Communication in the Physician-Patient Relationship - Essay Example

Physicians and patients communicate during the of their relationship. This is most important to allow patient’s progress. The role of communication in the physician-patient relationship is studied in this paper. Communication theories and practice are also observed in this paper and are compared, with the physician-patient relationship as the basis of discussion. Communication skills that are necessary to the said relationship were also specified. Communication in theory Communication is a process wherein a person conveys or receives information about topics such as needs, perceptions, etc. through the use of a certain medium. Communication may be done in a conscious or in a subconscious level and either intentionally or unintentionally. This process requires a vast range of skills such as speaking, observing, questioning, analyzing, and evaluating (Barnlund, 1968). Several models have been made regarding communication. One of these models is the Shannon and Weaver’s model or the Transmission Model of Communication. The following flowchart shows the basic premise of the model and its flow of communication. The information source produces the message and is then encoded into signals for message transmission. The channel is the media through which the message is sent. Through the process of message sending, some noise is present causing the message to be seen differently by the receiver. The receiver decodes the message sent and once it is decoded, it is deemed as having arrived to its final destination (Shannon & Weaver, 1949). Another model for communication is the Berlo’s Model of Communication or the S-M-C-R Model. The following diagram shows the basic flow of communication as explained by this model: In this model, the source or the one who delivers the message encodes the message via a channel which the receiver decodes. This model simply shows that the source communicates about the topic he/she is knowledgeable and his/her message is formed with a specific content, elements, treatment, structure and code. All these are delivered via a channel, which is comprised of the receiver’s sense and are decoded by the receiver (Berlo, 1960). All models of communication try to explain the basic flow and process of communication. In all models of communication, it shows that communicating is a two way process wherein both the sender and the receiver takes part. Communication in practice: Patient-Physician Relationship A physician’s communication skills play a great role in a patient-physician relationship. In fact, good communication has always been important in medical practice and is the keystone for patient-physician relationships. Communication is the main means for physicians to interact with their patients. Certain traits of communication allow trust between patient and physician to develop as well as to promote healing in the side of the patient. Good communication between patients and physicians has shown to have an impact on both doctor and patient. On the side of the patient, it fosters better patient behavior and satisfaction and better health outcomes. As for the side of the physician, good communication allows them to better understand and help the patient, enhances their image and allows a good atmosphere for medical practice (D’Ambrosia, 1999). Communication Skills for Physicians Good communication skills allow the physician to do a good job in some specific tasks in their profession. These tasks are of great importance to the physician, which include the following: 1. Explaining diagnosis and treatment. 2. Communicating with the relatives of the patient 3. Engaging the patient in the course of treatment and in decision-making 4. Consulting with other medical practitioners to obtain their opinion for the furthering of the progress of the patient 5. Giving advise on lifestyle and health issues 6. Obtaining informed consent for procedures and surgeries necessary for the patient 7. Dealing with patients and relatives are anxious and apprehensive about the current situation The most important role of communication for patient-physician relationships is to help the physician understand the patient during the whole treatment process of the patient. The physician must bridge the gap between himself/herself and the patient so that the patient may progress. This entails that the physician should develop certain communication skills. Without these skills, the relationship between the physician and the patient may become unsteady. Some of the skills are the following: 1. Good listening Listening is different from hearing. Listening would mean that the messages being sent to the physician is properly decoded. It means that the focus and the attention of the physician is solely on the patient and nothing or nobody else. However, listening is simply not by the use of the ears. The physician must also be able to decode the hidden messages being sent by the patient through body language and other forms of unintentional and subconscious communication. 2. Ability to show empathy, respect and proper emotions The physician must be able to have a certain bond with the patient. The patient should be able to show to the patient that there is concern and care for him/her and his current situation. The physician should be able to make the patient understand that he/she is a person as well and understands, or at the very least care about what the patient is going through. But this also means that the doctor should be able to put the so-called brave face on and show some kind of restraint with regard to their emotions. The patients often rely on the physicians to help them pull through their ordeal. 3. Ability to convey the proper messages Some physicians are misunderstood by their patients. This is the very thing that should not happen in a patient-physician relationship. The physician should be able to elicit the concerns of the patient. The physician should also be able to calm their fears. But at the same time, they should also be honest and truthful about the nature of the patient’s case. They must be objective so that they may be able to informing and educate their patients about the possible treatments available for them and the course of care. Good and quality communication sometimes is the difference between a patient’s recovery and continuous regression. Such from of communication between the physician and patient can actually be an effective risk and danger management tool. Poor communication is a factor in a lot of cases and sometimes lead to misdiagnose and even ultimately, death of some patients. In fact, patients who sue for malpractice against doctors often refer to the inability of the physicians to listen or the unwillingness to answer questions, simply poor communication practices. Good communication practices of the physicians allow patients to be well informed about their treatment options, the possible outcomes, and possible complications. They are often more satisfied patients (Boyle, Dwinnell, Platt, 2005). One example wherein the communication skills of the physician are of necessity is during the time when an informed consent of the patient is necessary to perform surgeries, etc. The physician should first obtain informed consent before he/she can plan the course of treatment and care for the patient. Informed consent is the independent authorization obtained from the patient. This can only be obtained should the physician be able to properly explain and describe the nature of the problem of the patient, the treatments and its possible alternatives, the effects of the treatments such as its benefits, risks and side effects and the consequences should there be no treatment done. The physician will be able to successfully obtain the informed consent of the patient when he/she communicates with them about the proper treatment and the possible alternatives. If the physician has poor communication skills, there will always be the possibility that the patient will not give the informed consent and will not be able to understand what the processes and treatments will be for (Fadlon, 2004). Another example wherein there is a great need for communication skills of physicians is during documentation of the patient’s treatment. This process is critical for the patient’s welfare. The physician should be able to write the proper treatment and understand what the patient needs. If there is good communication between the physician and the patient, the patient will voluntarily tell the doctor physical anomalies that he/she is feeling. There will be an open line of communication between the two of them. This will help in documenting the process of treatment of the patient. In summary, the physician should have good communication in three domains – communication with the patient, about the patient, and about medicine and science. The communication of the physician and the patient, in general, follows the communication models. But there are some differences and more specifics with the communication regarding the physician in the physician-patient relationship. This shown in the diagram below: Communication Skills for Patients But it is not just the physician should have good communication skills. As shown by the models of communication aforementioned, communication is a two-way process. Patients should be able to make their physicians understand the current situation they are in. They must be able to tell their doctor the physical symptoms that they feel. They should also be able to listen attentively to their physician’s opinions and advice. Patients must be able to understand what their physician is telling them regarding their treatment and course of care. Should they not be involved in their course of treatment, it is possible that the treatment path taken is not the one suited for them. Ultimately, there will be a lack of understanding between the physician and patient and will lead to a malfunction (Kern, et al, 2005). However, in medical practices, patients who are agreeable and communicate well with their doctor are not common. Difficult patients can be seen daily and are encountered by physicians in a regular basis. These kinds of patients are the ones who know that they need treatment but come to health institutions not because they want but because they know that they need to. Often, they are unwillingly brought by a friend or a relative and thus, they are uncooperative if they feel like being so. Often, the main reason as to why the patients become difficult are because of their current situation and the stress and apprehension it causes them. If the physician does not have good communication skills, they will not be able to understand their patient and vice versa. Difficult patients need soothing and calming and most especially, effective and honest communication. Difficult patients show these traits and more: a. sadness b. denial c. angry d. silent e. over-dependence Comparison of Communication Theory and in Practice Communication theories explain communication flow as well as its. Models are brought about to try to explain real-life phenomena. The Transmission Model can be used to explain the physician-patient communication relation. The roles in this model are played by both the patient and the physician, depending on who is sending the message and who is the receiver. This model is relatively simple, as can be seen in the diagram. The noise in the model represents the possible misunderstandings that can spring up from the relationship. Such noise could be apprehension or lack of cooperation on the part of the patient, sudden lack of focus or interest from the physician, and other such factors. There shall still be communication between the physician and the patient even if the noise makes the message vague and unclear. But for the physician and the patient to have good communication between them, the noise that accompanies the message being transmitted should be minimized. As long as there is minimal noise, there is relatively good communication. As for the S-M-C-R model, the source and the receiver alternate between the physician and the patient. The goal for the communication is for the receiver to know as well what the source knows. This can be seen in the likeness between the column for the source and for that of the receiver. The skills of the physician play a role in the message. The physician’s communication skills mould the messages’ structure, content, etc. Similar to that of the Transmission model, malfunction in the communication can also take part in the Berlo Model. The difference, however, is that the disruption in the Berlo Model is implied. The counterpart of the noise in the Transmission Model is in the message part and the channel of the Berlo Model. The problem with the message structure, content and its over-all status as it was sent shows the skills of the source as well as the eagerness, or the lack of, of conveying the message. This is true whether the source is the physician and the patient. The channel through which it was delivered shows the skills and participation of the receiver. Should the message be sent properly and well-packaged but the receiver be out-of-focus, good communication will not be attained. Out-of-focus or some such problem from the receiver would affect the senses (i.e. the five senses), which serve as the channel for the message. In general, the patient plays the role of the information source early on in the relationship but as time passes by, the physician plays the role of the source more and more. This, however, does not mean that the physician is the only source in the latter part of the relationship. On the contrary, the patient and the physician still switch roles with regards to their communication role in their relationship. Indeed, communication plays a big part in the physician-patient relationship. But it should be remembered that good communication skills are not the objective. It is simply a means to achieve the goal, which is to improve the patient’s well being. Communication skills are simply a vehicle to take a thorough medical history, perform precise physical examination, and assure patient compliance.  References: Barnlund, D. C. (1968). Interpersonal Communication: Survey and Studies. Boston: Houghton Mifflin. Berlo, D.K. (1960) The Process of Communication. New York: Holt, Rinehart, and Winston. Boyle, D., Dwinnell, B., Platt, F. (2005) Invite, Listen, and Summarize: A Patient-Centered Communication Technique. Academic Medicine. 80:29-32. D’Ambrosia. (1999) Physicians must put patients first in partnership to rebuild trust, American Academy of Orthopaedic Surgeons Bulletin. (47)2. Essential Elements of Communication in Medical Encounters: The Kalamazoo Consensus Statement (2001). Academic Medicine 76:390-393. Fadlon, J., Pessach, I., Toker, A.(2004) Teaching medical students what they think they already know. Education for Health. 17:35-41. Kern, D., Branch, W., Jackson, J., Brady, D., Feldman, M., Levinson, W. & Lipkin M. (2005). Teaching the Psychosocial Aspects of Care in the Clinical Setting: Practical Recommendations. Academic Medicine 80:8-20. Midwest Bioethics Center Task Force on Health Care Rights for Minors. (1995). Health care treatment decision-making guidelines for minors. Bioethics Forum, 11(4); A1-A16. Shannon, C. E. (1948). A Mathematical Theory of Communication. Part I, Bell Systems Technical Journal, 27, 379-423 Shannon, C. E. & Weaver, W. (1949). A Mathematical Model of Communication. Urbana, IL: University of Illinois Press Read More