Data Bases • Custom Term Papers • Free Term Papers • Free Research Papers • Free Essays • Free Book Reports • Plagiarism? Links • Top 100 Term Paper Sites • Top 25 Essay Sites • Top 50 Essay Sites • Search 97,000 Papers @ DirectEssays.com • Search 101,000 Papers @ ExampleEssays.com • Search 90,000 Papers @ MegaEssays.com Free Essays • Term Paper Sites • Chuck III's Free Essays • Free College Essays • TermPaperSites.com • My Term Papers • Get Free Essays • Essay World • Planet Papers	Search Lots of Essays Back to Subjects - Speech doctor patient communication doctor patient communication Definition of Physician – Patient Communication in the Interview The main purpose of the medical interview is to collect historical information that can be used to make a diagnosis of the disease and to understand the patient’s problem. (Henderson, 11) This is the beginning of the physician – patient relationship. The interview generally begins by the doctor greeting the patient, introducing himself/herself, and defines his/her professional role. Common courtesy dictates that the physician learns the patient’s name and refers to them with the proper title. Last name is proper for adults, while the use of the first name is comforting to children. The physician inquires about how the patient is and begins the process of finding out what is wrong with the patient. The first thing that the doctor does is to put the patient at ease and to make them as comfortable as possible. The physician should begin the conversation with an open – ended question, such as, “How are you feeling”. The physician then encourages the patient to mention all of the ailments that they are experiencing. This is when the physician can learn the most about the patient’s personality and environmental influences. It is important for the doctor to be attentive and take good notes. The doctor explores in great detail the time of the ailments and the severity. The physician inquires about the patient’s past health and any family history that is of relevance. The physician then checks the accuracy of all the data and details collected to date and informs the patient of the next step in the process, the diagnosis. It is important that the patient does most of the talking throughout the interview, so that the doctor can elicit all of the information about the patient’s illness. The physician should direct the interview, but not dominate the speaking. Review of the Major Studies of Physician – Patient Communication One of the most important parts of the physician – patient communication is the patients’ perception of the communication in the consultation. Patients’ adherence and satisfaction are directly linked to the way that they perceive and interpret the consultation. (Street, 977) This is demonstrated in the article, “Analyzing Communication in Medical Consultations, Do Behavioral Measures Correspond to Patient’s Perceptions?”. This investigation of 115 pediatric consultations examined this issue and yielded several notable conclusions. First, less satisfied patients received more directives and proportionally less patient – centered utterances from physicians than did more satisfied parents. Second, findings were mixed regarding the degree to which behavioral measures related to analogue measures of the parent’s perceptions. For example, the doctors’ use of patient – centered statements was predictive of parents’ perceptions of the physicians’ interpersonal sensitivity and partnership building, but the amount of information physicians provided parents was unrelated to judgments of the doctors’ informativeness. Third, with some important exceptions, relationships between behavioral measures and parents’ evaluations did not vary for the parents differing in education and anxiety for the child’s health. Finally, behavioral measures in the form of tended to be better predictors of the parents’ perceptions than were measures in the form of proportions. (Street, 976) This is an important study because it looks at and measures the patients’ satisfaction with care, understanding of medical information and health improvements. This is at the center of the consultation or interview, effective communication. This research is important because it informs us of how physician – patient interactions determine the medical outcome of the illness. The patient is viewed as the sick or unnatural being that requires to be made whole again. It is important to look at the way that they are viewed and the role that they play in the relationship. Talcott Parsons was the first social scientist to theorize the doctor-patient relationship his role-based approach defined analysis of the doctor-patient. Parsons began with the assumption that illness was a form of deviance that required reintegration with the social setting. Illness, or feigned illness, exempted people from work and other responsibilities, and thus was harmful to the social order if uncontrolled. Maintaining the social order required the development of a legitimized "sick role" to control this deviance, and make illness a transitional state back to normal life. In Western society, Parsons saw four norms governing the functional sick role: 1. the individual is not responsible for their illness; 2. exemption of the sick from normal obligations until they are well; 3. illness is undesirable; and 4. the ill should seek professional help. (Hughes, 12) However, this is only one half of the equation. The role of the doctor is very important in the relationship to determine how the treatment should be administered and the way that the determination came to pass. For Parsons, the physician's role is to represent and communicate these governing norms to the patient to control their deviance. Physicians illustrate, for Parsons, the shift to limited influence relationships in society, with physician and patient being protected by emotional distance. Medical education and social role expectations communicate socialized norms to physicians to act in the interests of the patient rather than their own material interests, and to be guided by an open communication rather than a personalized communication. Because physicians have mastered a body of technical knowledge, it is practical for the patients to allow physicians professional autonomy and authority, controlled by their role expectations. (Hughes, 15) Problems with communication between doctors and patients are numerous. Some barriers are time, severe illness, pain or clarity of communication. If you have ever heard a doctor say “layman’s terms”, this is an example of the doctor trying to give the patient enough information to understand the situation, but trying to not confuse them. One study examined this common problem with communication failure. Patients with chronic heart failure often feel unable to ask their doctors questions about their illness and believe that doctors are reluctant to provide them with too much knowledge. The study suggests that more effective communication between doctors and heart failure patients is urgently needed. Researchers in London interviewed 27 chronic heart failure patients aged 38-94 years about the effect heart failure had on their everyday lives. Most patients lacked a clear understanding of why they had developed heart failure, what it was, and what this implied for them. Many felt that their symptoms were a result of growing older and believed that nothing could be done. Although some patients were apparently unaware of their likely prognosis, most patients saw death as inevitable, but felt that doctors were reluctant to talk about death or dying. One patient stated: "I think they like to keep things away from the patient." (Rogers, 23) Patients also described several barriers to communication with their doctors, including difficulties in getting to hospital appointments, confusion, short term memory loss and the belief that doctors did not want to give patients too much information about their illness or its treatment. Some patients may benefit from more open communication about death and dying and strategies to help patients ask questions should be developed, particularly given that chronic heart failure has a worse prognosis than many cancers, they conclude. (Rogers, 25) The age-old question about medical consultations is, “What does the patient want from the encounter with the physician”? A study of arthritis suffers showed that , “They (patients) want to be able to trust the competence and efficacy of their caregivers. They want to be able to negotiate the health care system effectively and to be treated with dignity and respect. Patients want to understand how their sickness or treatment will affect their lives, and they often fear that their doctors are not telling them everything they want to know. Patients worry about and want to learn how to care for themselves away from the clinical setting. They want us to focus on their pain, physical discomfort, and functional disabilities. They want to discuss the effect their illness will have on their family, friends, and finances. And they worry about the future.” (Newman, 105) This is very important to show that they know what they want and the doctors need to listen to the patient’s needs. Prior to when medicine was more science than art, physicians worked to refine their bedside manner because cures were often impossible and treatment had limited effect. In the middle of the century when science and technology emerged, interpersonal aspects of health care were overshadowed. There is currently a renewed interest in medicine as a social process. After all, if there were no patients there would be no doctors. What is Still Unknown About Physician – Patient Communication and The role of technology in the 21st century is unknown in the medical field. The Internet and email present many possibilities in the communication between doctors and patients. As more and more people use the Internet to gather information, many are using technology to address their health needs and questions as well. Numerous web sites have health information, and some even provide online doctors who answer questions about medical conditions or problems. The answers are instantaneous, and the doctor is in 24 hours a day, seven days a week. Some consider the possibilities for this new doctor - patient relationship endless, but the American Medical Association is concerned that some patients may only visit Web sites and skip the office visit when they have health problems.(Johnson, 14) Doctors at one Web site, AmericasDoctor.com, say they are actually against practicing medicine on the Internet. They say they see themselves more as traffic cops helping consumers navigate through the vast amount of medical information that is on the Web. The site, which is affiliated with seven health-care organizations and hospitals, doesn't prescribe medication or keep medical records and gets about 400 million pages view a day. (AmericasDoctor.com) E-mail between physicians and patients offers important opportunities for better communication. Linking patients and physicians through e-mail may increase the involvement of patients in supervising and documenting their own health care, processes that may activate patients and contribute to improved health. These new linkages may have profound implications for the patient-physician relationship. Although the federal government proposes regulation of telemedicine technologies and medical software, communications technologies are evolving under less scrutiny. ( Mandl,495) Unless these technologies are implemented with substantial consideration, they may disturb delicate balances in the physician – patient relationship, widen social disparity in health outcomes, and create barriers to access to health care. Internet technologies have become useful tools for medical practice. Online, physicians can search the medical literature and find both synoptic and full-text medical journal content. Patients have access to medical information, self-help and support groups, and even medical experts. The World Wide Web can be used to link patient data across multiple institutions for retrieval by providers at the point of service or by researchers. Bibliography: References: Gartland, John, MD. (1998). “Is Physician – Patient Communication Improving?”. Medical Practice Communicator, 5, 2. Henderson, George. (1981). Physician – Patient Communication. Springfield, Illinois. Thomas Publishing. Hughes, J.,MD. (1994). “Organization and Information at the Bedside”. Changesurfer, 8, 10 –18. Johnson, Michael. (1999). “Is technology changing the doctor/patient relationship?”. Health Today, 11, 8 – 11. Mandl, Kenneth, MD., Kohane, Isaac, MD., Brandt, Allan, MD. (1998). “Electronic Patient – Physician Communication: Problems and Promise”. Annals of Internal Medicine, 129, 495 – 500. Newman, Stanton. (1992). “Understanding Rheumatoid Arthritis”. About Arthritis, 35, 30 – 45. Street, Richard, MD. (1992). “Analyzing Communication in Medical Consultations: Do Behavioral Measures Correspond to Patient’s Perceptions?”. Medical Care, 30, 976 - 987 Wilkinson, Emma. (2000). “Knowledge and Communication Difficulties for Patients With Chronic Heart Failure”. British Medical Journal, 96, 77 – 82. Word Count: 1868
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