Importance to make informed decisions and take

Importance of
doctor-patient relationship

Effective communication
between the doctor and patient is an important life skill that enables us to
better understand and connect each other. It allows us to build the trust and

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Good communication skills compose
of listening, non-verbal communication, sympathy , empathy, and effective
communication in medicine means simply that doctor and patient understand each

Doctor and patient centered communication

When we look for evidence based
management of disease, we find management plans that focus on disease and not
the permutations of our patients. Traditionally, doctors have been trained to
be disease centered, but diseases are wrapped with in packages that are
patients and a fundamental clinical skill is applying evidenced based medicine
to the spectrum of different patients. Patient centered communication is the
process of providing patients with the appropriate knowledge an understanding
to enable them to make informed decisions and take appropriate responsibility
for their care. Such an approach combines the professional knowledge and
opinions of the doctor with respect for the autonomy of the patient. For
example, if we want to treat thyrotoxic patient, we should explained the types
of treatment; medical , radiotherapy or surgery.

Clinical knowledge is not
disbanded in favor of patient choice. Rather, it is central to helping patient
decide what is best for them. Consider that the surgeon of the thyrotoxic
patient felt the thyroidectomy was the best course of action. It would be right
to explore her understandable concerns about the operations, pros and cons ,
consequences of having the operation and not having it. Negotiating the best
course of action for her should address these concerns. A balanced explanation
by the surgeon may emphasize the low incidence of serious complications,
despite her fears, and include expectation of what may happen if she does not
proceed to surgery now. Despite this process of shared understanding if the
patient, competent to decide and aware of the risks, declines surgery, she is
exercising her autonomy.

Understanding the patient
concerns and discussion about the treatment plan is pivotal role at the
management of the disease even that disease is not curable as this can be
improved the patient satisfaction, compliance and outcome of the treatment (29,30).
For example, discussing the management of diabetic, we should explain the
benefits of sugar control, reinforce the patient’s own motivation for diet
restriction, compliance of medications rather than telling the patient that you
need to take medicine regularly for blood sugar control. Explanation should be
short , simple and clear as possible., avoiding complex medical terminology. By
doing so, we can achieve the desire aim and management with less psychological
distress in patient with serious illness. 

Moreover, when we need to deal
with the breaking the bad news , there are some important principle we need to
take note of ;

the information, building up the news layer by layer

information in clear, simple, small pieces

important information

feedback and giving your patient plenty of opportunity to respond


realistic and honest but leaving room for hope

Breaking the bad news is important
for all medical doctors that everyone will encounter during the life. During
conversation, we should need to consider patient emotions, understandings, hope
for the future and background support for long term treatment and support from
the family. Explaining diagnosis alone and treating the patient cannot get the
best outcomes if patient is not cooperate with medical team.

Cross-Cultural Communication

Cultural factors can have large
influences on disease management. Further, patients from different cultures may
have differing beliefs about causes of their disease and effects of treatment. For
example, during Ramadan, Muslim patients may not eat anything, including
tablets, during daylight hours, and often eat a large meal after dark. Diabetic
is especially common in many Asian populations and Muslim beliefs any have
important repercussions on the style of management chosen. During discussion ,
it is important to adhere to the points , explain clearly , allow  plenty of time, show interest and concern and
give non-verbal reassurance, avoid jargon and check understanding. Sometimes,
if needed we should get help from interpreter to explore more about the disease
and management. However, there are some potential problems may arise when using
the interpreters such as incorrect understanding and transmission of
information, failure to communicate simply, domination of the patient by the
interpreter, failure to allow sufficient time (at least doubling time is
required )

As a general rule, the same
principles of good communications and explaining skills described earlier when
consulting with patient from different cultures. In other words, we should try
to do more of the same, rather than treat such patient differently.

Keep to a doctor’s framework

Communication is a two-way
process of sharing. A framework of points we need to discuss or management
options we wish to consider keeps the consultation on tack. Patients prefer
doctors who are open, informative and considerate. A good analogy is with
active and passive listening. A doctor who sits forward, makes good eye contact
and appears attentive is more likely to inspire a patient than one who sits
back and appears uninterested. Equally, a doctor who is actively trying to
reach the best management strategy through careful, well controlled discussion,
is more likely to achieve a better outcome than one who seems happy to let
patient ‘do what they like’.

Management options may
include further investigations and pharmacological or non-pharmacological
treatments. Patients may in the extent to which they wish to be involved in
management decisions, but most want to be informed about possible options. For
each option it is often worth stating your positions particularly where there
appears to be a strongly right option clinically. The problem with guidelines
is that they are created primarily for disease management and cannot be
explicitly applied to every patient with the disease.

To conclude, good
communication skills encompasses listening, non-verbal communication, stress
management and emotional awareness. Understanding the patient expectation will
allow us to handle well rather than one sided explanation.




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