Communication Breakdowns – Uninformative Doctors Or Ignorant Patients?

Yıl 2018, Cilt: 8 Sayı: 2, 100 - 109, 31.08.2018

Can Cemal Cingi Sıdıka Deniz Yalım

https://doi.org/10.32448/entupdates.459019

Öz

Objective:

Communication issues within clinical encounters are increasing within Turkey. To raise awareness of the problem and identify solutions, it was decided to undertake the current research.

Methods:

Separate questionnaires, one for doctors, the other for patients, were prepared and distributed between May and July 2018 to 100 doctors plus 100 adult patients at either Adana Numune Hospital or Eskisehir Osmangazi University Hospital.

Results:

Patients’ views: 60% responded that doctors give insufficient information in terms of quality and quantity. 80% stated that the doctor failed to convey a clear message. 40% described doctors as lacking enthusiasm in explaining the issue and curtailing the conversation. 40% felt that the inadequate length of the consultation contributed to a sense that the patient was undervalued by the doctor. 40% felt consultation times needed to be lengthened. 20% stated that the doctors listened inadequately. 30% felt that communication would be improved by better use of Turkish equivalents for latinate medical terms. 10% felt that the key element in communication was for doctors first to value patients.Doctors’ views: 100% felt they had the ability to explain, but that time constraints and patients’ inability to understand key elements hinder communication. 95% felt the issue rested with patients and their inability to comprehend. 60% considered the patients insufficiently educated or lacking adequate intellectual resources to understand. 90% proposed lengthening consultation times to improve communication.

Conclusion:

Blaming either party is not the solution. Short consultation times are the root cause of miscommunication and need to increase if communication is to improve. Improvements in patients’ education may in the future lead to more fruitful clinical encounters. Clinicians must develop an effective communication style to create healthier relationships with their patients.

Anahtar Kelimeler

Doctor patient relations, communication, healthcare, questionnaires

Kaynakça

• 1. Ha JF, Longnecker N. Doctor-patient communication: areview. Ochsner J 2010;10:38-43.
• 2. Kee JWY, Khoo HS, Limb I, Koh MYH. Communication Skills in Patient-Doctor Interactions: Learning from Patient Complaints. Health Professions Education 2018;4:97-106.
• 3. Henry SG, Holmboe ES, Frankel RM. Evidence-based competencies for improving communication skills in graduate medical education: a review with suggestions for implementation. Med Teach 2013;35:395-403.
• 4. Dorr Goold S, Lipkin M. The doctor-patient relationship: challenges, opportunities, and strategies. J Gen Intern Med 1999;14:26-33.
• 5. Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care 2009;47:826–34.
• 6. Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM. Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet 1996;347:724-8.
• 7. Little P, Everitt H, Williamson I, et al. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ 2001;323:908-11.
• 8. Bertakis KD, Azari R. Patient-centered care is associated with decreased health care utilization. J Am Board Fam Med 2011;24:229- 39.
• 9. Travaline JM, Ruchinskas R, D’Alonzo GE Jr. Patient-Physician Communication: Why and How. J Am Osteopath Assoc 2005;105:13- 8.
• 10. Matthews DA, Suchman AL, Branch WT Jr. Making “connexions”: enhancing the therapeutic potential of patient-clinician relationships. Ann Intern Med 1993;118:973-7.
• 11. Suchman AL, Matthews DA. What makes the patient-doctor relationship therapeutic? Exploring the connexional dimension of medical care. Ann Intern Med 1988;108:125-30.
• 12. Committee on Quality of Health Care in America. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: National Academy Press; 2001.
• 13. Vande Kieft GK. Breaking bad news. Am Fam Physician 2001;64:1975-8.
• 14. Şener M. Doktor Ne Söyler? Hasta Ne Anlar? http://www.drmustafasener.com/doktor-ne-soyler-hasta-ne-anlar (Accessed online at July 14, 2018).
• 15. Yağbasan M, Çakar F. Doktor hasta iletişiminde dile ve davranışa dayalı iletişimsel sorunları belirlemeye yönelik bir alan çalışması. Selcuk Üniversitesi Sosyal Bilimler Dergisi 2006;16:609-29.
• 16. Özkan Z. Doktor hasta iletişiminde beden dilinin gücü. Zeynep Kamil Tıp Bülteni 2008;39:87-91.
• 17. Karsavuran S, Kaya S, Akturan S. Hasta-hekim iletişiminde güven. Bir genel cerrahi polikliniği örneği. Hacettepe Sağlık Idaresi Dergisi 2011;14:185-212.
• 18. Öngören B. Hekim hasta ilişkisi ve sağlık hizmetlerinde iletişim. https://www.resear chgate.net/publication/322316807
• 19. Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ 1995;15:1423-33.
• 20. Bull SA, Hu XH, Hunkeler EM, et al. Discontinuation of use and switching of antidepressants: influence of patient-physician communication. JAMA 2002;288:1403-9.
• 21. Ciechanowski PS, Katon WJ, Russo JE, Walker EA. The patient-provider relationship: attachment theory and adherence to treatment in diabetes. Am J Psychiatry 2001;158:29-35.
• 22. Bogardus ST Jr, Holmboe E, Jekel JF. Perils, pitfalls, and possibilities in talking about medical risk. JAMA1999;281:1037-41.
• 23. Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med 2004;79:186- 94.
• 24. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997;277:553-9.
• 25. Ha JF, Longnecker N. Doctor-Patient Communication: A Review. The Ochsner Journal 2010;10:38-43.
• 26. Fentiman IS. Communication with older breast cancer patients. Breast J 2007;13:406-9.
• 27. Dimatteo MR. The role of the physician in the emerging health care environment. West J Med 1998;168:328-33.
• 28. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist 2000;5:302-11.
• 29. The AM, Hak T, Koe¨ ter G, van Der Wal G. Collusion in doctor patient communication about imminent death: an ethnographic study. BMJ 2000;321:1376-81.
• 30. Maguire P, Pitceathly C. Key communication skills and how to acquire them. BMJ 2002;325:697-700.
• 31. Lee RG, Garvin T. Moving from information transfer to information exchange in health and health care. Soc Sci Med 2003;56:449-64.
• 32. Kalet A, Pugnaire MP, Cole-Kelly K, et al. Teaching communication in clinical clerkships: models from the macy initiative in health communications. Acad Med 2004;79:511-20.
• 33. Duffy FD, Gordon GH, Whelan G, et al. Assessing competence in communication and interpersonal skills: the Kalamazoo II report. Acad Med 2004;79:495-507.
• 34. Makoul G. MSJAMA. Communication skills education in medical school and beyond. JAMA 2003;289:93.
• 35. Accreditation Council for Graduate Medical Education. Toolbox for the evaluation of competence. Available at http://www.acgme.org. Accessed 7 July 2004.
• 36. Arora N. Interacting with cancer patients: the significance of physicians’ communication behavior. Soc Sci Med 2003;57:791-806.
• 37. Roter DL. Physician/patient communication: transmission of information and patient effects. Md. State Med J 1983;32:260-5.
• 38. Brédart A, Bouleuc C, Dolbeault S. Doctor-patient communication and satisfaction with care in oncology. Curr Opin Oncol 2005;17:351-4.
• 39. Lee SJ, Back AL, Block SD, Stewart SK. Enhancing physician patient communication. Hematology Am Soc Hematol Educ Program 2002;1:464-83.
• 40. Platt FW, Keating KN. Differences in physician and patient perceptions of uncomplicated UTI symptom severity: understanding the communication gap. Int J Clin Prac 2007;61:303-8.
• 41. Hall JA, Roter DL, Rand CS. Communication of affect between patient and physician. J Health Soc Behav 1981;22:18-30.
• 42. Drossman DA. Guidelines for Improving Communication Skills and the Patient-Doctor Relationship. https://www.med.unc.edu/gi/faculty-staffwebsite/teaching /conferences/ archives / fgid-conference-archives/guidelines-for-improving-communication-skills-and-the-patient-doctor-relationship (Accessed online at July 4, 2018).
• 43. Miller SM. The interacting effects of coping styles and situational variables in gynecologic settings: Implications for research and treatment. J Psychosom Obstet Gynaecol 1988;9:23-34.
• 44. Wenrich MD, Curtis JR, Shannon SE, Carline JD, Ambrozy DM, Ramsey PG. Communicating with dying patients within the spectrum of medical care from terminal diagnosis to death. Arch Intern Med. 2001;161:868-74.
• 45. Singer HK, Ruchinskas RA, Riley KC, Broshek DK, Barth JT. The psychological impact of end-stage lung disease. Chest. 2001;120:1246-52.
• 46. Suchman AL, Markakis K, Beckman HB, Frankel R. A model of empathic communication in the medical interview. JAMA 1997;277:678-82.
• 47. Roter DL, Hall JA. Doctors talking with patients/Patients talking with doctors: Improving communication in medical visits. 1 ed. Westport, CT: Greenwood Publishing Group; 1992.