Significance of communication and empathy in healthcare Katarzyna Jankowska European Association for Communication in Health Care Teaching Committee Nicolaus Copernicus University in Toruń Collegium Medicum in Bydgoszcz, Poland Department of Pediatrics, Hematology and Oncology NIŚ – JULY 2, 2011

Communication the activity of conveying meaningful information Significance of communication ... Pg. 2

Poor communication between clinicians and patients -decreases quality of care -increases human and economic costs of care [Stein T., Frankel R. 2005] Significance of communication ... Pg. 3

Medical interviewing 200,000 interviews during the average lifetime of a practice a fundamental component of medical care one of the clinician’s most important activities Significance of communication ... Pg. 4

Research on communication and empathy Over the past 3 decades, researchers have rigorously tested the effects of communication interventions in the same way one may study the effects of a new drug on a population Significance of communication ... Pg. 5

Are there problems in communication between doctors and patients. J Are there problems in communication between doctors and patients? J.Silverman Cambridge reasons for the patient's attendance gathering information explanation and planning adherence to plans possibility of medico-legal problems lack of empathy and understanding Significance of communication ... Pg. 6

Discovering the reasons for the patient’s attendance 54% of patients’ complaints and 45% of their concerns are not elicited [Stewart et al 1979] in 50% of visits, the patient and the doctor do not agree on the nature of the main presented problem [Starfield et al 1981] only a minority of health professionals identify more than 60% of their patients' main concerns [Maguire et al 1996] consultations with problem outcomes are frequently characterised by unvoiced patient agenda items [Barry et al 2000] doctors frequently interrupt patients during their opening statement which causes that patients fail to disclose significant concerns [Beckman and Frankel 1984, Marvel et al 1999] doctors often interrupt patients after the initial concern, apparently assuming that the first complaint is the chief one, yet the order in which patients present their problems is not related to their clinical importance [Beckman and Frankel 1984] Significance of communication ... Pg. 7

Gathering information doctors often pursue a “doctor-centred”, closed approach to information gathering that discourages patients from telling their story or voicing their concerns [Byrne and Long 1976] both a “high control style” and premature focus on medical problems can lead to an over-narrow approach to hypothesis generation and to inaccurate consultations [Platt and McMath 1979] oncologists preferentially listen for and respond to certain disease cues over others – while pain amenable to specialist cancer treatment is recognised, other pains are not acknowledged or are dismissed [Rogers and Todd 2000] doctors rarely ask their patients to volunteer their ideas and in fact, doctors often evade their patients’ ideas and inhibit their expression. Yet if discordance between doctors’ and patients’ ideas and beliefs about the illness remains unrecognised, poor understanding, adherence, satisfaction and outcome are likely to ensue [Tuckett et al 1985] doctors only respond positively to patient cues in 38% of cases in surgery and 21% in primary care [Levinson 2000] Significance of communication ... Pg. 8

Explanation and planning in general, physicians give sparse information to their patients, with most patients wanting their doctors to provide more information than they do [Waitzkin 1984, Pinder 1990, Beisecker and Beisecker 1990, Jenkins et al 2001, Richard and Lussier 2003] doctors overestimate the time they devote to explanation and planning in the consultation by up to 900% [Waitzkin 1984, Makoul et al 1995] patients and doctors disagree over the relative importance of imparting different types of medical information; patients place the highest value on information about prognosis, diagnosis and causation of their condition while doctors overestimate their patient’s desire for information concerning treatment and drug therapy [Kindelan and Kent 1987] doctors consistently use jargon that patients do not understand [Svarstad 1974, Hadlow and Pitts 1991] there are significant problems with patients’ recall and understanding of the information that doctors impart [Tuckett et al 1985, Dunn et al 1993] only the minority of patients achieve their preferred level of control in decision making in cancer treatment [Degner et al 1997] Significance of communication ... Pg. 9

Medico-legal issue breakdown in communication between patients and physicians is a critical factor leading to malpractice litigation [Levinson 1994]. Lawyers identified physicians’ communication and attitudes as the primary reason for patients pursuing a malpractice suit in 70% of cases [Avery 1986] [Beckman et al 1994] showed that the following four communication problems were present in over 70% of malpractice depositions: deserting the patient, devaluing patients’ views, delivering information poorly and failing to understand patients’ perspectives. Patients of obstetricians with a high frequency of malpractice claims are more likely to complain of feeling rushed and ignored and receiving inadequate explanation, even by their patients who do not sue [Hickson et al 1994] in several states of the USA, malpractice insurance companies award premium discounts of 3 to 10% annually to their insured physicians who attend a communication skills workshop [Carroll 1996] Significance of communication ... Pg. 10

Lack of empathy and understanding numerous reports of patient dissatisfaction with the doctor-patient relationship appear in the media. Many articles comment on doctors’ lack of understanding of the patient as a person with individual concerns and wishes J.Silverman Cambridge 2008 there are significant problems in medical education in the development of relationship building skills: it is not correct to assume that doctors either have the ability to communicate empathically with their patients or that they will acquire this ability during their medical training [Sanson-Fisher and Poole 1978, Suchman and Williamson 2003] Significance of communication ... Pg. 11

Acreditiation Council for Graduate Medical Education (USA) American Board of Internal Medicine (USA) have identified doctor-patient communication as one of the core competencies required for good medical practice Significance of communication ... Pg. 12

Why I trust my Doctor? Doesn't make me feel inferior Doesn't rush me Knows my medical history Significance of communication ... Pg. 13

- the ability to integrate: Clinical competence - the ability to integrate: knowledge communication physical examination problem-solving I want to see two things about the central importance of communication to high-quality healthcare, First I want to talk about clinical competence Talk about good knowledge/clinical reasoning and poor communication and the reverse and Doctor Ellis Significance of communication ... Pg. 14

Effective clinical communication High quality health care Medical education cannot ignore the vital importance of Effective clinical communication High quality health care to Significance of communication ... Pg. 15

Calgary-Cambridge Comprehensive clinical method Kurtz S. Silverman J Calgary-Cambridge Comprehensive clinical method Kurtz S. Silverman J. combining content and process medical history decribing the content of the interview communication model describing the process of the interview Significance of communication ... Pg. 16

Calgary Cambridge 80% of the medical schools in the United Kingdom use this model Significance of communication ... Pg. 17

Four Habits Model Frankel R. Invest in the Beginning Elicit the Patient’s Perspective Demonstrate Empathy Invest in the End Significance of communication ... Pg. 18

Empathy the capacity to recognize and, to some extent, share feelings (such as sadness or happiness) that are experienced by another being. Significance of communication ... Pg. 19

Empathy Why are humans so good at reading other individuals’ intentions? Do higher primates have a specialized brain center or module for generating a “theory of other minds”? Significance of communication ... Pg. 20

The answer - mirror neurons Up to 30% of the brain is suspected to consist of these mirror neurons, making mirroring and imitating activity and behaviour one of the strongest impulses in a human Significance of communication ... Pg. 21

Mirror neurons one of the most important recent discoveries in neuroscience Giacomo Rizzolatti 1990 Brain imaging experiments using functional magnetic resonance imaging (fMRI) have shown that the human inferior frontal cortex and superior parietal lobe is active when the person performs an action and also when the person sees another individual performing an action. It has been suggested that these brain regions contain mirror neurons, and they have been defined as the human mirror neuron system. Significance of communication ... Pg. 22

Feelings of empathy -independent of our wishes- mirror neurons -conscious ask yourself questions: How would I feel in that situation ? Significance of communication ... Pg. 24

Patient-centred approach Physician tries to enter the patient’s world to see the illness through the patient’s eyes Significance of communication ... Pg. 26

Bovincini K.A 2009 Physicians with 18h of communication training can make significant progress in identifying and responding to patient-created empathic opportunities Significance of communication ... Pg. 27

The evolution of the doctor-patient relationship - The relationship has undergone a transition throughout the ages from Medical Paternalism-> Enhanced Autonomy Significance of communication ... Pg. 28

To attend those who suffer, a physicians must possess not only the scientific knowledge and technical abilities, but also an understanding of human nature The patient is not just a group of symptoms, damaged organs and altered emotions The patient is a human being, at the same time worried and hopeful, who is searching for relief, help and trust Significance of communication ... Pg. 29