Doctor-Patient

Communication

Nenny Sri Mulyani

Woro Tri Aksiwi
Dwi Murti
Learning objectives

By the end of this session students should

be able to:
Describe the different types of doctor-
patient relationships;
Importance Doctor-patient
communication.
A special and changing relationship

The importance of talking

Why Dont Doctors Talk To Patients In
Language They Can Understand?
Why the patient doesnt understand
what the doctor is saying
Communication skills and
strategies

Beck , 2002
 A special relationship

Sacred (and legally- and morally-

bound) relationship
The basis: patients ability to trust the
doctor with their well-being, and
even their lives
Beck, 2002
Types Doctor-Patient Relationship

Patient Physician control

control
LOW HIGH

Low Default paternalist

High Consumerist Mutuality

Lee, 2006
The Paternalistic Approach

If Ive told you once I

told you 1,000 times,
stop smoking!!
Paternalism

The traditional D-P relationship

Doctor Takes on role of parent

Patient submissive

But currently shift towards Mutuality

Gupta, 2008
 Disadvantages of the old practice
still current practice?

1. Restricts the patients inclination to help themselves.

2. Restricts the patients in giving their own opinion.
3. Reinforces the patients sick role.
4. Reinforces the hierarchical relationship between
doctor and patient.
5. Assumes the doctor knows everything about the
patients
rather than the patient knowing his or her own
condition
better (e.g. pain)
Gupta, 2008
CHANGE RELATIONSHIP
Doctors position: medical service-
supplier?
Patients position: partners, equally
participating in diagnosis and treatment

Business contract??

NHS, 1990
Patient controlled consultation
Youre paid to do what I
tell you!!
Fact
Researchers have found that problems rest mainly
on the doctors side:
Doctors do more talking than listening. (Korsch
et al, 1998).
Doctors often ignore the patients emotional
health.
Doctors underestimate the amount of
information patients want and overestimate how
much they actually give.
Doctors who cant communicate are more likely
to have a malpractice case brought against them.

Beck, 2002
Fact
Patients arent perfect either.
Patients described as frustrating
by doctors often:
do not trust or agree with the doctor.
present too many problems for one visit.
do not follow instructions.
are demanding or controlling. (Levinson et al,
1993)
Communication is very important
Indeed, numerous studies have shown
that doctors are not always good
communicators
Communication skills are rarely taught or
even considered during medical training.
The most
Important determinant of clinician global
satisfaction is the clinician-patient
relationship (Suchmann et al, 1993)
Doctors barriers to effective
communication

lack of specific knowledge;

lack of counselling skills;
lack of time;
lack of appropriate resources.

Beck, 2002
Patient barriers to effective
communication
Educational level
Sex
Social
Different languages
Membership of an ethnic minority

Beck, 2002
Communication skills and
strategies

Active listening
Nonverbal communication
Agendas
Empathize
Educating patients
Reassurance
Agreeing on a treatment plan
Taking responsibility
Avoid Overreacting
HOW?
STUDER GROUP ALLIANCE developed
TOOL to improve PATIENT-DOCTOR
Relationship
A protocol, practical, straight forward
A ----Acknowledge
I ----Introduce
D ----Duration
E -----Explanation
T -----Thank You
ADVANTAGES of AIDET

Studer Group Alliance

AIDET TOOL
Eye Contact, Smile, Shake hand,
Acknowledge Acknowledge everyone in the
room, bond with each person, Sit

Name, Specialist, Wear a name

Introduce badge!, Team
MANAGE UP..

HOW long?
PHYSICIAN TIMELINESS -Thank
you fory our patience, your time is
Duration valuable, How long will the test,
procedure, appointment or
admission actually take? How long
will it take to get result
 Active Listening, E&M activities, Clarifying
questions, Empathy, Explain the treatment
Explanation plan, Use language that patient and family,
understand, Use key words
Do you need more explanation?

Closing key words

Thank for choosing our clinic or hospital,
Thank you Thank for waiting, Thank for coming in
today, What other questions do you have?,
Anything else we could have done make
your visit any better?
Reality of Explanation
During a 20 minute encounter
Physicians self-report spending 9 minutes providing
information
REALITY: Physicians spent 1.5 minutes
The key driver for patient satisfaction
The quality and clarity of information that
patients receive from physicians
Thank you