-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 thing 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.
-This chapter will talk about the following issues. 1) Why patient provider
communication is important. 2) The nature of the patient-provider
communication and the factors that erode it. 3) Consequences of poor
communication, including noncompliance with treatment and use of alternative
health care. Finally, the efforts to improve patient provider communication.
- Refer to physician as provider because Canadians receive their primary care
from individuals other than physicians too like nurse practitioner etc.
- Nurses as providers are advanced practiced nurses who have gone beyond
the four years of nursing education, Nurse practitioner is a RN who has
additional info in health assessments, diagnoses, and management of injuries
and illness, who can send orders and prescribe drugs. Also 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 physician.
- Physicians supervise physician assistant, this role was introduced to
overcome the shortage of physicians. Their duties are similar to a physicainc
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?
Criticisms of provider talk about volumes of jargon, 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.
-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. Also, since lifestyle like smoking etc is a major
cause of health disorders, patient’s imitative is necessary to overcome the
problem and hence 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
- The Canadian health care system which requires 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 physicians role.
- The idea that health is a holistic, is a positive state to be actively achieved and
not merely the absence of disease 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:
1) Not listening 2) Use of jargon 3) Baby talk 4) Non person Treatment 5)
Strereotypes of Patients.
- . Not listening: The provider interrupts the patients explanation right after18
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: 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
- 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 quite 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 the provider
encounter 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 hey
have answer questions and deal with prognosis.
- Patient’s Contributions to Faulty Communication:
1)Patient Characteristics 2) Patient’s Knowledge 3) Patient Attitudes toward
- 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 conditions. 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 increases. Use of internet is decreasing this
problem, however internet is not so common with low class or older people.
- Patients Attitudes towards Symptoms:Patients find some symptoms
important about their illness which the proiver 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 factors that they
consider to be incidental and pay little attention when vital info is being told
and might believe that the provider made an incorrect diagnosis. 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
- Results of poor patient provider communication can lead the patient to not
use health care services anymore and switch to CAM therapies