Welcome to patient-centered care, patient-provider communication. This is lecture A. The objectives for this unit, patient-provider communication, are one, explain the importance, elements, and process of patient-physician communication. Two, discuss the concept of trust in the context of health care interactions. And three, describe various informatics tools and the practical considerations to support patient-provider communication. In this lecture, we will discuss the importance, elements and models of patient-provider communication. Plato was perhaps the first spokesman for patient-centered medicine, and importance of patient-provider communication. He observed that quote, a physician to slaves never gives his patient any account of his illness. The free physician, who usually cares for free men, treats their diseases first by thoroughly discussing with the patient and his friends his ailment, end quote. Patient-centered communication is on the national healthcare agenda. Patient centeredness is broadly defined as a biopsychosocial approach to medical treatment that embraces patients' preferences, experiences and expectations and in which patients are offered opportunities to participate in their care in ways that enhance partnership and understanding. According to the Institute of Medicine report, communication is regarded as key to any significant improvements in health care quality. Patient-centered care is included alongside the core quality requisites of safety, timeliness, effectiveness, efficiency and equity. Providers' ability to effectively and compassionately communicate information is key to a successful patient provider relationship. The accreditation council for graduate medical education identified interpersonal and communication skills as one of six areas in which physicians in training need to demonstrate competence. Patient outcomes depend on successful communication. The provider who encourages open communication may obtain more complete information, enhance the prospect of a more accurate diagnosis and facilitate appropriate counseling, thus potentially improving adherence to treatment plans that benefits long-term health. This type of communication, which may be referred to as the partnership model increases patient involvement in their health care through negotiation and consensus building between the patient and provider. In the partnership model providers use a participatory style of conversation where providers and patients spend an equal amount of time talking. The partnership model is one of several communication models that improves patient care and reduces the likelihood of litigation. When providers use communication skills effectively, both they and their patients benefit. Firstly, providers identify their patients' problems more accurately. Secondly, their patients are more satisfied with their care and can better understand their problems, investigations, and treatment options. Thirdly, patients are more likely to adhere to treatment and to follow advice on behavior change. Fourthly, patient distress and their vulnerability to anxiety and depression are lessened. Finally, provider's own well being is improved. There are four major types of provider patient relationship depending on the level of physician and patient control during a clinical encounter. We will go into more detail about these four relationship types on the next slot. As we discuss them think about your experience as a patient and as a provider if you are a provider during your clinical interactions. This slide depicts the core elements that define a communication style during a patient provider encounter. The core elements are the goals of the visit, the values of the patient and the role of the physician. There are four types of a patient-provider relationship. The traditional relationship is categorized as paternalistic. This is where the provider takes a parental role and the patient has a more submissive role. A second type of relationship is a mutual one where the provider and the patient are equal partners. There is a shift towards a mutual relationship. A third type of relationship is called consumerist, where the provider has a passive role and the patient has an active role in the relationship. The forth type of relationship is called default, and the patient adopts a passive role. The provider reduces his or her control in the relationship. Differences between physicians and patients including culture, gender, race and religion can introduce bias into patient provider communication and the type of relationship between the patient and the provider. This slide show the key tasks in communicating with patients, that good providers should be able to perform. Unfortunately, providers often fail in these tasks. Only half of the complaints and concerns of patients are likely to be elicited. Other providers obtained little information about patients' perceptions of their problems, were about the physical, emotional, and social impact of the problems. When providers give information, they do so in an inflexible way and tend to ignore what individual patients wish to know. They pay little attention to checking how well patients have understood what they have been told. Less than half of psychological morbidity in patients is recognized. As a result of these shortcomings, often patients do not adhere to the treatment and advice that the provider offers and levels of patient satisfaction are variable. Some providers may be reluctant to depart from a strictly medical model. Deal with psychosocial issues and adopt a more negotiating and partnership style. A provider may not want to inquire about the social and emotional impact of patients problems on the patient and family, in case this unleashes stress that the patient and/or family cannot handle. Providers may fear it will increase patients to stress, take up too much time and threaten the patients own emotional survival. Consequently, providers respond to emotional ques with strategies that block further disclosure. Providers may also not realize how often patients withhold important information from them or reasons for this. The main reasons for patients not disclosing problems include a belief that nothing can be done, reluctance to burden a doctor, desire to not seem pathetic or ungrateful. Concern that their problems are not legitimate, blocking behavior by providers as described on the previous slide, and worry that their fears of what is wrong with them will be confirmed. In 2003, the Institute of Medicine issued a report detailing the importance of patient-centered care and cross-cultural communication as a means of improving healthcare quality across patient groups. A communication tool cold AIDET developed by Studer Group exemplifies approaches for effective patient provider communication that are gaining popularity among the number of hospitals. The fundamentals of AIDET are knowledge, introduce, duration, explanation, and thank you. A provider should acknowledge the patient by greeting them and being attentive, introduce themselves to the patient, give a reasonable time expectation, make sure the patient is knowledgeable and informed and show appreciation to the patient for their cooperation. The respect model is widely used to promote providers awareness of their own cultural biases and to develop providers rapport with patients from different cultural backgrounds. It includes seven core elements which makes up the acronym RESPECT. One, rapport. Two, empathy. Three, support. Four, partnership. Five, explanations. Six, cultural competence. And seven, trust. It is important to connect with the patient and remember that the patient has come for help. Additionally, because of the need for help, it is key to remember to support the patient in their healthcare journey by asking and understanding barriers to their care. As mentioned before, there is a shift from a paternalistic relationship between patients and providers towards a mutual relationship, where they're equal partners. Because of this partnership, it is essential to understand that both parties are on the same page in terms of understanding the situation and having the necessary information. With respect to communication, culture can have an impact. Therefore, cultural competence is important to incorporate into the relationship. Providers should respect the patient, their culture and their beliefs as well as their preferences. As in any relationship, trust is a fundamental building block for communication. Trust and respect are further discussed in the next lecture. The Accreditation Council for Graduate Medical Education or ACME, developed best practices for communication in medical encounters. Developing effective patient-provider communication requires practice to gain skill in fostering a relationship. Gathering information, providing information, decision making, and impacting health promotion behaviors. On this slide are the roles and responsibilities of a provider to foster the relationship with a patient. Skills include greeting a patient appropriately, maintaining eye contact, listening actively, using appropriate language, encouraging patient participation, and showing interest in the patient as a person. Sharing information between the patient and the provider is important in a medical encounter. To gather information, the provider should ask open ended questions, allow patient to complete responses, listen actively, elicit patient's full set of concerns, elicit patient's perspective on the problem or illness. Explore the full effect of the illness. Clarify and summarize information, and inquire about additional concerns. To encourage shared decision making it is key for the provider to give information to the patient too. Skills include explaining the nature of the problem, and approach to the diagnosis and treatment. Giving uncomplicated explanations and instructions. Avoiding jargon and complexity. Encouraging questions and checking understanding, and emphasizing key messages. Another role and responsibility of the provider is to collaborate with the patient for decision making. To do this, skills include encouraging the patient to participate in decision making, outlining choices, exploring patient's preferences and understanding. Reaching agreement, identifying and enlisting resources and support, and discussing follow-up and plan for expected outcomes. For more information on shared decision-making, please see unit seven. Another function of the medical encounter is to enable disease and treatment related behavior. To do this, a provider should assess the patient's readiness to change health behaviors and elicit the patient's goals, ideas and decisions. Illness is not just biological, but also has psychosocial aspects and consequences as well. The provider should make the patient comfortable to express their emotions and concerns. Skills include being able to acknowledge and explore emotions. Express empathy, sympathy and reassurance. Provide help in dealing with emotions, and assess psychological distress. Responding to emotions refers to the providers ability to discuss difficult topics without displaying uneasiness and to accept the patient's attitudes without showing irritation or intolerance. Ultimately, responsiveness and empathy refer to the ability to react positively to direct and indirect messages express by the patient. These skills allow the provider to understand the patient's point of view and incorporate it into treatment. Patient provider communication is an integral component of collaborative high quality care. This concludes lecture a of patient-provided communication. To summarize, providers with good communication skills identify patients' problems more accurately and their patients adjust better psychologically and are more satisfied with their care. Such providers also have greater job satisfaction and less work stress. To enhance communication skills, there are effective methods and skills training available. It is essential to practice key skills and receive constructive feedback of performance.
