1. Illness Behavior & Dr - Pt Relationship

2. Illness Behavior 20% of the patients neglect their illness

3. I am a patient I am weak I need help

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

5. 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

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

7. Factors Affecting Illness Behavior Accessibility to Medical services

8. Physical barriers can make health facilities difficult to reach H

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

10. Bureaucratic barrier can make health services difficult to obtain H

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

12. Trigger Factors Another Interpersonal Crisis

13. Trigger Factors Effect of the Problem on Pt. Activity

14. Trigger Factors Pressure from Family or Friends

15. The setting of arbitrary deadline or putting limit Trigger Factors

16. 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

17. Communication Skills

18. 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

19. 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) …………….......... 2) ……………..........

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

21. Classification of Communication Skills  Verbal communications  Nonverbal communications

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

23. 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)

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

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

26. Nonverbal Communication is an universal language

27. Mind & Body

28. Body Language Facial Expression

29. Appearance

30. Body Language Hand to face Expression

31. Body Language Hand Expression

33. Body Language Body Posture

34. Body Posture

35. Body Language Touch

36. The effect of touch

37. Communications Paralanguage Velocity Volume Tone Pause Others

38. Body Language Body Bubble ????

39. Body Bubble 15 - 46 cm 46 cm - 1.2 m 1.2 m - 3.6 m More then 3.6 Public zone Social zonePrivate zone Intimate zone

40. Communications Environment Dr. Pt. Couch

41. Communications Environment

43. Discuss the advantage of this style of communications ???

44. Doctor - Patient Relationship

47. 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 ???

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

49. Doctors - Patient Relationship

51. Patient positive role

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

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

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

55. Doctor - Patient Relationship Understanding & Empathy

56. Review of Consultation Models

57. Hospital Model of Consultation

58. Complete history, physical Examination & Investigations ?!

59. Psychosocial component of the physical problems.

60. 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

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

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

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

64. Modification of Help Seeking Behavior Sick Role Secondary gain

65. Modification of Help Seeking Behavior Denial Poor Compliance

66. Modification of Help Seeking Behavior Hidden agenda Displacement

67. 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

68. Patient’s Ideas :

69. Patient’s Concern :

70. Patient’s Expectation Explanation

71. 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

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

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

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

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

76. The patient has the right to know all important details

77. Pendleton Fifth Task To involve patient in the management

78. Pendleton Sixth Task To use time & resources appropriately

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

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