-Starts with the story of a person who goes to a physician and has to wait for an hour and only
gets 5 minutes of doctor with no medication suggested, just told to take over the counter
medicines and fluids…leads the patient to think why they bothered to come to the doctor.
- Long waits, insensitivity, apparently faulty diagnoses and treatments that have no effect
are the stuff of these indignant stories.
- Refer to physician as provider because Canadians receive their primary care from
individuals other than physicians too like nurse practitioners etc.
- Nurses as providers - advanced practice nurses are those who have gone beyond the four
years of nursing education ex: Nurse practitioner is a RN who has additional info in
health assessments, diagnoses, and management of injuries and illness, who can prescribe
drugs, should be able to explain origins of disorders. Even if not a nurse practitioner,
nurses have an important role in medicine as they give treatment instructions and screen
patients before they see the doctor. NP can work with or without a collaboration of a
- Physicians supervise physician assistant, this role was introduced to overcome the
shortage of physicians. Their duties are similar to a physician but are taught to know their
limits and seek guidance from physicians. They can take medical histories, conduct
physical examinations, diagnoses, treatment, ordering and interpreting tests, writing
prescriptions and assisting in surgeries.
- Why is patient-provider communication important?
- Judging Quality of Care - Criticisms of provider talk about useless stuff, little
feedback and depersonalized care. People are usually not very knowledgeable about
medicine and hence judge the provider by his manners and how nice he is, even though
the technical quality and manner in which care delivered are unrelated.
- Patient Consumerism - Cause of the increasing emphasis on health, patients are
becoming more involved in their health issues and want to be involved in the decisions
that providers make about their health as compared to earlier times where providers were
given the full authority. Communication is becoming more necessary. Studies show that
patients know more about their condition and if patient’s expertise or opinion integrated
in treatment, they recover better.
- Setting of the medical office is also a constraint between patient provider communication
since the patient has been waiting for long and gets to talk only a bit when the provider
interrupts cuz he has more patients in line and is trying to make more effective use of
time, some the symptoms that patient’s think are important the provider might not and
may overlook the important signs.
- The Canadian health care system which requires you to see a physician first who then
refers the patient to a specialist requires long wait to see a specialist and can be
frustrating, affects them negatively and increases anxiety and stress. Also can lead the
patient to consider alternative means of dealing with their health issues.
- Rising of other health care providers and use of complementary and alternative therapies
decrease the dominance and authorities what physicians once had and responsibility of
physicians now shared with other health care providers is changing physician’s role. - The idea that health is a holistic - claiming that disease is a result of physical,
emotional, spiritual, social and environmental imbalance, lead patient towards other
treatment options like curing illness through behaviors, attitudes and spiritual belief and
techniques like acupuncture massage, psychic diagnosis, dance therapy - are
complementary alternative medicine therapies (CAM) which all require emotional
contact. These changes also alter provider patient relationship also requiring more
emotional contact and communication.
Providers Behaviours That Contribute to Faulty Communication:
- Not listening: The provider interrupts the patients explanation right after18- 22 secs of
patient explaining their problem. This can erode the communication between patient and
provider and may also lead to loss of imp information.
- Use of jargon (terms that are hard to understand): The use of jargon and technical
language is another important factor in poor communication. Patients only understand a
few complex terms that providers use. Sometimes its used to keep the patient from asking
too many questions or to impress people with their knowledge. On the other hand, the
providers use the technical language in their professional life and an inability to figure
out what the patient will understand.
- Baby Talk: The provider may also underestimate what the patient will understand about
an illness and its treatment, may lead them to simplistic explanations and baby talk,
which can make the people feel like a helpless child.
- Nonperson Treatment: This is the depersonalization of a patient and makes the patient
feel that they are not there and ignore them during a treatment, in order to keep the
patient quiet so the provider is able to concentrate eg, during a surgery. It would be
disturbing for a provider to do the job if the patient keeps fussing and asking unnecessary
questions. However, this greatly reduces the patient’s attitude towards the provider, visit
and their condition as well.
- Stereotypes of Patients: Communication can be eroded when the provider encounters a
patient or disease that they would prefer not to treat. For example first nation people are
stereotyped as ‘quite and passive’ or ‘angry’ or even ‘drunk’, which can lead to social
distancing. Patient of the provider with the same race and ethnicity gets more satisfied. --
Negative perceptions have seen by provider in elderly patients and females as well, since
they conduct longer visits, ask more questions and show more nonverbal support.
Physicians also prefer acutely ill patients over chronically ill patients as they have answer
questions and deal with prognosis.
Patient’s Contributions to Faulty Communication
- Patient Characteristics: Patients might not understand important details about the
illness or treatment. Neurotic patients may exaggerate their symptoms and compromise a
physician’s ability to determine the seriousness of a patient’s condition. Also, during
physicals visit patients are anxious which makes it harder to retain all the information.
Can be solved by focusing directly on patient’s concerns.
- Patient Knowledge: Some patients are unable to understand even simple info about their
case. They may also be class based, socio-linguistics that contribute to poor
communication. As people age, their medical problems increase but their ability to
present their complaints and understand treatment guidelines also decreases. Use of internet is decreasing this problem, however internet is not so common with low class or
- Patients Attitudes towards Symptoms: Patients find some symptoms important about
their illness which the provider wont as the provider concentrates n the underlying
severity of the illness where as patient is more concerned about the pain and symptoms
that interfere with their activities.
Patients may misunderstand the provider’s emphasis on certain factors.
Patients don’t give enough info, might be embarrassed about some health history (having
an abortion), and may fear asking questions. Example of a guy who was embarrassed to
go the doctor cause had a lump in his groin, thought it was cancer but when finally went
to a surgeon, it turned out to be hernia but the patient thought the surgeon was hiding the
cancer info from him so the patient doesn’t freak out. However, only after the successful
surgery for hernia did he believe that the surgeon was actually right.
Interactive Aspects of the Communication Problem: Since providers don’t receive
feedback, rarely learn about the results of the communication. Never knows for sure that
once the patient leaves, if they got cured by the treatment given by the provider or went
out somewhere else to seek advice or may have died. Also if the patient does get treated
wont come back or if dissatisfied patients wont complain directly, might just change the
provider. Learning promoted by positive feedback than negative, providers don’t usually
receive a lot of feedback so don’t learn a lot about their communication with patients and
when they do receive feedback, its negative feedback which they are not sure how to
change or what to do instead.
Results of poor patient provider communication - can lead the patient to not use health
care services anymore and switch to CAM therapies to overcome their problems. Patients
who do switch to other CAM therapies is because patients need a more caring
relationship and are not satisfied with the 10 minute doctor session.
- Nonadherence to treatment regimens: When patients don’t adopt the treatment their
providers recommended nonadherence. At least one third of all patients fail to comply
to the antibiotics prescribed to them once they sta