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Perspectives on patient-doctor communication
Abstract
Until recently, the content, structure, and function of communication between doctors and patients has received little attention and has been excluded from the realm of scientific inquiry; as a result, most clinicians have had little formal training in communication skills. In this paper leaders in doctor-patient communication present four approaches that are currently used as the basis for clinical training and research, summarize the progress made in forming a consensus, and outline the implications of these perceptions for practicing physicians.
... Research conducted across other health-care professions also suggests that patients value rapport with their practitioner and that the nature of these professional relationships can directly affect the effectiveness of treatment (Epstein et al., 1993;Koya et al., 2017). Within the field of medicine, professional behaviors characterized as empathetic and compassionate have been associated with improved access to qualitative assessment data, better outcomes, reduced risk of professional litigation, improved patient adherence to medical protocols, and many other benefits (Bonvicini et al., 2009;Epstein et al., 1993;Koya et al., 2017;Leach, 2005;Platt et al. 2001). ...
... Research conducted across other health-care professions also suggests that patients value rapport with their practitioner and that the nature of these professional relationships can directly affect the effectiveness of treatment (Epstein et al., 1993;Koya et al., 2017). Within the field of medicine, professional behaviors characterized as empathetic and compassionate have been associated with improved access to qualitative assessment data, better outcomes, reduced risk of professional litigation, improved patient adherence to medical protocols, and many other benefits (Bonvicini et al., 2009;Epstein et al., 1993;Koya et al., 2017;Leach, 2005;Platt et al. 2001). Compassionate care skills may include nonverbal and verbal behaviors associated with collecting information (e.g., asking open-ended questions, summarizing what has been heard), active listening (e.g., eye contact, nodding, and minimal expressions [e.g., "hmmmm"]), remaining silent while the patient responds, picking up on suggestions (e.g., "Let's see if I have this right," "Sounds like . . ...
... ."; Coulehan et al., 2001;Epstein et al., 1993;Hardee, 2003). When practitioners use compassionate care skills, this may allow for opportunities to listen and gather information related to meaningful parent goals and outcomes (Taylor et al., 2018). ...
The demonstration of compassionate care skills by behavior analysts may be integral to establishing successful parent–professional relationships in the delivery of interventions for autism spectrum disorder (ASD; Taylor et al. Behavior Analysis in Practice, 12, 654–666, 2018). Behavior analytic tools to determine parents’ perceptions of goals, procedures, and outcomes are limited in number and scope (e.g., Kazdin, Journal of Applied Behavior Analysis, 13, 259–273, 1980; Reimers et al., Behavioral Disorders, 18, 67–76, 1992; Witt & Martens, Psychology in the Schools, 20, 510–517, 1983). This study explored the development and testing of an assessment tool to support parent–practitioner collaboration in clinical practice. A comprehensive process was undertaken to develop the Parent Partnership Questionnaire (PPQ). This process involved collecting descriptive data from families, qualitatively analyzing those data, integrating the findings into an assessment tool (PPQ), soliciting feedback on the PPQ, and testing the reliability of the PPQ. Strong intercoder reliability was reported for the PPQ. Further, clinicians were able to administer the tool with good procedural fidelity. This study provides a resource to support clinicians’ work with families and potentially advance the integration of compassionate care into services provided by behavior analysts.
... In order to develop the ME-CO Scale, the literature on communication was explored, focusing on several essential aspects: (a) the definition of effective medical communication [30], (b) the skills and strategies proposed by the patient-centered approach [31], and (c) the literature on communication skills in the medical field [32][33][34][35][36]. However, these aspects were not sufficiently exhaustive, since the self-efficacy construct specificity did not allow the systematic application of the studies' findings to the Italian context. ...
The study presents the validation of a scale measuring physicians’ efficacy beliefs about their ability to manage issues related to communication with patients. Specifically, the tool focused on three fundamental phases of the clinical interview: collecting information, returning information to patients, and creating and maintaining a relationship with them. The research included two studies. Study 1 generated an item pool based on the literature review and developed a self-report questionnaire administered to a pilot sample of 150 physicians (MAge = 49.36; SD = 1.98). The responses were subjected to exploratory analysis. In total, 636 physicians (MAge = 47.99; SD = 8.68) took part in Study 2. Exploratory and confirmatory analyses yielded a final version of the tool consisting of an eight-factor structure with 31 items. Findings provided evidence of the robust psychometric properties of the scale and its usefulness in assessing physicians’ self-efficacy and defining effective interventions aimed at strengthening the doctors’ communication skills. The scale detected different aspects of physicians’ communication self-efficacy (asking questions, active listening, giving information, communicating an inauspicious diagnosis, non-verbal communication, recognition of patient’s clues and suggestions, information checking, and empathy).
... Beaucoup d'entre ces professionnels n'ont pas l'entraînement nécessaire et / ou la préparation spécifique pour faire face à de telles situations (Vallés & García, 2013 ;Vaquero & Centeno, 2013 ;Zalon, 1995). C'est pour cela que l'entraînement de ces professionnels doit comprendre les compétences d'accompagner le patient et sa famille, leur fournir toute information qui est à leur portée, les aider dans la prise de décisions et avant tout, assurer leur bien-être émotionnel et la qualité de vie (Novack, 1987 ;Epstein et al.,1993). ...
... Beaucoup d'entre ces professionnels n'ont pas l'entraînement nécessaire et / ou la préparation spécifique pour faire face à de telles situations (Vallés & García, 2013 ;Vaquero & Centeno, 2013 ;Zalon, 1995). C'est pour cela que l'entraînement de ces professionnels doit comprendre les compétences d'accompagner le patient et sa famille, leur fournir toute information qui est à leur portée, les aider dans la prise de décisions et avant tout, assurer leur bien-être émotionnel et la qualité de vie (Novack, 1987 ;Epstein et al.,1993). ...
... Beaucoup d'entre ces professionnels n'ont pas l'entraînement nécessaire et / ou la préparation spécifique pour faire face à de telles situations (Vallés & García, 2013 ;Vaquero & Centeno, 2013 ;Zalon, 1995). C'est pour cela que l'entraînement de ces professionnels doit comprendre les compétences d'accompagner le patient et sa famille, leur fournir toute information qui est à leur portée, les aider dans la prise de décisions et avant tout, assurer leur bien-être émotionnel et la qualité de vie (Novack, 1987 ;Epstein et al.,1993). ...
The aim of this manual is to offer a guide and training tool for social workers and other helping professions dealing with clients in the dynamic European social, economic, political, cultural, and religious frame in the beginning of the 21st century. After discussions on methods, explained in this book (I.3.), we organized the twenty chapters around four main aspects: a first part with founding elements (I.1. — I.5.), a second part with insights (II.1. — II.3.), a third part with reflections on spirituality and ethics regarding different social levels (III.1. — III.6.), and a fourth part with selected fields of application (IV.1. — IV.6.). With the first chapter (Opatrný, I.1.), readers are placed in the context of the European situation in the new millennium with a growing religious plurality and cultural diversity. These are the result of secularization waves, the adaptations and transformations of Christendom, migration processes, economic changes, and new geopolitical constellations. The second chapter (Gehrig, I.2.) puts in the centre the core reality and reason for existence of the social work profession: the human being. To help other people professionally requires an understanding of the person, the environment, the complexity of life and a reflexive attitude and capacity to comprehend these situations, processes, and persons. The chapter opens the discussion from a Christian humanist perspective with a focus on the concept of person. The third chapter on interdisciplinarity and method (Baumann, I.3.) is like a hinge between the initial contextualization, the following insights and the rest of the book. Its more complex and theoretical orientation based on Lonergan’s model of four levels of conscious intentionality offers a holistic tool for reflection on practice by which social workers can enhance their ability to be more attentive, intelligent, reasonable, and responsible. In continuity with the chapter and its interdisciplinary orientations, Gehrig shows in I.4. how spirituality is a field for encounters between theology and social work. Insights concludes with a theoretical comparative reading on the connection of social work to related concepts of law, ethics, and religion as expressions of norms (Birher, I.5.). Social workers are aware of how normative frames influence the professional practice and situations, clients find themselves in our societies. The second part of the book with its three chapters centres the attention on the core concepts of the topic, the founding elements. This part starts with a short explanation of the fundamental ethical and practical question of commitment to 328 clients in social work in the context of spirituality and ethics (Opatrný, II.1.). The issue of commitment appears as a continuous element in the book and its chapters. For understanding of the concept of spirituality in this manual and for social work, chapter II.2. (Opatrný and Gehrig) delivers the necessary understandings, followed by some basic ideas on social ethics addressed to the profession (Lacca, II.3.). In the third, more extensive part of the book, readers find explanations of spirituality and ethics on different social levels in practical fields, especially the context of organizations. Baumann offers a bridging chapter between parts two and three (III.1.), where the spirituality of the clients, of social workers, and the ethos of the organizations in a secular age are connected towards a spiritually and ethically attentive, intelligent, reasonable and responsible practice. In III.2., Opatrný reflects on the practice of spiritual assessment as a tool and expression of spiritual sensitive practice in the helping professions. Readers can find here some models and practical orientations. The following chapter III.3. (Lacca), enlarges the questions related to assessment by an ethical reflection on the topic. The rest of the third part is dedicated to the organizational field and leadership. Readers will find an example with the case of ecclesial charitable organizations (III.4., Birher), where the author connects with the ideas expressed in I.5. on norms and explains them; in III.5, Blank and Šimr show the cases of a Protestant and a Catholic organization in Germany and the Czech Republic and its support for the topic of spirituality; III.6. (Baumann) finishes part three with reflections on leadership in social work related to spirituality. The fourth part with selected fields of application shows how the topic of spirituality and ethics appears in exemplified groups and fields of reference for social work. IV.1. (Muñoz and Pereñiguez) describes for social workers the dramatic situations of refugees and migrants and the emerging spiritual questions related to it. Both authors then present in IV.2. a dialogue on how spirituality can be a part of female empowerment and an instrument for social change. In chapter IV.3. (Moya Faz and Baumann) we have included the topic of mental health, as spirituality frequently appears in psychological and health care research. Social workers have a strong professional presence in this field, too; actually, mental health is a topic in most of the training programs for social work. Youth work and spirituality in Ireland (IV.4., McManus) expresses an emerging topic and is the result of the enriching encounters and trainings of academics and practitioners in the project. Of course, the 329 challenging European social reality of elderly people is a necessary and urging focus in the topic of social work and spirituality and an ethical practice. Suchomelová and Moya Faz summarize the important aspects in chapter IV.5. The applications part finishes with a short reflection on the community development (Opatrný), as social work is not only case work or organizational practice, and people always belong to communities, groups of reference and relational local social realities which have to be integrated in the spiritually sensitive social work.
The healthcare industry of Thailand faces growing demands to meet evolving patient needs driven by an aging population, chronic disease, and higher consumer expectations. Improving patient experience is crucial for encouraging regular health checkups and enhancing health outcomes by addressing barriers that hinder patient engagement. This explored how service design may improve outpatient experience in a health checkup centre. The aim was to investigate the current customer journey and service blueprint in health examination services to identify pain points and expectations for service quality. Qualitative research was done to analyse existing service blueprint and customer journey at the health checkup centre, with the data obtained by semi-structured interviews, observation and shadowing patients throughout the services. Results were that pain points experienced by patients in health checkup services included long waits, lack of information during service, and service complications. The insights obtained from the investigation can serve as a basis for developing a design framework and optimal service blueprint, aimed at improving patient experiences in the future. Service design is a promising approach for hospitals to systematically and strategically improve service and enhance the overall patient experience.
AI applications are becoming more and more prevalent each day. ChatGPT is a recent AI tool that has amazed many people with its capabilities. It is expected that large language model solutions like ChatGPT will provide unique solutions and transform many industries. In many medical educational institutions, it is desired that medical students experience simulated patient encounters before meeting with real patients. These simulations can be designed to closely mimic the experience of a real-life patient encounter, allowing students to practice communication and history-taking skills in a realistic setting. Designing dialogues for these simulations is an important and time-consuming challenge. In this study, we evaluate if ChatGPT, an AI tool based on GPT-3, can generate adequate patient-doctor dialogues that can be utilized for medical student training. We analyze patient-doctor dialogues generated by ChatGPT for ten common ENT diseases and discuss the pros and cons of these dialogues. We believe the patient-doctor dialogues provided by ChatGPT can be a good starting point for teaching medical students how to communicate with patients.
Relationship-centered communication (RCC) is an effective approach to patient-provider communication. This article describes RCC components known as the essential elements of communication. The article also describes current standard conceptual models for applying RCC to the patient encounter, including a structure for relationship building. The authors also explore the challenges to using RCC.
Psychologie je základní věda a předmětem jejího studia je lidské chování a chování na motorické úrovni (co je člověk schopen udělat), na emocionální úrovni (co člověk cítí) a na kognitivní úrovni (co si člověk myslí), kromě dalších složitých lidských atributů a konstruktů, jako je vědomí, zkušenost, osobnost, inteligence nebo mysl. Úkolem psychologie je také porozumět nebo vysvětlit, čem je mentální aktivita podobná a v čem se mezi jednotlivci liší, vytvářet individuální rozdíly na základě jejich věku, pohlaví nebo jiných biologických nebo sociálních podmínek (Fernández-Ballesteros, 2002), které ovlivňují zejména vztahy k sobě samému, k ostatním a světu. V sociální práci je pak duševní stav klientů (a také v jiné perspektivě sociálního pracovníka) součástí předmětu sociální práce: prevence a zvládání sociálních problémů a podpora sociálního rozvoje.
Ze všeho, co bylo dosud řečeno, vyplývá, že psychologie si nejprve klade za cíl popsat mentální aktivity rozmanitými prostředky vnímání a empirického výzkumu, které se pak snaží vysvětlit nebo jim porozumět systematickou reflexí (srov. Kap. 1.2: Metoda); na praktické úrovni se psychologie také snaží zlepšit mentální fungování na základě získaných znalostí. Empiricky popsané rozdíly ukazují širokou škálu odrůd se statistickou pravděpodobností; v tomto smyslu lze otázku psychopatologie posuzovat také z hlediska statistických odchylek od toho, co je považováno za „normální“ rozsah fungování. Americká psychiatrická asociace (2013) proto nazvala svůj oficiální a normativní souhrn psychiatrických poruch „Diagnostický a statistický manuál duševních poruch“. V současné době je v platnosti 5. vydání („DSM – 5TM“) které je výrazem nepřetržitého procesu výzkumu a vědeckých znalostí o duševních poruchách. Jinými slovy, funkce, které jsou předmětem psychologie, jsou náchylné k patologii nebo onemocnění, a jsou tedy předmětem studia psychopatologie na fenomenologické úrovni, stejně jako psychiatrie na lékařské a terapeutické úrovni.
Mluvit o psychické nebo mentální dimenzi osoby znamená vzít v úvahu neurologické, afektivní, kognitivní výkonné nebo metakognitivní aspekty (které zahrnují typ nebo kvalitu sociálních vztahů nebo sociálního fungování). Pokud jde o afektivní aspekty, tak jsou tvořeny stavem mysli, impulzy a emocemi, které mohou vést ke složitějším konstruktům, jako je sebeúcta nebo empatie. Zohledňují se také kognitivní aspekty, od těch nejzákladnějších, jako je pozornost, vjemy a paměť, až po ty nejpropracovanější a nejkvalitnější, jako je jazyk, které umožňují správu informací a vedou ke komplexnějším propracováním, jako je sebepojetí nebo atriburty; výkonný a metapsychologický. Při plánování nebo výběru strategií nebo regulaci aktů je třeba vzít v úvahu výkonné aspekty, které by podmínily sebeovládání nebo interakci. Na metakognitivní úrovni existují aspekty, které zcela přesahují ty předchozí a jsou umístěny v duchovní sféře, jako je myšlení nebo schopnost milovat. Přemýšlení a milování implicitně přináší svobodu, jsou charakteristickými rysy, které odlišují člověka od jiných zvířat, která mají také psychické funkce.
Na této úrovni působí spiritualita ve vztahu ke kvalitě života a jako ochránce fyzického a duševního zdraví, jako psychosociální zdroj emoční pohody a podporuje aspekty jako je odolnost, pozitivní zvládání nebo sociální podpora, nabízení pokynů, průvodců nebo strategií, jak čelit utrpení duševních chorob bez změny vědomí (González – Celis & Gómez-Benito, 2013). Dalo by se říci, že je to jedinečný, specifický a osobní transcendentní zážitek. Lze jej ztotožnit s osobním hledáním a smyslem života (srov. Frankl, 1945). Proto je spojena s procesy jako je zvládání nebo odolnost v kontextu stresových nebo problémových situací, a její význam je potvrzen u duševních onemocnění, jako jsou deprese, sebevražda, úzkost, psychóza a zneužívání návykových látek (Koeing, 2009; Ronneberg et al., 2016) a také u fyzických nemocí (Cohen & Koeing, 2003; Rivera – Hemandéz, 2016).
Spiritualita – podobně jako náboženství obecně – může být také ovlivněna duševními poruchami, a může také negativně přispět k symptomům a průběhu nemoci (Griffith, 2010). Tato skutečnost byla jedním z faktorů a výzev – kromě těch ideologických – jak v klinické praxi, tak ve vývoji psychoterapie, např. v kontextu obsedantně kompulzivních poruch (Baumann, 2007), které marginalizovaly studium a uznávání náboženských a duchovních potřeb, postupů a zdrojů pacientů v oblasti duševního zdraví (Baumann, 2012). Témata, která v této kapitole rozvineme, jsou: Problém duše – tělo nebo mysl - mozek. Duch a svoboda; zdraví a nemoc vs. normalita a patologie (Podmínky duševního zdraví a projekt Duševní zdraví a životní); duševní zdraví (vina, bolest a deprese; úzkost a strach; smysl života, existenciální prázdnota a beznaděj a exkurz: sebevražda, lidský a záhadní čin/skutečnost); právní problémy, které mohou nastat v průběhu onemocnění; spiritualita a práce s lidmi s duševními problémy; potřeba specializovaného školení a vzdělávání.
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