The nature of patient-provider communications

Who can be considered healthcare providers?

• Advanced practice nursing:

  • Nurse practitioners – sees their own patients, provides routine medical care, prescribes treatment, monitors progress of chronically ill patients and sees walk-in patients (ALL UNDER THE SUPERVISION OF AN ATTENDING PHYSICIAN)

  • Certified nurse midwives

  • Clinical nurse specialists

    • Has specialties (surgical nurses, pedia, ICU, etc.)

  • Certified registered nurse anesthetists

    • Relatively new in the US, none in the Philippines

    • Can cover if there is shortage in anesthesiologists

• Physician assistants

  • 2 year post-college program

  • 1st year courses are the same as medical students, 2nd year courses are Clinical Rotations with direct patient contact

  • requires at least 2 years of college and experience in health care before acceptance

  • Good alternative to med school because med school is expensive and too long

  • Didactic, lecture-based

  • Advantage: requires at least 2 years of college

“Issues” with other healthcare providers

• Not popular in the Philippines

• Redundancy of other health care professions such as psychiatrists, general practitioners, internists, etc.

• Cannot practice on their own – needs to be “attached” to private medical practitioner

  • Need someone to cosign med orders, etc.

Nature of Patient-Provider Relations

• Judging quality of care

  • Quality of care is often judged based on the MANNER IN WHICH CARE IS DELIVERED

    • How you deliver the diagnosis and how you establish rapport is important

  • If the provider is warm and/or friendly, patients often see them as “nice and competent”.

  • If provider is cold or aloof, patients see them as distant and incompetent.

  • Strike a balance between direct and gauge how straightforward you could be

• Patient consumerism: Doctors are no longer seen as “all-knowing”; patients have increasingly adopted a consumerist or “patient as customer” attitude towards their health care.

• Setting: Average visit lasts 12 to 15 minutes and patients are interrupted not even 23 seconds into their history.

Structure of the Healthcare Delivery System (in US; pretty same in the Philippines but not well-developed)

• Private, fee-for-service-care: paid for out of pocket by patient

  • Usually called private patients

• HMO (Health Maintenance Organization): employees and employers have an agreed upon monthly rate, and employees are entitled to use health services at either no cost or a greatly reduced rate. Employees/patients must be pre-approved in order to see a “within-network” specialist or non-emergency provider.

• Preferred Provider Organizations: Network of doctors offers members a discounted rate, members do not need pre-approval to visit an in-network specialist

Provider behaviors that contribute to faulty communication

• Overuse of jargon

• Baby Talk

• Nonperson treatment

  • Instead of talking to the patient directly, the doctor will talk to the parents

• Patient stereotypes: Black, Hispanic patients; Elderly, Sexism, Psychological symptoms

  • Can come from both the patient and the healthcare providers

Patients’ contributions to faulty communication

• Patient characteristics: neuroticism, anxiety

  • Neurotic: extremely pessimistic

  • Highly anxious: they may project that anxiety unto you

• Patient knowledge

  • Explain why their side/knowledge is wrong and why your side is right

  • Show concrete evidence to support your claim

• Patient attitude towards symptoms: consider patient’s embarrassment, emphasis on symptoms that produce pain or limit movement

  • Embarrassed: usually any kind of mental illness because of stigma (also cultural)

  • pain/limited movement: harder to deal with

Improving patient-provider communication

• 2-way training

  • Patients need to be able to express how they feel, their symptoms

  • Always take into consideration how you’re coming across

    • Can the patient understand you without dumbing it down?

• Information-Motivation-Behavioral Skills Model of health behavior: One needs the right information, the motivation to adhere, and the skills to perform the behavior.

The patient in the hospital setting

• Cure: responsibility of the physician; goal is to restore patient to good health

• Patient Care: orientation of the nursing staff; humanistic side of medicine; goal is not only to restore patient to good health, but also to help patient keep their emotional and physical states in balance.

• Maintaining the Core of the hospital: responsibility of hospital administration; ensures smooth functioning of the system as well as the flow of resources, services, and personnel.

Special issues in patient-provider relations

• Burnout of providers

  • More patients than providers

• When the patient is a child – Best practice is to prepare BOTH the patient and their parents. Ensure the hospital environment is as caring as possible.