This document discusses the importance of patient-centered communication in managing lifestyle diseases. It notes that lifestyle diseases like diabetes and heart disease have increased due to changes in living patterns and are difficult to treat as they require changes to lifestyle and mindset. Effective communication between doctors and patients is important for compliance, improved health outcomes, and reducing malpractice. Barriers to communication include patients not providing full medical histories and doctors interrupting patients. The ideal relationship is one of mutuality where doctors and patients collaborate as equal partners.

1. Importance of Patient-Centered
Communication in Lifestyle Diseases
Dr Ritu Awasthi-Shukla

2. Disease Transition
Communicable Non Communicable
Diseases Diseases (Lifestyle
Diseases)

3. Communicable Diseases
 Tuberculosis, Malaria, Cholera, Influenza,
Measles, Polio etc
 Transmitted from one person to another
through a causative agent directly or
indirectly
 Prevalent among lower stratum of the
society
 Line of treatment and management is
simple and easy to follow
 Acute diseases

4. Non Communicable Diseases
 Lifestyle Diseases
 Changes to the way people live have
created new environmental and
behavioral risk factors, leading to a rise
in lifestyle diseases
 start slowly and often asymptomatically
but last longer
 Type 2 diabetes, Cardiovascular
Diseases, Hypertension, Stroke
 Management of lifestyle disease requires
change in living pattern, attitude and
mindset

5.  Improved quality of living and
awareness are the only prerequisite of
overcoming these diseases
 “The diabetic who knows the most, lives the
longest”- Elliott P. Joslin, 1929

6. What Doctors say about patient…..
 People are not ready to listen and
change so it‟s difficult to bring about
positive changes
 Patient hide useful information on the
first visit
 It is easier to change the mindset of
the people when somebody has
suffered in the family.

7. What Patients want from Doctors
 Make the patient aware that majority of the
diseases are preventable and this prevention
costs only a minimum of expenditure, if
compared to the cost incurred on the
treatment.
 Awareness of right treatment options for the
patient.
 In addition to prescribing medicines to the
patients, Doctors should also give some time
to educate the patients and attendants about
the causes of various diseases and what
measures should be taken to prevent the
common ailments which can be serious at
times if neglected

8.  A study published in JAMA found that
72% of the doctors interrupted the
patient‟s opening statement after an
average of 23 seconds
 Patients who were allowed to state
their concerns without interruption
spoke for only an average of 6 more
seconds

9. Patients are at fault too…..
 Patients described as “frustrating” by
doctors do not trust or agree with the
doctor
 present too many problems for one
visit
 do not follow instructions
 are demanding or controlling

10. Traditional Model
 Linear/ Unidirectional
Communication
 Biomedical approach
to addressing medical
problems
 ”Prescription followed”
 ”weight loss”
 “Healthy Diet”
 Symptomatic
Treatment
 “Patient as diseases/
organ”

11. Why is it important?
 Compliance with the medical
treatment
 Improves Patient‟s satisfaction
 Improved health and emotional status
of the patient
 Improves Doctor‟s satisfaction
 Reduces Malpractices
 (Stewart and Roter)

12. Barriers to effective
communication
 There may be many barriers to effective
physician-patient communication.
 Patients may feel that they are wasting the
physician's valuable time;
 omit details of their history which they deem
unimportant;
 be embarrassed to mention things they think
will place them in an unfavorable light;
 not understand medical terminology;
 believe the physician has not really listened
and, therefore, does not have the information
needed to make good treatment decisions

13. Culture and D-P Communication
 How illness is discussed and treated
in a culture
 Myths and misconceptions already
prevalent in the society
 Poor Language skills

14. Types of doctor–patient
relationship*
Patient Control Doctor’s Control
Low High
Low Default Paternalism
High Consumerist Mutuality
*Stewert and Roter

15. Default relationship
 Patients adopt a passive role even
when the doctor reduces some of his
or her control, with the consultation
therefore lacking sufficient direction

16. Paternalistic Relationship
 Doctor is dominant and acts as a
„parent‟ figure who decides what he or
she believes to be in the patient‟s best
interest
 Patient Submissive

17. Consumerist Relationship
 the patient taking the active role and
the doctor adopting a fairly passive
role,
 acceding to the patient‟s requests for
a second opinion, referral to hospital,
a sick note, and so on

18. Relationship of mutuality
 active involvement of patients as equal
partners in the consultation
 meeting between experts‟, in which both
parties participate and engage in an
exchange of ideas and sharing of belief
system
 The doctor brings his or her clinical skills and
knowledge
 Patients bring their expertise in terms of their
experiences and explanations of their illness,
and knowledge of their particular social
circumstances, attitudes to risk, values and
preferences

19. Changing Role of Doctor
 Patient-Centered
Communication
 Biopsychosocial
approach
 Facilitator/ Listener
 Behavior Change Expert
 Negotiating small
changes
 “Patient as person”

20. Collective Role of Doctor and
Patient
 Shared decision making
 Patient preferences should be sought
out and validated
 Doctor and Patient engage in a
reciprocal relationship

22. “While the doctor focuses on illness,
the patient may be more interested
in wellness.” Athena du Pre

23. Thank you