Transcript european association for communication in healthcare

Significance of communication
and empathy in healthcare
Katarzyna Jankowska
European Association for Communication in Health
Care Teaching Committee
Nicolaus Copernicus University in Toruń
Collegium Medicum in Bydgoszcz, Poland
Department of Pediatrics, Hematology and Oncology
NIŚ – JULY 2, 2011
Communication
 the activity of conveying meaningful
information
Significance of communication ... Pg. 2
Poor communication
between clinicians and patients
-decreases quality of care
-increases human
and economic costs
of care
[Stein T., Frankel R. 2005]
Significance of communication ... Pg. 3
Medical interviewing
 200,000 interviews during the
average lifetime of a practice
 a fundamental component of medical
care
 one of the clinician’s most important
activities
Significance of communication ... Pg. 4
Research on communication
and empathy
 Over the past 3 decades, researchers
have rigorously tested the effects of
communication interventions in the
same way one may study the effects
of a new drug on a population
Significance of communication ... Pg. 5
Are there problems in communication
between doctors and patients?
J.Silverman Cambridge
 reasons for the patient's attendance
 gathering information
 explanation and planning
 adherence to plans
 possibility of medico-legal problems
 lack of empathy and understanding
Significance of communication ... Pg. 6
Discovering the reasons
for the patient’s attendance
 54% of patients’ complaints and 45% of their concerns are not
elicited [Stewart et al 1979]
 in 50% of visits, the patient and the doctor do not agree on the
nature of the main presented problem [Starfield et al 1981]
 only a minority of health professionals identify more than 60%
of their patients' main concerns [Maguire et al 1996]
 consultations with problem outcomes are frequently
characterised by unvoiced patient agenda items [Barry et al 2000]
 doctors frequently interrupt patients during their opening
statement which causes that patients fail to disclose significant
concerns [Beckman and Frankel 1984, Marvel et al 1999]
 doctors often interrupt patients after the initial concern,
apparently assuming that the first complaint is the chief one, yet
the order in which patients present their problems is not related
to their clinical importance [Beckman and Frankel 1984]
Significance of communication ... Pg. 7
Gathering information

doctors often pursue a “doctor-centred”, closed approach to
information gathering that discourages patients from telling their
story or voicing their concerns [Byrne and Long 1976]

both a “high control style” and premature focus on medical
problems can lead to an over-narrow approach to hypothesis
generation and to inaccurate consultations [Platt and McMath 1979]

oncologists preferentially listen for and respond to certain disease
cues over others – while pain amenable to specialist cancer
treatment is recognised, other pains are not acknowledged or are
dismissed [Rogers and Todd 2000]

doctors rarely ask their patients to volunteer their ideas and in fact,
doctors often evade their patients’ ideas and inhibit their
expression. Yet if discordance between doctors’ and patients’ ideas
and beliefs about the illness remains unrecognised, poor
understanding, adherence, satisfaction and outcome are likely to
ensue [Tuckett et al 1985]

doctors only respond positively to patient cues in 38% of cases in
surgery and 21% in primary care [Levinson 2000]
Significance of communication ... Pg. 8
Explanation and planning

in general, physicians give sparse information to their patients, with most
patients wanting their doctors to provide more information than they do
[Waitzkin 1984, Pinder 1990, Beisecker and Beisecker 1990, Jenkins et al 2001,
Richard and Lussier 2003]

doctors overestimate the time they devote to explanation and planning in
the consultation by up to 900% [Waitzkin 1984, Makoul et al 1995]

patients and doctors disagree over the relative importance of imparting
different types of medical information; patients place the highest value on
information about prognosis, diagnosis and causation of their condition
while doctors overestimate their patient’s desire for information
concerning treatment and drug therapy [Kindelan and Kent 1987]

doctors consistently use jargon that patients do not understand [Svarstad

there are significant problems with patients’ recall and understanding of
the information that doctors impart [Tuckett et al 1985, Dunn et al 1993]

only the minority of patients achieve their preferred level of control in
decision making in cancer treatment [Degner et al 1997]
1974, Hadlow and Pitts 1991]
Significance of communication ... Pg. 9
Medico-legal issue

breakdown in communication between patients and physicians is a
critical factor leading to malpractice litigation [Levinson 1994]. Lawyers
identified physicians’ communication and attitudes as the primary
reason for patients pursuing a malpractice suit in 70% of cases [Avery
1986]

[Beckman et al 1994] showed that the following four communication
problems were present in over 70% of malpractice depositions:
deserting the patient, devaluing patients’ views, delivering
information poorly and failing to understand patients’ perspectives.

Patients of obstetricians with a high frequency of malpractice claims
are more likely to complain of feeling rushed and ignored and
receiving inadequate explanation, even by their patients who do not
sue [Hickson et al 1994]
in several states of the USA, malpractice insurance companies award
premium discounts of 3 to 10% annually to their insured physicians
who attend a communication skills workshop [Carroll 1996]

Significance of communication ... Pg. 10
Lack of empathy
and understanding

numerous reports of patient dissatisfaction with the
doctor-patient relationship appear in the media. Many articles
comment on doctors’ lack of understanding of the patient as a
person with individual concerns and wishes J.Silverman
Cambridge 2008

there are significant problems in medical education in the
development of relationship building skills: it is not correct to
assume that doctors either have the ability to communicate
empathically with their patients or that they will acquire this
ability during their medical training [Sanson-Fisher and Poole
1978, Suchman and Williamson 2003]
Significance of communication ... Pg. 11
Acreditiation Council for Graduate Medical
Education (USA)
American Board of Internal Medicine (USA)
have identified
doctor-patient communication
as one of the core competencies
required for good medical practice
Significance of communication ... Pg. 12
Why I trust my Doctor?
 Doesn't make me feel inferior
 Doesn't rush me
 Knows my medical history
Significance of communication ... Pg. 13
Clinical competence
- the ability to integrate:
 knowledge
 communication
 physical examination
 problem-solving
Significance of communication ... Pg. 14
Medical education cannot ignore
the vital importance of
Effective
clinical
communication
to
High quality
health care
Significance of communication ... Pg. 15
Calgary-Cambridge
Comprehensive clinical method
Kurtz S. Silverman J.
combining content and process
 medical history decribing the content
of the interview
 communication model describing the
process of the interview
Significance of communication ... Pg. 16
Calgary Cambridge
 80% of the medical schools in the
United Kingdom use this model
Significance of communication ... Pg. 17
Four Habits Model
Frankel R.




Invest in the Beginning
Elicit the Patient’s Perspective
Demonstrate Empathy
Invest in the End
Significance of communication ... Pg. 18
Empathy
 the capacity to recognize and, to
some extent, share feelings (such as
sadness or happiness) that are
experienced by another being.
Significance of communication ... Pg. 19
Empathy
 Why are humans so good at reading
other individuals’ intentions?
 Do higher primates have a
specialized brain center or module for
generating a “theory of other minds”?
Significance of communication ... Pg. 20
The answer
- mirror neurons
 Up to 30% of the brain is suspected to
consist of these mirror neurons, making
mirroring and imitating activity and
behaviour one of the strongest impulses in
a human
Significance of communication ... Pg. 21
Mirror neurons
one of the most important recent discoveries in neuroscience
Giacomo Rizzolatti 1990
Brain imaging experiments using functional magnetic
resonance imaging (fMRI) have shown that the human
inferior frontal cortex and superior parietal lobe is active
when the person performs an action and also when the
person sees another individual performing an action. It has
been suggested that these brain regions contain mirror
neurons, and they have been defined as the human mirror
neuron system.
Significance of communication ... Pg. 22
Feelings of empathy
-independent of our wishesmirror neurons
-conscious
ask yourself questions:
How would I feel in that situation ?
Significance of communication ... Pg. 24
Patient-centred approach
Physician tries to enter the patient’s
world to see the illness through the
patient’s eyes
Significance of communication ... Pg. 26
Bovincini K.A 2009
 Physicians with 18h of communication
training can make significant progress
in identifying and responding to
patient-created empathic
opportunities
Significance of communication ... Pg. 27
The evolution of the
doctor-patient relationship
- The relationship has undergone a
transition throughout the ages from
Medical Paternalism->
Enhanced Autonomy
Significance of communication ... Pg. 28
To attend those who suffer, a physicians must
possess not only the scientific knowledge and
technical abilities, but also an understanding of
human nature
The patient is not just a group of
symptoms, damaged organs and
altered emotions
The patient is a human being, at the
same time worried and hopeful, who
is searching for relief, help and trust
Significance of communication ... Pg. 29
