Communicating with Ill Patients

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Communicating with Ill Patients

• Psychology of Illness

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Would you like a coffee while your waiting?
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Problems of the Patient
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Losses

• Loss of physical function
• Loss of mental function
• Loss of social abilities
• Loss of self-image
• Disfigurement or change in body image

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More Losses

• Loss of Home
• The home equals security and safety
• Knowing where things are what to expect
• The home means being in control of ones life
• Having a familiar routine
• Controlling where things are and when we do
  things

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More Loses

• Loss of Privacy
• Having a sense of space that is ones own
• The invasion of ones body space via the
  hospital gown
• Inability to control who enters your space
• Rooms without walls or doors

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More Loses

• Loss of Independence
• Patients go where they are told when they are
  told
• Inability to eat and/or drink what they wish
• Loss of certain food choices or activities
• Necessity of needing help in performing basic
  tasks (activities of daily living ADLs)

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Stigma of Permanent Disabilities

• Creates a sense of inferiority
• Sometimes ill people are stigmatized as
  different, scary or strange
• Sense of being less of a person

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Five Fears of the Disabled

• 1. My disability is a punishment
• 2. My disability is revolting
• 3. I will be a burden to my family
• 4. A deformed body leads to a deformed mind
• 5. I am less valuable since I cant get around
  as others can

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Patients Have a Sense of Vulnerability

• Is care being given correctly?
• Are staff competent?
• Patients may express paranoid tendencies
• The situation is beyond their control
• Theres nothing I can do to help!
• Im a victim of circumstances

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My mistake. Im supposed to rub it on your chest.
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Stay there. I got the wrong one.
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Uncertainty About the Future

• Fears my be based upon fact or fantasy
• Am I really getting better?
• Will I get sick again soon?
• When can I go back to work?
• How will my family copy with my illness once I go
  home?
• Whos going to pay the medical bills?

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The results of your tests were negative. Get
lost!
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Privileges of the Patient
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Benefits of Being a Patient

• I dont have to go to work or school
• Im exempt from household chores and duties
• I can relax read, watch TV or just sleep
• Others will wait on me
• People will come to visit me and bring flowers

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Explicit Rights of the Patient

• The American Hospital Associations Patients
  Bill of Rights
• Twelve rights to which all patients are entitled

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Patients Bill of Rights

• 1. Patient has the right to considerate and
  respectful care
• 2. The patient has the right to obtain from his
  physician complete information concerning his
  diagnosis, treatment and prognosis in terms the
  patient can understand.

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Patients Bill of Rights cont

• 3. The patient has the right to receive from his
  physician information necessary to give informed
  consent prior to the start of any procedure or
  treatment
• 4. The patient has the right to refuse
  treatment to the extent permitted by law and to
  be informed of the consequences of his actions

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Patients Bill of Rights cont

• 5. The patient has the right of privacy
  concerning his own medical care
• 6. The patient has the right to expect that all
  communication and records pertaining to his care
  should be treated as confidential

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Patients Bill of Rights cont

• 7. The patient has the right to expect that
  within its capacity a hospital must make
  reasonable response to the request of a patient
  for services
• 8. The patient has the right to obtain
  information as to any relationships his hospital
  has with other health care institutions insofar
  as his health care is concerned

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Patients Bill of Rights cont

• 9. The patient has the right to be advised if the
  hospital proposes to engage in or perform human
  experimentation affecting his care or treatment.
• 10. The patient has the right to receive
  reasonable continuity of care.

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Patients Bill of Rights cont

• 11. The patient has the right to examine and
  receive any explanation of his bill, regardless
  of source of payment.
• 12. The patient has the right to know what
  hospital rules and regulations apply to his
  conduct as a patient

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Excuse me. The little light is going in a
straight line.
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Interacting with Patients, Family and Other Staff
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Why is Effective Communication Important?

• We need to establish rapport with others
• We need to obtain information concerning the
  patients condition and progress
• We need to relay pertinent information to other
  health care professionals
• We need to educate patients, family and other
  health care providers

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What Factors Influence Communication?

• The way the information is presented
• Clarity of voice
• Vocabulary used
• Organization of content
• The attitude of the speaker
• Non-verbal cues (facial expression, body
  language, etc.)

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Which one of you is General Smith?
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What Factors Influence Communication?

• Tone and volume of speakers voice
• Too loud? Too soft? Too fast?
• The degree to which both speaker and receiver are
  able to listen effectively
• Paying attention to the meta-message of what is
  being said instead of just the words
• What is the over-all meaning of the message?

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Vocabulary Problems

• Use of the wrong word(s)
• Omission of important ideas
• Use of long rambling sentences
• Use of medical jargon inappropriately
• With patients and families

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Problems of Clarity

• Speaking too quickly
• Speaking while doing something else
• Failure to ask if the patient understands the
  directions

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Problems with Organization

• Lack of understanding of the procedure or process
  by the clinician themselves
• Having too much information and trying to give
  it all to the patient
• Poor preparation by the clinician
• Lack of a clear educational goal in the mind of
  the clinician

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Ways to Improve Communication

• Effective Listening
• Analytical listening listening for specific
  kinds of information
• Directed listening in order to answer specific
  questions
• Attentive (active) listening for general
  information in order to get the overall picture

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Difficulties Patients Experience Hearing What
Youre Saying

• Language Barriers
• Perceptual Defenses
• Patients are least likely to learn when they are
  the most ill.

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Difficulties Patients Experience Hearing What
Youre Saying

• Sensory Overloading
• Some people can only absorb so much information
• Be direct, concise and consistent
• Patient may have difficulty determining what is
  the most important issues or problems

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Difficulties Patients Experience Hearing What
Youre Saying

• Pre-occupation with other issues
• General emotional stress decreases cognitive
  abilities
• Medications may impair visual and auditory
  processing of information
• Lack of adequate cerebral blood flow or
  oxygenation may impair cognition

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Strategies for Improving Listening Skills

• Be selective what you listen to
• Concentrate on central themes rather than
  individual statements
• Listen in paragraphs
• Judge content rather than delivery
• Listen with an open mind dont focus on
  emotionally charged words

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Strategies for Improving Listening Skills

• Summarize in your own mind what you are hearing
  before speaking again
• Clarify before continuing
• Re-state the problem back to the patient to be
  sure you have heard correctly by using the It
  sounds like youre saying (feeling) .. method.

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Dealing with Difficult Issues

• How to engage patients and families
  professionally.

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Guidelines for Dealing with Difficult Situations

• Remove the patient, family member or staff member
  from a high traffic area and try to maintain
  privacy
• Sit down when talking with the person(s) and
  listen totally to the situation.
• Listen empathically
• Allow the person to vent the frustration

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Guidelines for Dealing with Difficult Situations

• Use active listening to clarify difficult and/or
  emotional issues
• Stay in the role of the professional
• Try not to lose your own cool!
• Maintain eye contact unless this is culturally
  inappropriate
• Promise the person that you will follow up on the
  issue(s)

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Guidelines for Dealing with Difficult Situations

• Use the appropriate chain of command to report
  the incident or pass on the information
• A team approach is also useful when appropriate.
  (ICU ER)
• Do not leave the person hanging after you have
  become involved!
• Tell them whats happening even if its beyond
  your control

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Maintaining the Professional Role
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Personal Professional Characteristics

• Emotions versus cognition?
• Poker face versus crying
• Formality versus informality?
• Stiff versus goofy
• Personal disclosure versus distance?

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Make sure this one doesnt leave before he pays
his bill
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And we are out of here!

• The end