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Activity guide

DOCTOR - PATIENT COMMUNICATION ON THERAPEUTICS

Activity Guide

Introduction Although the doctor’s role in promoting appropriate use of medicines is


important, patients and the cultural context in which therapy is selected
cannot be ignored. The patients’ knowledge and perception towards disease
etiology and treatment are critical determinants in the correct use of
medicines and the success of the treatment. Without patients’ education in
the appropriate use of medicines, patients will lack of understanding on how
to use the medicines (including when not to use them) and the importance of
medicines in health care.

Therefore, it is obvious that doctors should provide the patients with correct
knowledge and understanding. Doctors should equip themselves with
knowledge about the social and cultural background of the patients, patient
beliefs on disease and therapy, information the patients expect from the
doctors, the skills on retrieving information from the patients, and the skills
on conveying messages suitable for each individual patient.

Objectives After attending this practical session, students are expected to be able to:
1. Discover different beliefs on diseases and therapeutics
2. Conduct interactive communication using patient role models
3. Convey appropriate therapeutic messages using patient role models

Activities 1. Brief lecture and clarification on topic (15’)


2. Role play - facilitator and real patients (30’)
3. Plenary discussion (20’)
4. Small-group exercise (100’)
5. Plenary discussion (15’)

Preparations Read the Lecture handout


Read the small-group activity guide

Time allocation 180 minutes

References Management Sciences for Health in Collaboration with the World Health
Organization, 1997, Managing Drug Supply. Kumarian Press, West
Harford, pp:496-512
Mann RD & Avorn J, 2001, The role of therapeutic agents in modern
medicine. In Boxtel et al (eds.) Drug Benefits and Risks, International
Textbook of Clinical Pharmacology . John Wiley & Sons, Chichester, pp3-
15.
World Health Organization, 1994, Guide to Good Prescribing. WHO-EDM,
Geneva.

File: SS/Desktop/Farklin/therapeutic communication


Small-group Activity Guide
DOCTOR - PATIENT COMMUNICATION ON THERAPEUTICS

Instruction:

1. Students are requested to form small-groups of 6.


2. Read the two scenarios below, discuss them with the group members to comprehend the situations
3. Role play in small-group using the scenarios. Two members act as the physician and the patient, as
the others are observing. Scenario 2 needs two patients. Each role play should not exceed 10
minutes, and the observers should comment only after the completion of each role play. Do the role
play several time until each group member has experience as the physicians as well as the patients.

Scenario A

Mrs. Tina, 38 y.o., is consulting Dr. Saleh. She is suffering from a tooth-ache. Her cheek is swollen, and
she has experienced the pain overnight. She is asking Dr. Saleh for a ‘magic’ to remove the pain
immediately. She has tried warm towels and gorgled with salt solution to reduce the pain. Dr. Saleh
knows that it is an acute dental pain. What he can do at the moment is to give Mrs. Tina analgesic tablets
to relieve the pain, and asks her to see a dentist when the pain is relieving. Dr. Saleh knows there are
three options for analgesics, i.e., aspirin, paracetamol, and mefenamic acid. Aspirin is a powerful
analgesic, but it may induce asthma and causes stomach irritation. Mefenamic acid is less powerful
analgesic; it is sold with prescription only due to its serious adverse effects. Paracetamol is the best
choice based on its efficacy and safety, but this drug is too common; people are familiar with it and
anyone can buy paracetamol everywhere. Among those 3 options, mefenamic acid is the most
expensive. Dr. Saleh wants to prescribe paracetamol because it is the best choice, but Mrs. Tina refuses.
She prefers to have a “sophisticated” drugs, not “just paracetamol”. Dr. Saleh is convincing Mrs. Tina that
paracetamol is the best choice.

Scenario B

Nanang (26 y.o.) is a son of Mrs. Sapti, a 70 y.o. women, who is suffering from chronic rheumatoid
arthritis. He always accompanies her mother to see Dr. Rustam for routine visits. They are now in Dr.
Rustam’s consultation room. As usual, Dr. Rustam is prescribing diclofenac tablets, an anti-rheumatoids
and diazepam, a sedative sleeping-aid. She is not saying anything but grinning while Dr. Rustam is
writing the prescription. Actually, Mrs. Sapti is getting bored with taking medication. She is sick of the pills
and feels lonely at night. She wants to talk to somebody at bedtime, but everyone at home believes she
sleeps well because the doctor gives her diazepam. She does not tell anyone, nor Nanang, that she has
not taken the medicines during the last 2 weeks (psssst....don’t tell the doctor!), and now she feels painful
here and there, especially at her tights. Luckily, Dr. Rustam notices the grin and realizes that there is
something wrong going on. He is trying to discover the unexpressed feeling and convincing Mrs. Sapti
about the importance of treatment. He remembers a senior geriatrist told him that for elderly patients, a
gentle touch is better than a sleeping pill. He is offering to replace the diclofenac tablet to a topical rub,
and stops diazepam. Instead of prescribing diazepam, he is asking Nanang to arrange someone to
accompany Mrs. Sapti at bedtime and talk to her while rubbing her tights.

Challenge your talent, enjoy the performance....!!!

File: SS/Desktop/Farklin/therapeutic communication


Small-group Activity Guide
DOCTOR - PATIENT COMMUNICATION ON THERAPEUTICS
Observers’ check list

Doctor: ______________________________ Patient(s):


__________________________________

Step Details Done Not Comments


done
1 Defining patient’s problem

2 Specify treatment objective

3 Select medicine

4 Start treatment (and write


prescription)
5 Give information

6 Monitor for treatment result

7 Other relevant details:

Doctor: ______________________________ Patient(s):


__________________________________

Step Details Done Not Comments


done
1 Defining patient’s problem

2 Specify treatment objective

3 Select medicine

4 Start treatment (and write


prescription)
5 Give information

6 Monitor for treatment result

7 Other relevant details:

File: SS/Desktop/Farklin/therapeutic communication


File: SS/Desktop/Farklin/therapeutic communication