhury et al. 1997).

Question 6

What makes patients and staff act as they do?

Answer 6

These are cross cultural findings.

• Relative power. Patients are in a weak bargaining position. They are vulnerable and helpless, and many are ill informed about their status. The experience of illness leads them to seek a passive role. However, this situation is changing in high income countries as patients gain confidence and acquire knowledge about their condition (see below).
• Routine work. Patients are treated as objects of work and each client is one of many. What a patient perceives as a unique situation is routine for the staff.

Two influences on the staff–patient relationship are cultural norms and bureaucracy.