Illness Behavior & Dr - Pt Relationship

Illness Behavior 20% of the patients neglect their illness

I am a patient I am weak I need help

Causes of Denial of Illness It is not easy for the patient to show his weakness Doctor’s authority

Illness Behavior Factors Affecting Illness Behavior  Gender  Age  Race  Learned behavior  Accessibility to health services  Symptom presentation  Lay beliefs  Social Class  Previous experience  Trigger factors  Locus of control

Factors Affecting Illness Behavior Symptoms : severity of the symptom Patient ideas & understanding about the symptom Patient previous experience with this symptom

Factors Affecting Illness Behavior Accessibility to Medical services

Physical barriers can make health facilities difficult to reach H

Factors Affecting Illness Behavior Previous experience with health services ???

Bureaucratic barrier can make health services difficult to obtain H

Illness Behavior Learned behavior Somatic complain Inappropriate reaction (Pt. Family & Dr.) Somatic fixation

Trigger Factors Another Interpersonal Crisis

Trigger Factors Effect of the Problem on Pt. Activity

Trigger Factors Pressure from Family or Friends

The setting of arbitrary deadline or putting limit Trigger Factors

Illness Behavior Final Message & Conclusions  Doctors need to understand illness behavior for proper understanding of their patients  Doctors need to explore & acknowledge patient’s believes & worries

Communication Skills

Objectives:  To improve your skills in exploring and acknowledgement of patient’s thoughts and feelings.  To increase your awareness about your patients’ verbal and nonverbal cues.  To help you to develop new communication skills in order to deal with your patients’ cues. Communication Skills

Exercise 4 Write down three words that best describe the way you want to be perceived by your patients: 1)……… 2) ………… 3)………. Write how can you use your communication skills to convey this message? 1) …………… ) ……………

Who is the patient ?! Awareness of Patients’ verbal and Nonverbal Cues

Classification of Communication Skills  Verbal communications  Nonverbal communications

Communication Skills Verbal communications How to formulate questions Discussion, explanation & Advice Understanding pt. verbal cues

Verbal communications How to formulate questions Direct Qs (Yes or No) Suggestive Qs Why Qs Many Qs at a time Indirect Qs (Open-ended Qs)

Communication Skills Nonverbal communications 1- Body language & Facial expression 2- Appearance 3- Touch 4- Paralanguage 5- Body bubble 6- Environment

Verbal communication for tilling information, but nonverbal communication for negotiation Verbal communication nonverbal communication Reference: (McCaskey 1979 )Rakel 10% of communications 90% of communications

Nonverbal Communication is an universal language

Mind & Body

Body Language Facial Expression

Appearance

Body Language Hand to face Expression

Body Language Hand Expression

Body Language Body Posture

Body Posture

Body Language Touch

The effect of touch

Communications Paralanguage Velocity Volume Tone Pause Others

Body Language Body Bubble ????

Body Bubble cm 46 cm m 1.2 m m More then 3.6 Public zone Social zonePrivate zone Intimate zone

Communications Environment Dr. Pt. Couch

Communications Environment

Discuss the advantage of this style of communications ???

Doctor - Patient Relationship

Doctors - Patient Relationship Why doctors need to have a positive relationship with their pt. ??? How dose this relationship start & how it progress ??? What are the skill needed to build a positive relationship ???

Doctors - Patient Relationship Why ??? For the patient care & satisfaction For doctor satisfaction For effective use of resources

Doctors - Patient Relationship

Patient positive role

Doctors - Patient Relationship How ??? Professional relationship personal relationship Intimate relationship

To Establish & To Maintain Dr-Pt Relationship Welcoming the Patient Showing respect

To Establish & To Maintain Dr-Pt Relationship “ Don’t waste my time, just say yes or no” The ability tolisten to listen

Doctor - Patient Relationship Understanding & Empathy

Review of Consultation Models

Hospital Model of Consultation

Complete history, physical Examination & Investigations ?!

Psychosocial component of the physical problems.

Byrne & Long 1976 Patient Centered Doctor Centered Consultation Consultation Use of pt’s knowledge and experience SilenceClarification Listening Interpretation Reflection Use of doctor’s special skills and knowledge Analyzing Gathering Probing Information

The Real Reason for Consultation Failure to explore the real reason of patient problem is the main reason of consultation failure (Byrne & Long 1976)

The Expanded Model of Consultation Management of Presenting Problem Management of Continuous Problem Modification of Help Seeking Behavior Opportunistic health Promotion (Stott & Davis 1979)

Modification of Help Seeking Behavior The child as the presenting complain Frequent attender Somatic patient

Modification of Help Seeking Behavior Sick Role Secondary gain

Modification of Help Seeking Behavior Denial Poor Compliance

Modification of Help Seeking Behavior Hidden agenda Displacement

Pendleton 7 Tasks 1.To define the real reasons for pt attendance 2.To consider other problems 3.To choose with the pt. appropriate action for each problem 4.To achieve a share understanding 5.To involve pt. in the management 6.To use time & resources effectively 7.To establish & maintain Dr.-pt. relationship

Patient’s Ideas :

Patient’s Concern :

Patient’s Expectation Explanation

Skills Needed To Explore the Real Reasons for Pt. Attendance Open ended questions Indirect questions Use of silence Recognition of pt cues Immediate response to pt. cues Confrontation Reflection Probing Summarization

Pendleton Third Task With the patient to choose an appropriate action for each problem. Why

With the patient to choose an appropriate action for each problem Patient responsibility Patient compliance

Pendleton Fourth Task With the patient to achieve shared understanding of the problem DoctorPatient Knowledge Questions Doubts Theories Experience Knowledge Questions Doubts Theories Experience

Pendleton Fourth Task With the patient to reach Shared Understanding of the Problem

The patient has the right to know all important details

Pendleton Fifth Task To involve patient in the management

Pendleton Sixth Task To use time & resources appropriately

Pendleton Seventh Task To Establish & Maintain Dr.-Pt. Relationship

Final Message & Conclusions A lot of practice is needed to be able adopt the proper consultation model