Integrated Medical Education Resources: 130904P - DOCTOR PATIENT COMMUNICATION: REVIEW OF THE LITERATURE

Presentation for year 3 medical students Faculty of Medicine King Fahad Medical City Riyadh on September 4, 2013 by Professor Omar Hasan Kasule Sr.

IMPORTANCE OF COMMUNICATION

· Communication is fundamental to good medicine, the way doctors communicate can have long term outcome benefits[1];

· Effective doctor communication reduces pre-operative anxiety and increases the patient’s satisfaction[2].

· Good doctor patient communication increased elderly patient use of free drug samples[3].

PROBLEMS WITH COMMUNICATION: EXAMPLES

· Experience shows that doctor patient communication is not as effective as it should be.

· An Indonesian study revealed several problems in doctor-patient communication: the doctor patient relation was not participatory and doctors tended to be paternalistic[4].

· Analysis of a videotape of an ophthalmology consultation revealed several negative communication modes: the interview was physician centered with physicians speaking 70% of the words, asking closed-ended questions that restricted the patient's contribution to "yes/no" or brief responses, and failing to identify patients who had missed doses of medication[5].

· Research showed a communication gap between patients and gastroenterologists regarding the severity of symptoms and the nature of the functional diagnosis[6].

· Communication between doctors and stroke victims was poor with negative consequences on disease management[7].

· A need for more training in communication was expressed for radiologists[8].

· Doctors and their patients have different perceptions of communication skills of doctors during interviews[9].

FACTORS OF COMMUNICATION

· Gender, socio-economic status, and intellectual ability affect communication effectiveness.

· A literature review suggested that gender dyads affected interview length and content for example a female/female dyad has longer interview time. Doctor patient discussion of side effects of drug was affected by racial and income differences[10].

· People with intellectual disabilities require special approaches to ensure effective communication for example physical examination has to be demonstrated before it is discussed[11].

INFORMATION TECHNOLOGY

· Modern information and communication technology has been introduced in doctor patient communication with variable outcomes. Electronic medical records have both negative and positive effects on doctor patient communication: better information integration and processing but with impaired patient-centeredness[12].

· Use of computers in doctor-patient interaction reduces eye contact, verbal and non-verbal contact[13].

· Social media mediate and improve communication between patients and doctors[14].

· Patients who looked up cancer related information on the internet had more effective communication with their doctors[15].

· Health assessment questionnaires improve doctor patient communication[16].

ASSESSMENT OF COMMUNICATION

· A patient self- assessment tool can be used to assess doctor patient communication[17].

· A 2-way communication check list improved doctor-patient communication[18].

· Quantifying word use by patients and doctors can help in research to improve communication[19].

NARRATIVE MEDICINE

· Narrative medicine is an expansion and improvement on the normal communication being a patient-centered holistic approach to talking to and listening to the patient[20].

· Three factors were identified to improve communication: two-way communication, biopsychosocial content and nonverbal communication[21].

REFERENCES