Importance of Physician/Patient Communication Essay

Thesis Statement The communication relationship between physician and patient has an impact on diagnoses and treatment options. 1. Four types of truth-telling affect the communication relationship of physician/patient. The quality of communication physicians and patients maintain in the treatment process is very important as it has a bearing on the outcome of the treatment process. The quality of medical care physicians give to patients determines the quality of services exchanged between the two. For communication to be effective, several factors have to be in place. Communication has to be clear, communication has to be timely, communication has to contain the right content, the communication must be disseminated through the proper media and targeting the right recipient. Truth-telling is very central to the physician/patient relationship. How a patient is going to react to the news broken by the physician is highly dependent on the kind of truth-telling approach the physician chooses. The four types of truths; direct, factual, personal and interpretative also known as hermeneutical truth apply in different situations. In truth-telling, the physician has to consider the full impact of the news and therefore decide on whether to apply principle of non-disclosure or full disclosure . Depending on the situation the truths could reveal or conceal information. This is determined by the kind of relationship existing between the patient and the physician. In the process of truth-telling the right environment has to be present. There is a need for trust between the patient and the physician as the level of trust the two parties have for each other directly impacts on communication and perception. There is need for empathy especially considering the fact that some of the news the patient is likely to receive could be bad news concerning issues ranging from death to serious medical conditions. This calls for the physician to gauge the situation and decide on what to reveal or what to conceal. Such a step is likely to save the patient from the agony of having to cope with bad news or the consequences of such breaking of news. There is a need for patience on the part of the physician as well as the part of the patient considering the fact that medical disclosure has an undeniable impact on the communication relationship between the patient and the physician. Physicians should be able to carefully analyze information before disseminating such to the patient. This calls for the physician to be able to set realistic goals for the patient and not to raise hopes even when the situation is clearly negative. This implies that it is the responsibility of the physician to choose what kind of truth to apply as some situations may call for direct truth while others may call for factual truth. In some instances, personal truth may be applicable while in other cases, only interpretive truth could be applicable. However, the bottom line is for the physician to be analytical enough to differentiate situations and decide on the best approach to use. Truth-telling is very important in the medical disclosure process since how poorly or well executed the disclosure is carried out, always has a legal implication. In some other cases, the process of disclosure could have business implications especially if the health care setting is in private practice. A physician is supposed to consider numerous factors especially in regard to the physician’s code of conduct. This calls for the physician to consider issues such as cultural factors . Depending on the culture of the patient, the physicians should device or even improvise communication strategies which will not go in contravention of the cultural beliefs and cultural norms of the patients. This points to the importance of physician’s knowledge in cultural issues in the community where the physician serves. The physician must understand how different cultures treat issues such as death. Such knowledge is important because breaking news in an offensive manner could cause unnecessary tensions between the physician and the patient. Truth-telling therefore should be determined by cultural considerations and depending on cultural orientations of the patient, it is the responsibility of the physician to choose the method of communication, the approach to use as well as how the different types of truths are applicable in the given cultural context . Truth-telling from the physician’s perspective, consist of full disclosure or limited disclosure . Several factors determine what type of disclosure the physician finally settles on. However, it is crucial for the physician to consider the patient’s right to know when it comes to the decision on whether to give full disclosure or limited disclosure . The right to know as it applies to the patient is a fundamental human right. However, to the physician it is a question of ethics and implications. This results into a kind of conflict within the physician’s mind as well as between the physician and the patient . The situation worsens if the legal implications of a full disclosure are higher than the potential benefits. This is when a physician is supposed to make a rational decision and go for the limited disclosure . It is evident that some issues that surround the physician’s ability to tell the truth are beyond the physician’s ability and as a result, the physician has to possess high communication skills. The physician is faced with the problem of honouring and fulfilling the needs and demands of the patient. Equally important are the personal traits of the physician given the fact that some decisions a physician makes are largely determined by the character of the physician . A physician who is indecisive is likely to fail to make the right decisions while a physician who is apt is likely to make decisions on the kind of disclosure to make to the patient . Apart from physician’s personal ability to deal with challenging situations, other factors come in play in regard to physician’s perspective about disclosures. The impact of the physician’s origin is demonstrated in the kind of decisions which the physician makes when it comes to disclosures. For instance, the origin of the physician especially in regard to expatriates has an effect on the kind of decisions considering the fact that different places have different norms and standards of doing things. However, physicians’ code of conduct demands that every physician consider the outcome of truth-telling in regard to psychological repercussions of the decisions the physician makes. The origin of the physician also determines the effectiveness of the physician’s communication as historical and cultural factors all have an effect on truth-telling. If a physician has gone through a traumatizing past or had encountered difficult and challenging situations in the past, this can have an impact on the kind of decision the physician makes . However, professionalism dictates that the physician must always act in the best interest of the patient in as long as the decisions do not hurt any party. There still remains a dilemma amongst many physicians when faced with the question of whether to obey the wishes of the patient or to go by their instincts as informed by professionalism. The physician’s conduct, when around the patient, can aid or hinder patient’s compliance and satisfaction . It is imperative for the physician to understand the psychological process or disposition the patient undergoes while sick. By the physician behaving in an offensive or unprofessional manner, this can lead to the patient becoming non-compliant and to become dissatisfied. This sets the precedence for communication breakdown and at this level the question ceases being what kind of truth-telling to tell but how to save the situation and improve the relationship between the patient and the physician. If a physician behaves in an offensive manner next to the patient’s bed, this again hinders the trust the patient has on the physician and the whole institution of health care . This implies that the conduct of a physician has far reaching implications for the professionals not only in the sense of communication but also in the aspect of business relationships . A physician who conducts business in a knowledgeable manner by respecting the cultural background of the patient as well as upholding religious beliefs and background of the patient is likely to enjoy compliance from the patient . Such a physician easily overcomes obstacles and communication becomes easy. The physician who sets such a conducive environment is more likely to experience less challenges in the process of truth-telling and the physician may not experience difficulties in choosing amongst the four types of truths the best and the most suitable for the given situation . Truth-telling from the patient’s perspective can be fully truthful or limited for many reasons. This is because there are effects associated with self-disclosure as there are implications for malpractice. The psychological effects of self-disclosure include the following. A feeling of unworthiness, desperation, vulnerability, as well as the high chances of suffering from psychological conditions such as stress or depression. There are physiological effects associated with self-disclosure. Such may include the craving of a patient to commit harmful actions, self-negligence resulting into body harm as well as harming of those around the patient. Patient dissatisfaction leads to claims of malpractice which ultimately have the potential of affecting the professional. Claims of malpractice affect the credibility of a physician, the credibility of the institution and could also have financial implications . The patient has a right to receive the best care possible and therefore the issues the patient brings out must be addressed fully and without prejudice. The effect bad news delivery has on the communication relationship of the physician/patient vary from individual to individual . For the physician, verbal/non-verbal communication aspect of delivering bad news holds the key to what kind of communication relationship the two are likely to enjoy. As such, the physician must be equipped through training and utilization of the relevant technology to execute and deliver communication in the best way possible. Bad news have different impacts on different patients. This calls for the physician to be analytical about situations and never to take situations for granted by generalization but rather to treat each case as special. Bad news delivery has negative consequences not only for the physician but more so for the patient who suffers psychologically as a result of bad news delivery. Poor delivery of bad news has on many occasions resulted to patients being shocked and in some cases, dying as a result of the effects of bad news delivery . This calls for the health care providers to be genuinely concerned on the impact of delivering bad news and therefore to take time to judge situations on merit before settling on the kind of disclosure suitable for the given situation. There is a need for the physician to assess the ability of the patient to cope with bad news as this is the only to ensure that the impact of bad news delivery are kept at minimal. Social construction in health communication has an impact on the patient’s perspective on communication. Therefore, there is a need for physicians to analyze and understand the patient’s locus of control when it comes to delivering of bad news. Some patients are more stronger than others and can therefore cope with pain associated with bad news. On the other hand, there are some patients who are weak in terms of the ability to cope with bad news. Therefore, social construction in health communication should be considered in the delivery of bad news. The internal/external locus of control requires both the patient and the physician to be weary of implications of communication not only to patients and physicians but also to the society at large. This is especially so considering the fact that some societies view issues related to health matters as communal or familial and it is therefore not the choice to be left to the patients and physicians only . The impact of different communication styles vary between males and females. This requires the physician to be considerate when breaking or delivering news. Communication dynamics therefore must be taken into consideration before deciding on the best type of communication to apply. The context is important because different news may mean different outcomes for males and females alike. It is worth noting that the context should be considered in the determination of the best channel to use in communicating news. Traditionally, story telling and narratives have been favoured by many physicians as effective means of communication regardless of the patient’s gender. However, with the advent of technology, there is a need for physicians to be equipped in other means of communication such as Internet. It is worth noting that usage of analogies, metaphors and similes can aid process of communication. However, such aids could be a form of distraction if not applied carefully. The above-mentioned types of aids must be applied only in proportionate measures with due regard or consideration to the confusion they may bring about . Physicians must be able to choose what type of aid suits what kind of situation and ultimately settle on application of aids which cause the least amount of distraction . The best choice of communication aids must be dictated by the different needs of communication for both the physician and the patient. In conclusion, it is worth noting that communication plays a very central role in health care provision and physicians must always bear in mind the implications of the choices they make in regard to communication. There is a need to improve communication relationships between physicians and patients as the effectiveness of such communication relationship is what determines how effective health care provision will be. References Appelbaum, P.S. , & Grisso, T. (1988). Assessing patients’ capacities to consent to treatment. New England Journal of Medicine, 319(25): pp. 1621-1629. Bourgeois, M. S. (1991) Communication Treatment for Adults with Adults with Dementia, Journal of Speech & Hearing Research, 14: pp. 829-841. Davis, Dena S. Legal Trends in Bioethics (review), Journal of Clinical Ethics. 1996: 7(2): pp. 183-96 Dodek, D. Y and Dodek, A. (1997) From Hippocrates to facimile. Canadian Medical Association Journal. 156 (6): pp. 841-858. Finucane, P, Myser, C & Ticehurst, S. 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