Chapter 1

Doctor-patient communication

Vivian (Weiwei Liu)

Public health and Management
Department

Consultation Styles

Its serious isnt it

doctor?

Ideal Patient
Permitted to:

Regarded as being in need of care

In Return :
Seek help from and cooperate with a doctor

 Ideal Doctor
Apply a high degree of skill and knowledge
Act for the good of the patient
Remain objective and emotionally detached

Conflict of Interest
Interests of patient v society
Interests of patient v other patients
Problems of confidentiality

Types of D-P Relationship

Patient Control
Low
High

Physician control
Low
High
Default
Consumerist

Paternalist
Mutuality

Doctor patient communication

skills-6 steps
Start
Active

listening to the patient

- listening to the patient what causes the illness

- Observation of verbal and nonverbal language
- Patience to feel and express

Collection

of medical history
Physical examination
- Let the patients know what the doctor expected?

Diagnosis,

treatment and prognosis

- To ensure patient understanding of their main

health problems
- Need for patient participation and cooperation
- Discussion of self-care and medication

After

treatment

- Clarify what to do next?

Step 1: Start

Self introduction, greeting patients

Pay attention to the patients health status
- Showing care and respect

Identify patient and escort

- In order to call their name in the following conversation

Sit down with the patient to make eye

contact, avoid:
- Dont turn your back on patients
- Only focus on the text material or on the computer for recording
- Ensure that attention is not dispersed (e.g. telephone

interference, other viewers walk by)

Cases:

Establish harmonious relationship

- Doctor: before we discuss your disease, I want to know

some of your personal things.

- patient: doctor, what do you mean?
- Doctor: tell me what you think of the most important
thing is to yourself. Where do you live? With whom?
Hows your work? How about your spare time? Etc..)

Make a promise of secrecy to the

patient

Step 2: Active listening

Listen

to

- Pay attention to the

speaker
- Eye contact
- Fast response
Nonverbal

communication

- Body language
- Facial expressions
- Gesture

Verbal
communication

- Speed and tone

- For the scene language
- Express sympathy and
concern

Encourage patients to tell their issues, to

identify the main problem:

Which one of the question is the most troubling you?

What kind of goal do you want to achieve today?

Ensure the patient will not be interrupted

A recent survey shows, family physicians interrupt their

patients in every 23 seconds.
If not interrupted, the patient average talk time < 90
seconds.

Active listeningnonverbal language

Physicians need to observe the patient
emotion

Body language, facial expressions, the speed and tone

- whether the patient being anger, worry, frustration

Medical indicia, such as hot crimson, fatigue, pain

spasm

Active listeningmirrored feedback method

Listen carefully and let the patients know
youre listening
Mirror feedback method is used to show that youre
understanding what is told
That is to say you feel very tired for more than
one month.
That must be stressful.
Yes, I know that you fear
Of course, I agree

The initiative to encourage patients to

clarify in detail

Please go on, tell me more.

Could you explain what you said dizziness refers
to?

Think more initiative sentences~

Step 3: Collection of
medical history
The

effective use of open and closed

questions

Open-ended

questions was used to get more

information or to explore unexpected
discovery
How do you feel after dinner every time?
Does this problem affect your daily activities?
The use of extended words, such as can you tell me some

more about that?

 No

matter what the patient says, to maintain a

calm and reliable voice
- Even though you are very busy, you should let the patient talk fast

to keep up with your speed

- Use tone to the patients to show you care

Let

the patient correction

- Medical history
- Open and closed issues
- Previous diagnosis

To

control the conversation and schedule

Step 4: Physical examination

Tell the patient what you are doing

Explain possible discomfort, such as cold,
pain and oppression.

Step 5: Diagnosis, treatment and

prognosis
Recognize

from patients need

Put forward specific request or
response
request

need

Consultation with the patient

treatment plan:
Discuss the various options, negotiate a mutually
acceptable plan;
Encourage patients to express their own ideas;
Recognizing the patients return, risk and perceived
barriers;
Patients are encouraged to participate in the
implementation of the plan.

Explain the process of identifying

patients understand:

Clear and well organized, avoid jargon and terminology,

use of a clear explanation;

Let the patient mirrored feedback your statement, to

determine whether or not to understand;

Giving clear medication instructions:

- Write down the dose, whether to eat and the possible side-effects

of information
- Explain to the patient directly or to his/her family member.

Step 6: Summary
Make a positive conclusion

Provide a more realistic hope

- Good prognosis;
- If patient happen to meet a poor prognosis, provide
effective pain control

Give a clear follow-up guidance

Make appointment to review

When and how to take medicine?
Need to use the written explanation

Use of facial expressions and gestures to

show your care

Handshake
Pat on the shoulder
Greetings to the patients accompanies

Accurately tell the patient what will happen in

the final diagnosis step
Use the medicine before dinner.
As soon as you feelImmediately come to examine.

A few cases for thought

Case 1: Autonomy and family

member
A

patients son insisted that the doctor should

not tell his mother that she has been diagnosed
with chronic leukemia, otherwise he will take
her home against medical advice.
The mother seems to be generally passive and
submissive to the sons decisions related to her
health care.
How should the patients right be addressed?

Case 2: Demand of medical

treatment

A patient with mental illness demanded to be treated

with the newest psychiatric drugs
The doctor assessed and found that the patient was
not suffering from significant side effect from the
existing drug, which is also one of the newer drugs
that had passed the patent period (cheap generic
drug is locally available)
What is the extent of patient right in this case?

Dealing with refusal of treatment

When mentally competent and properly

informed, the patients refusal must be
respected. [Principle of respect for autonomy]

Assess mental capacity Treatments can be

provided to mentally incapacitated persons
based on best interests principle [Principle
of beneficiary]

Resolving ethical dilemma related to

autonomy advice for clinicians
Listen carefully do not jump to conclusion
of patient not cooperative too easily
Gather more information relevant to the case
situation
Consider your own bias and assumptions
Explore reasonable options of compromise
Involve minders and friends trusted by
patient as appropriate

Conclusion
listening

feeling

request

need

To improve the diagnosis efficiency

To establish relations of cooperation
Enhanced patient participation and compliance
Improving patient satisfaction