Lecture I gave at Mustafa Kemal University in Turkey, Antakya. Main topic is about doctor patient communication, which could help to increase health outcomes. Important subject about patient-centered communication and approach.

1. Doctor Patient Communication
Dainius Jakučionis
Vilnius university, Medicine faculty
Family doctor, Cognitive and
behavioural psychotherapist, Teacher

2. Disclaimer

3. Why do You want to be a doctor?
•Family
•Money (₺)
•Wanting to help
•Significance
? @

4. What is the
aim/goal of
doctor‘s job ?
? @

5. “We come unbidden into this life, and if
we are lucky we find a purpose beyond
starvation, misery, and early death which,
lest we forget, is the common lot. I grew
up and I found my purpose and it was to
become a physician. My intent wasn't to
save the world as much as to heal myself.
Few doctors will admit this, certainly not
young ones, but subconsciously, in
entering the profession, we must believe
that ministering to others will heal our
woundedness. And it can. but it can also
deepen the wound.”
― Abraham Verghese, Cutting for Stone

6. „A physician is a
professional who
practices medicine,
which is concerned
with promoting,
maintaining or
restoring human
health through the
study, diagnosis, and
treatment of disease,
injury, and other
physical and mental
impairments.“
―Wikipedia.org

7. „I believe a man for a man
should be a man first
and only then can he be a
doctor“
― Ernestukas Blb, Facebook friend

8. Expectations
? @

9. The main determinants of health
(Dahlgren and Whitehead, 1991)

10. Communication
Sender Receiver
Noise

11. Patients remember
12,8%
After visit After month
17,1-
60%
Mcguire, L. C., Morian, A., Codding, R. and Smyer, M. A. Older adults' memory for medical information:
Influence of elders peak and note taking. International Journal of Rehabilitation and Health, 2000. 5 (2), pp. 117--128.

12. Patients sue
doctors…
Why…?
? @

14. 1Jeffrey Allen and Alice Burkin by Berkeley Rice: “How Plaintiffs’ Lawyers Pick Their Targets,” Medical Economics (April 24,
2000);
2Wendy Levinson et al., “Physician-Patient Communication: The Relationship with Malpractice Claims Among Primary
Care Physicians and Surgeons,” Journal of the American Medical Association 277, no. 7 (1997): 553-559
• “People just don’t sue doctors they like”1
• The surgeons who had never been sued spent
more than three minutes longer with each patient
than those who had been sued did (18.3 minutes
versus 15 minutes)2
• They were more likely to make “orienting”
comments, such as “First I’ll examine you, and
then we will talk the problem over” or “I will leave
time for your questions” or “Go on, tell me more
about that”2

15. Patient-centered approach

16. MK Czerwiec, http://www.comicnurse.com/

17. MK Czerwiec, http://www.comicnurse.com/

18. MK Czerwiec, http://www.comicnurse.com/

19. MK Czerwiec, http://www.comicnurse.com/

20. 1.exploring the experience and expectations
of disease and illness;
2.understanding the whole person;
3.finding common ground regarding
management (partnership);
4.health promotion;
5.enhancing the doctor-patient relationship;
6.the realistic use of time;
Brown J, Stewart M, Tessier S. Assessing communication between patients and doctors: a manual for scoring patient-
centred communication. London: Thames Valley Family Practice Research Unit; 1995. (Working Paper Series 95-2).

21. • communication,
• partnership,
• health promotion,
Most patients
strongly want a
patient centered
approach.
Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, et al.
Preferences of patients for patient centred approach to consultation in
primary care: observational study. BMJ. 2001;322:468–472.

22. Facilitating behaviour
(Zandbelt et al, 2006)
• Drop a functional/attentive silence
• Non-verbal encouragement to
continue talking
• Verbal encouragement to continue
talking (echoing included)
• Summarize what the patient has said
• Put an open question or an open
request to the patient

23. • Put a closed question to the patient
• Educated guess
• Factual reflection (paraphrase
included)
• Emotional reflection
• Process reflection
• Respectful statements/praise

25. Drop a functional/attentive
silence
you give the patient space to
continue his story;
you do not say a word, but
keep on listening attentively;
This does not include: silence during, for example, writing,
looking at the computer screen, physical examination.

26. you encourage the patient to
continue his story;
non-verbal encouragement,
for example gesture, nodding
or facial expression;
Nonverbal encouragement
to continue talking

27. Verbal encouragement to
continue talking
you verbally (explicitly or indirectly)
encourage the patient to continue
his story;

28. • Explicit encouragement (‘Go on’,
Tell? ‘Yes?’);
• Neutral expressions/to give a sign
of attention (‘Uh-huh’, Mmm’)
• ‘Interjections’: brief conclusion,
brief echo, ‘finish sentence’,
unfinished sentence (‘So you want
eh….’, ‘So you…’): not really
facilitating interventions, but a sign of
attentive listening;
Continued…

29. Summarize what the
patient has said
To summarize the information that has
previously been discussed in the
conversation, particularly what the
patient has said;
Criterion: to repeat >2 facts or 2
facts with explicit reference to a
summary;

30. Put an open question or an
open request
• ‘How did it start?’; ‘How do
you feel about this?’; ‘How are
your ankles?’ ‘And how is your
blood pressure?’
• ‘What are you afraid of?’
• ‘What aggravates the
complaints?’

31. Closed question
for certain information;
can be answered with a ‘yes’ or a
‘no’;
‘Is the pain on the left or the
right side?’; ‘Where do you
feel the pain?’;

32. Educated guess
you sum up patient thoughts
(which are based by virtue of
knowledge and experience);
’You will probably be
nervous.’ ‘You will probably
be tired?’

33. Factual reflection
you repeat/reflect the essence of
the actual information that the
patient has given;
‘If I understand it rightly
your bowels in particular are
troubling you.’ ‘You would
like to be a bit fitter’

34. Emotional reflection
–‘I notice that you are upset’
– ‘I see that it startles you’
– ‘I can imagine that it takes you by surprise’
– ‘A difficult time…’.
– ‘It is quite a lot to take in and all at the
same time’
– ‘This must drive you mad’
– ‘No, that is annoying too…’

35. Process reflection
you denominate or label an observed
process in the conversation;
‘I think we are talking at cross-
purposes’; ‘I think you become
more and more quiet when we
talk about it in this way’;

36. Respectful statements or
Praise
• ‘I am impressed by the way you
manage to keep on working.’
• (as the patient takes out of
his/her bag a little booklet with
blood sugar levels): ‘Good, you
took everything with you.’

38. Empathy
? @

40. Everything
mentioned
earlier works
only when
used with
empathy!!!

41. Link: https://www.youtube.com/watch?v=1Evwgu369Jw

42. Additional
tip

43. How react to criticism?
Empathy
Agree with
critique
Feedback and
Negotiation
Ask
questions
Try to
understand
‘I agree with...’, ‘It is possible that...’,
‘It makes sense...’
Express your feelings and
opinions diplomatically. Show
understanding. Apologize, if it’s
your fault. Encourage.
D.Burns “Feeling good”, 1980;
Jan Praško lecture, 2014;
Listen

45. Summary
Good communication helps patients
and doctors
Empathic communication skills
improve outcomes
You can learn and practice it

46. Questions?

47. Çok teşekkür
ederim