Transcript doctor patient encounter

INTRODUCTION TO
PHYSICIAN-PATIENT
COMMUNICATION
Ildikó Bán MD
Depts. of Family Medicine and
General Internal Medicine,
University of Pécs
2007
WELLCOME!
WHY IS COMMUNICATION
SKILL TRAINING
IMPORTANT FOR A FIRST
YEAR MEDICAL STUDENT?
What we want and don’t want
THE IMPORTANCE OF THE
COMMUNICATION SKILLS
in foreign countries…..
 role plays
 joint consulting
 video taped consultations
 case reports
WHAT SHALL WE DO IN
THIS SEMESTER?
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6 lectures on doctor patient
communication, video taped situations
4 small group seminars, role playing
interactive teaching methods
about the grading
feedback
STUDY
What makes a doctor good
doctor?
from the aspect of the patients
STUDY
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72% the most important the personal
doc-pat. realitionship (pays
attention, listents to the patient, shows
empathy)
28% the most important the skill and
the knowledge (competence,
efficiency, time saving)
GOALS
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Patient’s side:
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solving the problem
understanding the nature of his problem
understanding his role in the process
GOALS
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Doctor’s side:
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getting the information
is there anything else?
understanding the problem
actual physical and psychological status
planning
convincing the patient (explanation..)
Collaboration with the patient
SPECIAL FEATURES
previous experiences
lots of personal and anamnestic details
relatives, circumstances, envirnoment
different places (office, patient’s home)
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STEPS OF THE DOCTOR
PATIENT INTERACTION
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GREETING
INTRODUCTION
INTERVIEW
PHYSICAL EXAMINATION
DISCUSSION, DECISION
SAYING GOOD BYE
DOCTOR PATIENT ENCOUNTER
GREETING
GREETING:
INTRODUCTION
INTERVIEW
PHYSICAL EXMINATION
DISCUSSION
DECISION
SAYING GOOD BYE
depends:
mistakes:
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age, sex
personality
intimate, intrusive
self confident
to miss it
DOCTOR PATIENT ENCOUNTER
GREETING
INTRODUCTION
INTRODUCTION:
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Depends:
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INTERVIEW
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PHYSICAL
EXAMINATION
First meet?
mistakes:
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You miss it
The patient starts
DISCUSSION
DECISSION
SAYING GOOD BYE
Don’t be afraid to say you are a medical student!
DOCTOR PATIENT ENCOUNTER
GREETING
INTERVIEW:
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INTRODUCTION
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INTERVIEW
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PHYSICAL
EXAMINATION
DECISION
DISCUSSION
SAYING GOOD BYE
The patient’s goal-let the P. talk
Problem oriented proper questions
Focus on the most important-ask
back
mistake:
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„too much information”
„disease oriented”
DOCTOR PATIENT ENCOUNTER
GREETING
INTRODUCTION
PHYSICAL EXAMINATION:
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INTERVIEW
PHYSICAL
EXAMINATION
DISCUSSION
DECISION
SAYING GOOD BYE
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Very intimate
Cause as little discomfort as possible!
Keep on talking!
DOCTOR PATIENT ENCOUNTER
GREETING
DISCUSSION, DECISION:
Suspected diagnosis
 plan, steps, prognosis
 BE UNDERSTANDABLE!
mistakes:
 Not understandable
 Not controlled
 The doctor makes the decision
 THE TRUST IS FUNDAMENTAL
 The next appointment
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INTRODUCTION
INTERVIEW
PHYSICAL EXAMINATION
DISCUSSION
DECISION
SAYING GOOD BYE
DOCTOR PATIENT ENCOUNTER
GREETING
SAYING GOOD BYE:
INTRODUCTION
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INTERVIEW
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PHYSICAL EXAMINATION
DISCUSSION
DECISISON
SAYING GOOD BYE
NEVER LET THE PATIENT GO WITH
UNANSWERED QUESTIONS
Never forget to say good bye
Show that you care about your patient
DIFFICULT SITUATIONS
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Angry patient
Insecure patient
Nervous patient
Suicidal
Dying patient
POWER OF COMMUNICATION
„Doctors who
communicate poorly may
never be forgiven, those
who do it well never will
be forgotten.”
SEE YOU SOON!