El4 rufai project work
- 1. From ancient times, physicians have recognized that the health and well-being of patients depends upon a collaborative effort between physician and patient. Patients share with physicians the responsibility for their own health care. The patient-physician relationship is of greatest benefit to patients when they bring medical problems to the attention of their physicians in a timely fashion, provide information about their medical condition to the best of their ability, and work with their physicians in a mutually respectful alliance The doctor–patient relationship is central to the practice of healthcare and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease. The doctor–patient relationship forms one of the foundations of contemporary medical ethics. Most universities teach students from the beginning, even before they set foot in hospitals, to maintain a professional rapport with patients, uphold patients’ dignity, and respect their privacy. A patient must have confidence in the competence of their physician and must feel that they can confide in him or her. For most physicians, the establishment of good rapport with a patient is important. Some medical specialties, such as psychiatry and family medicine, emphasize the physician–patient relationship more than others, such as pathology or radiology. The quality of the patient–physician relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease and life, and time available, the better will be the amount and quality of information about the patient's disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient's knowledge about the disease. Where such a relationship is poor the physician's ability to make a full assessment is compromised and the patient is more likely to distrust the diagnosis and proposed treatment, causing decreased compliance to actually follow the medical advice. In these circumstances and also in cases where there is genuine divergence of medical opinions, a second opinion from another physician may be sought or the patient may choose to go to another physician. Additionally,
- 2. the benefits of any placebo effect are also based upon the patient's subjective assessment (conscious or unconscious) of the physician's credibility. The physician may be viewed as superior to the patient simply because the physician has the knowledge and credentials and is most often the one that is on home ground. The physician–patient relationship is also complicated by the patient's suffering (patient derives from the Latin patior, "suffer") and limited ability to relieve it on his or her own, potentially resulting in a state of desperation and dependency on the physician. A physician should at least be aware of these disparities in order to establish a good rapport and optimize communication with the patient. It may be further beneficial for the doctor–patient relationship to have a form ofshared care with patient empowerment to take a major degree of responsibility for her or his care. Fundamental Elements of the Patient-Physician Relationship Physicians can best contribute to this alliance by serving as their patients’ advocate and by fostering these rights: (1) The patient has the right to receive information from physicians and to discuss the benefits, risks, and costs of appropriate treatment alternatives. Patients should receive guidance from their physicians as to the optimal course of action. Patients are also entitled to obtain copies or summaries of their medical records, to have their questions answered, to be advised of potential conflicts of interest that their physicians might have, and to receive independent professional opinions. (2) The patient has the right to make decisions regarding the health care that is recommended by his or her physician. Accordingly, patients may accept or refuse any recommended medical treatment. (3) The patient has the right to courtesy, respect, dignity, responsiveness, and timely attention to his or her needs.
- 3. (4) The patient has the right to confidentiality. The physician should not reveal confidential communications or information without the consent of the patient, unless provided for by law or by the need to protect the welfare of the individual or the public interest. (5) The patient has the right to continuity of health care. The physician has an obligation to cooperate in the coordination of medically indicated care with other health care providers treating the patient. The physician may not discontinue treatment of a patient as long as further treatment is medically indicated, without giving the patient reasonable assistance and sufficient opportunity to make alternative arrangements for care. (6) The patient has a basic right to have available adequate health care. Physicians, along with the rest of society, should continue to work toward this goal. Fulfillment of this right is dependent on society providing resources so that no patient is deprived of necessary care because of an inability to pay for the care. Tipson BuildingDoctor/PatientRelationsMostof the informationusedfordiagnosisandmanagementis gleanedfromthe H&P.It isimportantthat youare able to effectivelycommunicate withpatientstobest helpthem.Essential tocommunicationisbeingable toquicklyestablishrapportwith yourpatients.• Demonstrate toyourpatientsthatyou understandtheirsituationsandfeelingsbyshowingempathy duringpatientinterviews.Empatheticcommunicationisone of yourmostvaluedmodalitiesandhelps to ensure a trustingrelationshipbetweenyouandyourpatients.The followingstepswill strengthen your patientcommunicationskills:1.Seektominimize distractionsandinterruptionswhenvisitingwith your patients.Putyourbeeperonsilentmode duringyourvisit.Close adoorif outside noise isa distraction.(However,askyourpatient’spermissionfirst.) Remember,too,thatpatientscanoffergreat insightintotheirconditionsfromwhattheytell you.Solimitthe numberof timesyouaskquestionsor otherwise interruptwhenyourpatientsare presentingtheirchief complaints.2.Engage inactive listening.Concentrateonwhatthe patientiscommunicatingverballyandnonverbally.Take intoaccount bothfacts and emotions.3.Be deliberate aboutthe nonverbal cuesyousend.Leanforward,maintain eye contact,nod appropriately,anddon’tcrossyour arms.4. Offerconcrete feedback.Whenyou summarize whatyou’ve heard,frame yourresponsesbysaying“Letme see if Ihave thisright…” Seekto identifyorclarifythe patient’sfeelingsby saying“Tell me how you’re feelingaboutthis”or“I have the sense that…”5. Allowthe patienttocorrector add to yourresponsesuntil he orshe confirmsyour understanding— “DidImissanything?”Accordingtoseveral sources,the effective use of empathy promotesdiagnosticaccuracy,therapeuticadherence andpatientsatisfaction.•Enhance your counselingandlisteningskillsbyusingasimple five-stepprocess.Gatherinformationaboutthe context of the patient’svisitbyasking:1) Whatis goingon in yourlife?2) How do youfeel aboutthat(or how doesitaffectyou)?3) What aboutthe situationtroublesyoumost?And4) How are youhandlingthat? Thenshowunderstandingbyobserving:5) “That mustbe verydifficultforyou.”Thistechnique is identifiedbythe acronymBATHE(whichstandsforbackground,affect,trouble,handlingandempathy). • Be preparedto provide culturallyresponsive care.Be aware of how your owncultural values,beliefs
- 4. and assumptionsmayinfluenceyourdeliveryof care.Understandthe impactof culture onyour patient’srecognitionof symptomsandbehaviorsrelatedtoillness.Be readytoaddresslanguage barriersthroughthe use of familymembers,translators/interpretersandothercommunityresources,if necessary.•Gain a newperspective onyourpatientsbyassessingyourownbiases.Youwill encounter patientswho,forone reasonor another,cause youfrustration,grief orevenanxiety.If thisisthe case, take time to examine whyyoufeelthisway.The reasonaparticularpatientgivesyoutrouble mightbe foundinyour ownpast.For example,if youruncle wasnoncompliantwithhisdiabetesmanagement, perhapsyounowhave lesstolerance of patientswhoexhibitsimilarbehavior.O
- 5. ResearchQuestions Which factorsare associatedwithpatientsatisfactioninprimaryhealthcare? Isthere a difference in patientsatisfactionbetweenpublicandprivate sectorsof primaryhealthcare? Isthe level of patient satisfactionachievedfromaconsultationperceiveddifferentlybypatientsanddoctors? Aims To identifythe characteristicsof afamilydoctormostlikelytoleadtopatientsatisfaction Tocompare and contrastcharacteristicsof familydoctorsinpublicandprivate sectors of primaryhealthcare To compare patientsatisfactionbetweenpublicandprivate sectorsof primaryhealthcare Objectives To identify: the perceptionsof patientsinthe governmenthealthcentresof theirdoctors’personality traits,professionalvalues,dutiesandresponsibilities,communicationskills,andclinical care the perceptionsof patientsinthe private primaryhealthcare sectorof theirfamilydoctors’personality traits,professionalvalues,dutiesandresponsibilities,communicationskills,andclinical care the perceptionsof patientsinbothpublicandprivate sectorsof primaryhealthcare on the mostimportant characteristicsof a familydoctorthat leadtopatientsatisfactionObjectives Tocompare patient satisfactionbetweenpublicandprivate sectorsof primaryhealthcare To identifythe perceptionsof familydoctorsasregards critical factorsin theirpractice associatedwithpatientsatisfaction Toprovide feedbackonthe resultsof the studyto doctorsin varioussectors of primaryhealthcare Research Setting Malta isa small islandwithanestimatedpopulationof 410,290 (National StatisticsOffice,2008) Two -thirdsof primarycare providedbyprivate sector Publicsectorconsistsof 9regional healthcentres and 47 districtclinics 24 -hourcomprehensivehealthcare servicesfree atpointof deliveryPrimary HealthCare Patients’firstcontact withhealthcare
- 6. PrimaryHealthCare Patients’firstcontactwithhealthcare system Hubfrom whichpatientsare guidedthroughthe health system(The WorldHealthReport,2008) Place where relationshipsbetweendoctorsandpatients develop Healthpromotionanddisease prevention Basisconsistsof gooddoctor-patientrelationships and continuityof care (Azzopardi &D Factors AffectingPatientSatisfaction Gooddoctor-patientrelationship Beingempathic;givingthe patienttimeandattention Honesty, trustworthiness,able tokeepconfidentiality Meetingthe patients’desiresandexpectations; congruence betweendoctor’sandpatient’sperceptionsof the consultation Factors AffectingPatientSatisfaction Easy accessibility Goodcommunication Goodclinical care;givinganexplanationof the symptoms Continuityof care Qualityof medical facilitiesPrimaryHealthCar Factors mostlikelytoleadtopatientsatisfaction 1. Beingreadyto explainwhatiswrongbefore givingtreatment 2. Beingup to date withrecentdevelopmentsinthe profession 3. The abilitytomake the rightdiagnosis 4. Beingenthusiastic
- 7. 5. Having a nice attitude withpatients 6. Beinghonestyandtrustworthy Doctors’perceptionsof patientsatisfaction 1, Semi-structuredinterviewscarriedoutondoctorsworkinginthe clinics 2. In the publicsector, doctorsspendmuch lesstime withthe patientthaninthe private sector3. Limitedtime explains difference incommunicationskillsbetweensectors 4. Poorperceptionof patientsatisfactioninthe publicsector Doctor Satisfaction 1. Dependsongooddoctor-patientrelationshipsandcontinuityof care Verylow inpublicsector,high inprivate sector Affectslevel of patientsatisfactionachievedR