Why do the doctor learn communications?

On the virtual workshop “Around Medicine” [ 1 ] Association of communicators in the field of education and science (Axon), an oncologist from the NMIC oncology named after Petrova Maxim Kotov gave a lecture on the effective communication of the doctor and the patient. Yana Pchelintsev and Alexander Borisov give the main theses of this speech, especially relevant during the period of pandemia and increased attention to the functioning of the healthcare system.

Numerous studies have shown that the qualitative interaction of the doctor and the patient becomes the key to not only successful treatment, but also a decrease in the number of complaints about doctors.

“The skills of communicating with the patient are basic for the doctor, as well as performing surgery, prescribing treatment, reading skills, etc.,” Maxim Kotov believes. - However, it is important to understand that “good communication” and “effective communication” are different things. It is believed that effective communication is mutual receipt of information. He can further use all the information that the doctor receives from the patient to make a diagnosis, the choice of treatment methodology, etc., the patient also receives information on the basis of which he begins to trust the doctor.

Empathy - guarantee of trust

In 1996, the Kalgary-Kambridge model of the communication of the doctor and patient was proposed [ 2 ]. It includes several stages: the beginning of the consultation; information collection; inspection; clarification and planning; Completion of consultation.

In developed medical systems, doctors try to adhere to this model. It helps to build trust, which will become the key to successful treatment. However, at each stage, communication participants are faced with many problems and barriers.

Studies of consultations of general practice doctors of Great Britain and the United States show that in about half cases the doctor does not reveal the patient's problem. The patient begins to tell - and on average, after 19 seconds, the doctor interrupts and clarifies complaints. (Note that about a third of Russian doctors believe: if the patient is not interrupted, then the time will be spent inefficiently [ 3 ].) As a result, the doctor “clings” to the first complaints, detail them. All this leads to the fact that the problem with which the patient came is often unbearable.

The longer the doctor does not interrupt, the more important clinical information he will receive from the patient. It is necessary to be able to stimulate the patient to the story, giving, including non -verbal signals (for example, nodding as a sign of consent), and observe the response. Researchers note that when using facilitations (communication organization, in which the doctor encourages the patient’s story with verbal and non -verbal signals), patients are more satisfied with communication with the doctor and make less claims [ 4 ]. In addition, this leads to an improvement in the quality of the information received from the patient [ 5 ].

Approaches to the collection of information about illness can be built on two models: the traditional and model “Disease - experience of the disease”. The difference between the second, more modern approach is that the doctor records not only symptoms, family history and diseases; Significant attention is paid to the psychological aspects of the problem: not only the disease itself can bother the person, but also its consequences, the risks of treatment, etc. In the framework of this model, the doctor listens to the patient’s considerations about the disease, his anxiety and expectation due to treatment. He asks questions, for example: “What, in your opinion, are the symptoms caused?”, “What are you afraid of in the process of treatment?”, “Do you think this can be cancer?” etc. These additional issues strengthen trust in the doctor and can push him to new considerations about the patient's problem.

Diagnosis as a boring lecture

And now the time comes to inform the patient about what the doctor found out and how he plans to treat. At this stage of the consultation, a number of communicative barriers are also found. Here are the data described above the Anglo-American study:

• In 20% of cases, during consultation with general practice doctors, the prescription of drugs was not discussed, in 80% of cases the dosage was not discussed and in 90% of cases - the duration of the course of treatment [ 6 ];
• Patients value information about the diagnosis, prognosis and causes of the disease, but doctors focus on treatment and drugs [ 7 ];
• Doctors did not explain 79% of medical terms, and patients rarely showed that they did not understand them or understood them incorrectly [ 8 ];
• As a result of 10% to 90% of patients, medicines prescribed by the doctor are not used, etc. [ 9 ].

The doctor explains either too long and incomprehensible, or too briefly and indifferent; He does not explain his words and is in no hurry to make sure that the patient understood everything. A medical explanation looks like a boring lecture. But here an important task is realized - to convey the information to the patient and convince to follow the recommendations.

So what to do?

Skills of communication with patients can be learned. However, this is not so simple, because doctors often have to completely change the behavior model. For training, the experimental methods are used: observation, feedback from the tutor and multiple repetition of actions. Pupils view or listen to video and audio recordings of real consultations, study in the workplace with real patients or participate in an artificially created situation where specially prepared actors play the role of the patient.

In the process of preparing for this training, the organizers find out the needs of the doctor himself: what skills he would like to work out? Maybe this is sympathy, maybe - the ability to explain clearly. The behavior of the "patient" and a doctor-student is observed by a coach and a group of colleagues. Discussions and assimilation of new experience help to introduce the acquired skills in practice.

Good communication will protect against complaints

Properly built communication not only helps to increase the satisfaction of the doctor and the patient with the results of their meeting. It, as the researchers have repeatedly noted, allows the doctor to avoid complaints or lawsuits by patients.

In the United States, the difficulties of interacting with a doctor become the cause of 7 out of 10 appearances of patients in the court [ 10 ]. About a third of the complaints are filed due to neglect of the opinions of patients and their relatives. In Canada, researchers compared how the doctor’s assessments for the communication exam influence in the future the number of complaints from patients [ 11 ]. It turned out that the higher the assessment, the fewer dissatisfied patients in the doctor.

The patient cannot at the move evaluate the correctness of the prescribed treatment or fidelity of the diagnosis, but he easily recognizes the attentive attitude from the doctor. What consultations, from the point of view of the patient, are bad? [12] Short, illogically constructed conversations during which doctors neglect the patient’s opinion, do not give themselves difficult to explain the diagnosis, do not show empathy and do not respond to the patient’s emotions. And it is precisely such meetings with the doctor who leave the patient dissatisfied and encourage him to complain about the doctor.

This problem is relevant in our country. There are few Russian studies of this topic, but they confirm global grades. According to the League of Patient Defenders, in the first place among the reasons for the appeal of citizens to the league is a violation of ethical norms on the part of the doctor: rudeness, unwillingness to explain risks, comment on appointments [13].

It's time to solve these problems.