Putting Patients First ‘Championing Consumers’ Rights’ Tania Thomas Deputy Health and Disability Commissioner April 2007

A Patient/Consumer-Centred Approach Health professionals do not deal with diseases; they deal with people who are concerned about their health. Ensuring that patients receive safe, high-quality care necessarily means involving consumers in their own care. This means encouraging clinicians and disability services providers to think about ways of integrating consumers' perceptions into consultations.

Consumers are their own best experts While the health professional may be well informed about a particular patient's clinical condition, progress and treatments, the individual patient is an expert in the experience of that condition. Successful management of the condition requires the knowledge of both the professional and the patient, allowing a joint decision making process to take place.

Joint decision making process Consumer identifies and defines the issues affecting them Decides and specifies the expectations of the consultation and the aims they have for their health/well being Identifies the strengths and resources necessary for the change they want Specify, decide and undertake the steps which need to be taken to reach their goals.

Communication Approachability Compassion Empathy Active Listening

Approachability Easy to talk to Makes an effort to put people at ease Is warm, pleasant and gracious Is sensitive to and patient with the interpersonal anxieties of others Builds rapport well Is a good listener

Compassion Genuinely caring about other people Concerned about their health and the context within which they live and work Available and ready to help Empathetic Some people think only intellect counts: knowing how to solve problems, knowing how to get by, knowing how to identify an advantage and seize it. But the functions of intellect are insufficient without courage, love, friendship, compassion and empathy – Dean Koontz.

Empathy Empathy is the ability to appreciate another's problems and feelings without actually experiencing them. Our habit of perceiving the world as best suits our interests often blinds us to others’ perceptions and impairs our ability to work with them to resolve conflicts and find solutions. ‘Empathy' is quite simply applied imagination and only requires a little exertion and discipline. Empathy skills are those that involve paying attention to other people At the outset empathy involves real curiosity and a desire to know or understand. There is a genuine interest in what the person is saying and feeling.

Asking questions You cannot have empathy without asking questions. Some typical ones are: 1. "Can you say more about that?" 2. "Really? That's interesting. Can you be more specific?" 3. "I wasn't aware of that. Tell me more." 4. "I'm curious about that…let's discuss this in more depth." 5. "Let me see if I understand you correctly…here is what I hear you say…"

Missing the message Those that do not have empathy have a tendency to misread the other person. They do not ask questions to clarify. They do not pay attention to non-verbal cues. Those people who are analytical by nature will listen to the words, facts and figures and completely miss the real message of what is being said. 7% of the message is carried in the words

Active Listening Listening is not easy and requires a certain set of skills. An active listener: concentrates on what is being said (doesn't read, shuffle papers or otherwise non-verbally communicate a lack of interest) listens to all facts and tries not to interrupt until the speaker has concluded his/her statements. When someone is talking for a long period of time, it is sometimes helpful to either take notes or ask them to stop so that you can feed back to them what you have heard. listens for key words of interest on which to comment and ask questions (communicating that I am really interested and want to hear more or better understand what you are saying.) is objective; hears people as they are, not the way you'd like them to be. holds back personal judgments until the speaker has presented his/her ideas.

Partnership Reaches a workable agreement with patients on the nature of their problems, appropriate goals of treatment, and roles of doctor and patient in management. Works with patients to manage effectively the full impact of disease and illness on themselves and their families. Collaborates with patients to empower them to take an active role in their own care. Determines patients’ ideas about their problems, their preferences about treatment, and their concepts of the responsibilities of doctor and patient in management. Communicates information clearly to patients so that they are able to understand their problems and realize what may be done and what they can expect. Determines how much information regarding their condition patients want or are able to handle.

Partnership (continued) Addresses differences of opinion with consumers so that together they reach a conclusion that is both acceptable and safe for the patient. Willingness to collaborate with consumers about management, rather than needing always to ‘take charge.’ Awareness of personal values and cultural differences and how these might interfere with providing unbiased assistance to consumers with different values or points of view.

WOK Choose the ingredients carefully to meet the needs Specialist knowledge Consumer knowledge Other resources Uniqueness retained – can always find the carrot Communication and partnership sauce gives it the flavour.