Physician and Patient Communications

Interpersonal communication in a hospital setting is integral since it helps doctors in collecting the necessary information that would ensure appropriate counseling, accurate diagnosis, and provision of therapeutic information. Importantly, it plays an important role in establishing a caring relationship between a physician and the patients (Duffy et al, 2004). Apparently, the field of medicine requires doctors to have such skills purposely to ensure that the best outcome, as well as patients satisfaction, is achieved. As a matter of fact, best results and patients satisfaction is the best measure of how effective a healthcare facility is in terms of service delivery. It ought to be noted that communication skills as a single entity will not be enough to create and sustain an indefinite therapeutic physician-patient relationship. 

The physician-patient relationship in this case compromises of a common perception as well as feelings pertaining to the kind of the problem, aims of the treatment and the psychological support (Duffy et al, 2004). Nevertheless, interpersonal skills help in creating the primary communication skills (Duffy et al, 2004). As such, proper communication incorporates approaches that are both patient-physicians oriented. The main aim of physician-patient communication is to ensure that the health of the patient and healthcare is improved significantly (Duffy et al, 2004). Studies that focus on physician-patient communication have revealed that some patients are still discontented even when the physician perceives that the communication was sufficient or rather excellent. This is a likely indication that some physicians are overrating their communication abilities. A study by Toungue, Epps & Forese, (2005) indicated that about 75% of orthopedic surgeons perceived that they conversed expertly with their patients. However, few patients (21%) were satisfied with the communication with their doctors. Duffy et al, (2004) also indicate that the majority of patients want their communications with their doctors to be enhanced. This article will, therefore, assess physician and patient communication. It will start by examining the models of interpersonal relationships, communication skills, merits of effective communications, challenges faced in physician and patient communications, strategies for improvement, and provide conclusive remarks. 

Model of International Relationships

Various theories have been put forth to illuminate the interaction between physicians and patients. Examples of such models include the model of interpersonal by Peplau. 

Peplau’s Model of Interpersonal relationship

This model is centered on the doctor-patient relationship as well as the therapeutic activities that occur during the process. The mode of communication that takes place under this model encompasses complex aspects like environment, practices, beliefs and attitudes that prevail in an organizational culture. This model has four phases describing how physician-patient relationship can be achieved with an aim of establishing a common goal. The first phase is the orientation phase. Under this phase, the physician is engaged directly with the patient during a treatment session. The patient during this phase gets a chance to ask questions and get responses to them from the physician. This phase is important for the physician since it will build a good rapport with the patient which would later help in building trust between the involved parties. 

The second stage is the identification phase. Under this phase, the physician and the patients start working cordially. This sort of interactions helps in furthering the understanding of each other, trust as well as acceptance since the patient will be participating actively in the treatment plan. The third stage is the exploitation phase. Under this phase, the patient makes maximum use of the services being rendered in the hospital plus the capitalizing on the established relationship with the physician. As a matter of fact, this will help both the patient and the physician to have a common goal during the treatment. Finally, there is the resolution phase. This phase is a product of good communication that has been established. As such, the physician meets the needs of the patient hence deeming the patient independent. Therefore, he/she will no longer require the help of the physician and this marks the end of the relationship. 

Communication Skills

Communication skills are founded on three pillars namely the nonverbal communication, listening and personal relationships. The nonverbal communication is an ongoing process that is characterized by postures, facial looks, and gestures. This type of communication ought to agree with the verbal communication. Notably, in stressful times, it is hard to note the variations between these types of communications. However, physicians need to strive to ensure that they get a proper meaning from such type of communication. The second pillar of effective communication skills is listening. 

Listening plays an integral role during communication. As such, physicians ought to pay attention to their patients while talking. Additionally, they are required to mobilize the necessary senses derived from both the verbal and nonverbal communications fro the patient. By being good listeners, physicians can be in a position to cater for the needs of the patients and incorporate them during the care to ensure that the patient is satisfied. It should be noted that patients’ needs are never static, they evolve with time. Therefore, by listening keenly to the patient's needs, a physician can be able to understand the diverse patient's needs and act accordingly.

A personal relationship is the third most important pillar of effective communication. Duffy et al, 2004 noted that personal relationship is marked by compassion, care, and kindness. As such, physicians need to demonstrate these aspects to their patients in order to create good interpersonal relationships. Once such relationship has been established, the patient will always have the liberty to ask the physician any question relating to his/her health condition. The physician, on the other hand, ought to provide the patient with the necessary information which ought to portray trust, care, acceptance and a harmonious relationship (Duffy et al, 2004). Basically, this type of relationship not only ensures that there if effective transmission of information. Rather, it plays a crucial role in providing a mental and emotional supports which are also an element that needs to be incorporated in a communication environment. 

Merits of Proper Communication between Physicians and Patients

According to Arora, (2003) effective physician-patient relationship is important in the field of medicine. Physician-patient communication has three main goals. These include building a proper interpersonal relationship, enhancing the exchange of information and involving patients during the decision-making process (Arora, 2003). Notably, this type of communication depends on a physician's bedside habits that the patient uses to determine the competence of the doctor. A proper physician-patient communication has the capability of regulating the emotions of a patient. Besides, it also facilitates the understanding of medical information. 

As aforementioned, good communication practices helps the physicians to understand the needs of the patients and respond to them appropriately (Arora, 2003). Kindler, Szirt, Sommer, Häusler & Langewitz, (2005) established that patients who stated that their communication with their physicians was good were more satisfied. The satisfaction was based on the accuracy of their diagnosis. As such, such patients would adhere to the physician's advice and prescriptions during a treatment program (Kindler, Szirt, Sommer, Häusler & Langewitz, 2005). Studies have also shown that patients who agree with their physicians on matters relating to their treatment often end up recovering with ease.

Additionally, O'Keefe, (2001) showed that good communication can induce a sense of control. This, on the other hand, infuses that ability to overcome illness and pain. O'Keefe, (2001) also indicated that sense of control has the potential to reduce the growth of tumors as well as improve the daily functioning of a patient. Good communication is also associated with improved mental health and psychological functioning. According to Little et al, (2001), effective communication has the ability to reduce the time that patients are supposed to stay in hospitals. Indirectly, this helps in reducing the costs incurred when seeking medical services as well as cases of re-hospitalization. Notably, systems that are patient-centered often obtain better outcomes and the physician is always left satisfied with the end results. Toungue, Epps & Forese, (2005) also stated that satisfied patients will never think of launching complain relating to malpractices. Besides, they will me meritorious for the physician in relation to work satisfaction, little job-related stress as well as decreased burnout. 

As such, in order for physicians to be successful, they ought to demonstrate excellent communication skills. They need to connect and communicate with the patients and other health professionals in order to create a better working relationship, shun mistakes and provide quality care. According to James (2013), more than 440,000 individuals die annually due to medical errors that are preventable. However, Starmer et al., (2014) indicated that good communication could reduce the rates of errors which are evident in a most hospital setting. 

Challenges Associated with Physician and Patients’ Interpersonal Communications

In spite of the myriad merits that good communication offers in the field of medicine, there are many drawbacks which are associated with the physician-patient relationship. There is the element of decline in physician’s communication skills. Researchers have found out that as physicians continue with their professional duties, their communication skills deteriorate and often tend to lose their concentration on patients’ care. Additionally, scholars have established that medical training is very emotional and physically brutal. As such, most physicians substitutes communication with medical techniques and protocols. 

Baile et al, (2000) noted that physicians face the challenge of non-disclosure of information. The author stated that physician-patient interaction is a dynamic process and cases of miscommunications are very likely to occur. Baile et al, (2000) also add that this will be true where the patients need to understand their diagnosis, the reason for the care, outcomes as well as their involvement in the treatment (Baile et al, 2000). These elements affect that decision that the patients will make pertaining to their treatment and the outcome of the care that can significantly affect the illness. Lee, Back, Block & Stewart, (2002) indicated that physicians who are likely to involve their patients in the decision-making process have excellent communication skills.

Furthermore, some physicians demonstrate the avoidance behavior. Reports have indicated that some doctors tend to shun discussing with their patients on emotional issues. This is because the issues stressed them and they were not able to handle the situation or they lacked the ample time to work on it adequately. Such instance often distresses the patients further. As a result, the affected patients will not be willing to share their problems with the physicians. On the other hand, this feeling will affect their rate of recovery (Little et al, (2001). In this line of thought, researchers have also established that some physicians have the habit of discouraging their patients from airing out their issues and expectations in attrition to requesting extra information. This type of influence speaks volumes about the physician’s communication abilities. This behavior may make a patient feel that he/she is disempowered and might not be in a position to attain common health objectives with the physician. Notably, failure to provide the patient with sufficient information will lead to poor understanding and lack of agreement between the patient and the physician. The product of such disagreement will be a therapeutic failure. 

The, Hak, Koëter & van Der Wal, (2000) stated that in present moments patients have discovered that they are no longer passive. Therefore, they can resist any form of authority that the doctors are granted by the society. As such, resistance from patients forms another hurdle that affects effective communication. The patients, in this case, can resist any form of discussions with the physicians. As a matter of fact, this will end up depriving the doctor of obtaining the vital information that would hasten the recuperation of the patient.

Strategies for Improving Physician-Patient Communication

Enhancing Physicians Communication Skills

Five strategies can be used to improve physician-patient communications. The first is by improving the communication skills of the physicians. Communication skills in this regard entail both the mode of delivery and the content. Some examples of skillful or rather excellent communication skills include listening and administration of open-ended questions. In addition, enhanced physician-patient communication skills are integral since it ensures that the patient is involved in the decision-making process. As a result, the patient will be committed to adhering to the agreement reached with the physician. On the other hand, the patient will be more satisfied and the quality of healthcare provided will be enhanced (Arora, 2003).

Baile et al, (2000) indicated that the most challenging task in a medical setting is communicating bad news to patients. However, the authors state that such news can be delivered with ease in cases where an interpersonal relationship has been established. Baile et al, (2000) stated that physicians ought to understand certain information from the patient. These include information sharing, their knowledge, and expectations. The authors note that miscommunication poses detrimental effects abs may limit a patient’s understanding, active involvement as well as expectations of treatment. As such, Baile et al, (2000) indicate that the major cause of patients’ dissatisfaction is miscommunication. Furthermore, they add that a decline in patients’ satisfaction could reduce the psychological adjustment. In the same report, Baile noted that most patients regard physicians as their sole source of psychological support. In this regards, physicians need to demonstrate empathy to reduce the feeling of isolation that is often among many patients who have been admitted to hospitals.

Conducting Training on Communication

Physicians lack the innate communication skills owing to their different natural talents. However, they have the ability to understand the impact that good physician-patient communication would have on the outcome of their duties. Lee, Back, Block & Stewart, (2002) stated that physicians can acquire such skills and adjust their style of communication where they are provided with adequate incentives relating to self-monitoring, self-awareness as well as training. As such, training will help in improving the communication skills of the physicians with their patients.

Encouraging Physician-Patient Collaboration

In the current world, there is the need for doctors to involve their patients when making decisions regarding the health of the patients. This is because physicians are susceptible in making biased decisions. Arora (2003) indicated that involving patients in making treatment choices is important since in makes them be responsible. Therefore, the decision-making process ought to ensure that information is exchanged between the physician and the patient. The physician should provide the patient with a detailed explanation of the treatment options and ensure that he/she shares a common goal with the patient.

Understanding the Patients’ Health Beliefs

Toungue, Epps & Forese, (2005) stated that beliefs and values influence the relationship and interaction between the physician and the patients. The authors also assert that there may exist divergent values which may influence healthcare through many ways. This may include competing therapies, disruption of the therapy that has been prescribed or patients being afraid of the healthcare provider. Perceptions of this type might negatively influence the physician’s treatment decision. In fact, such notions would make the patient have negative thoughts about the outcomes despite the fact that the therapy might be appropriate. In most cases, physicians use biomedical theories to have insight about the illness of the patient. However, the beliefs and values of the patients that are a product of the social norms and anatomy may affect the outcome of the therapy.

With this understanding, it is imperative for the physicians to address such challenges in order to enhance patients’ adherence to medical therapies. This will not only ensure that the treatment plan is beneficial but also the patient understood the benefit of the treatment. Physicians need to have insight about patients’ understand of the term disease. In addition, they should be made aware of the meaning of relationship and its symbolic meaning. After this process, the patients ought to be provided with a summary of the information as well as being informed about the issue at hand from a physician point of view. Furthermore, the patient should be given a chance to provide a summary about the physician said. Such information is integral when building an agreement between the physician and the patient. Toungue, Epps & Forese, (2005) stated that physician-patient agreement plays an important role in influencing the outcome. 

Toungue, Epps & Forese, (2005) indicated that the majority of patients often generate their own perception of adherence based on the views they source from their own world. Such notions are also derived from social contexts. The mentality of this type is regressive in a medical setting since they cause a diversion from the expectation which on the other hand leads to negligence to the desired practice (Toungue, Epps & Forese, (2005). Physicians with excellent communication skills can easily understand patients’ social values, experience as well as expectations. 

Conclusion

It is apparent that most patients do not bother to know the much that their physicians know. Rather, they concentrate in understanding how much the physician cares. In this article, physician-patient communication is regarded as a critical element in the healthcare. Physicians have been mandated with the duty of ensuring that patients good health are restored using all the available mechanisms. As such, physicians are not only respected but also issued with the power to conduct their duties effectively. Physicians have the ability to influence the health of patients. however, in order for them to achieve that purpose, a couple of factors need to be considered such as physician-patient communication.

The contents of this paper suggest that good physician-patient communication is essential to ensuring that the entire care process is successful. Communication, in this case, serves four main purposes namely incentive, support, motivation and most importantly reassurance functions. With all these functions, it is apparent that communication brings about the good interpersonal relationship between the physician and the patient. This, on the other hand, guarantees job satisfaction and nurtures self-confidence and positive thinking that would affect the health outcomes. 

This article has also elucidated that with good communication skills, a good interpersonal relationship will be cultivated. Apparently, good interpersonal relationship has been identified as one of the strategies in which physicians ought to embrace in order to avoid complaints in a hospital setting. Notably, physicians who exhibit such skills are able to detect issues prior to them running out of control. By so doing, they are well positioned to provide quality outcomes and patients satisfaction. Besides, it reduces the costs of care, yields a better patient understanding of issues relating to health as well as enhance patients’ adherence to treatment therapy. 

References

Arora N. (2003). Interacting with cancer patients: the significance of physicians' communication behavior. Soc Sci Med, 57(5):791–806.

Baile et al (2000) SPIKES—a six-step protocol for delivering bad news: application to the patient with cancer. Oncologist . 5(4):302–311. 

Duffy F. D., Gordon G. H., Whelan G., et al. (2004). Assessing competence in communication and interpersonal skills: the Kalamazoo II report. Acad Med, 79(6):495–507. 

James, J.T. (2013). A New, Evidence-Based Estimate of Patient Harms Associated with Hospital Care. Journal of Patient Safety , 9(3):122-128.

Kindler C. H., Szirt L., Sommer D., Häusler R., & Langewitz W. (2005). A quantitative analysis of anaesthetist-patient communication during the pre-operative visit. Anesthesia , 60(1):53–59 

Lee S. J., Back A. L., Block S. D., Stewart S. K. (2002). Enhancing physician-patient communication. Hematology Am Soc Hematol Educ Program . 1:464–483. 

Little P., et al. (2001). Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ . 323(7318):908–911.

O'Keefe M. (2001).Should parents assess the interpersonal skills of doctors who treat their children? A literature review. Journal of Pediatric Child Health, 37(6):531–538. 

Starmer, A. J. et al (2014). Changes in Medical Errors after Implementation of a Handoff Program. New England Journal of Medicine , 371:1803-1812. DOI: 10.1056/NEJMsa1405556 (Starmer et al., 2014)

The A. M., Hak T., Koëter G., & van Der Wal G. (2000). Collusion in doctor-patient communication about imminent death: an ethnographic study. BMJ, 321(7273):1376–1381. 

Tongue J. R., Epps H. R., Forese L. L. (2005). Communication skills for patient-centered care: research-based, easily learned techniques for medical interviews that benefit orthopedic surgeons and their patients. Journal of Bone Joint Surg Am , 87:652–658.