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Introduction
• Family physicians conduct about 180,000 office visits in their careers (Roter & Hall, 2006).
• Managed care has made greater demands on healthcare professionals (Meldrum, 2011; Roter & Hall, 2006; Hickson, et al, 2002).
• Yet, 80% of malpractice suits are blamed on patients suggesting that they felt “brushed off” or that physicians did not establish rapport with patients (Hickson et al. 2002).
Patient Adherence
• Financial costs of noncompliance are about $13.35 billion a year in the US and result in 125,000 deaths (Roter & Hall, 2006).
• 50 % of patients do not take their medications correctly and up to 90% do not follow procedural treatments.
• 10 % of hospital admissions are because of noncompliance.
• Researchers suggest that communication is key to improving these statistics.
Topics include:• Communication to improve compliance.• Ways to efficiently improve adherence.• Immediacy behaviors that establish trust so
patients will listen.• Methods of sharing bad news.
Lessons From Aristotle
• Rhetorical triangle essential to persuasion
Ethos
Logos
Pathos
Ethos or Credibility = Caring and Competence
"If patients like their physicians and trust not only their technical skills but also their commitment to advocate a plan of treatment that really is best suited for the patients, the patients are more likely to comply,” (Roter & Hall, 2006, p. 15).
Empathic Listening
Perspective of the disease Effect on his or her lifestyleUnderstanding of why to take the drugs if the
patient feels wellAffordability of the drug or treatmentEffect of drugs on social activitiesAbility to continue work functionsEmotional factors (Roter & Hall, 2006)
Logos – Logical Understanding• Dr. Mark Gebhardt (2011) suggested that
physicians should involve the patient in the decision-making process to increase patient awareness and emotional involvement.
• 42 % of patients misunderstand the directions for treatment. This is highest among older patients (Martin et al, 2005).
• Patients comply more often if they understand the how and why.
Pathos - Emotion
• Korsch and Harding (1998) posit that patients must believe that the treatment is doable.
• If treatment makes them feel bad, they will not follow through so explain the why.
• Use positive appeals or explain positive outcomes rather than using fear or scolding.
• Consider the patient’s family support, priorities, and motivation.
Time Anxiety impedes recall.– Anxiety is reduced if the healthcare
professional shows empathy and does not appear rushed.
•Patients who are not interrupted will complete their unique stories and explain all of their complaints within the first two minutes of the visit (Meldrum, 2011).•Research suggests that positive listening behaviors improve time efficiency.
What behaviors would cause you to think that someone is:
• An empathic listener
• Caring
• Attentive (Halley, 1997)
• Relaxed
Immediacy BehaviorsBehaviors that enhance psychological closeness.
• Genuine Smile• Respectfulness• Open posture• Using patient’s name• ProxemicsImmediacy improves trust, patient satisfaction,
and patient compliance (Martin et al, 2005).
Sharing Bad News (Neil, et al, 2002)
Give the news in private without interruptions Find out what the patient understands about the diagnosis Find out what the patient wants to know Warn the patient that bad news is coming and share the
information in simple language at a pace the patient can handle
Be honest and caring Listen to the patient's fears and respond by identifying,
acknowledging, and validating his or her reaction Summarize what has been said and identify sources of support
such as support groups Make an early follow-up appointment
Sharing Bad News
Positive, effective communication applies by using immediacy, listening empathically, and giving the patient time to express his or her feelings.
• Take a few minutes to share your techniques of sharing bad news.
Patient self-efficacy
• Patients must understand the how and why of the treatment and believe that they can follow through with the treatments.
• A non-depressed patient is 3 times more likely to comply than someone who is depressed (DiMatte, et al, 2000).
• Self-efficacy is impeded if the side-effects hinder work performance.– Ask about concerns and offer alternatives.
Recall
60 % of patients forget doctor recommendations after 10 minutes.
Provide information to the patient and to those with the patient.
Check for understanding.Provide information in writing.Encourage patients to set alarms or put
information on their calendars.
Tips to Enhance Compliance
Enter the room only focused on the patient.Show immediacy behaviors: smile, sit next to the
patient, employ open posture, call patient by name.Do not interrupt the patient unless it is necessary to
ask a question.Ask about obstacles the patient may have in
adhering to treatments. This could be that it interferers with the work day by making him or her sick or sleepy or that it is too expensive. Then discuss alternatives.
Tips to Enhance ComplianceSuggest to patients who are
technologically adept set alarms on cell phones.
Be friendly, calm, and positive.Clarify that the patient
understands how to follow through with the treatment and why the treatment is important.
Conclusion• Compliance is key to patient wellness.• Establish an atmosphere of trust and discuss
understanding of treatments.• Consider the variables. Patients differ in
understanding, desire to be part of the process, and ability to follow through.
• Be aware of the patient’s ability that is based on lifestyle, financial ability, cognitive ability, and attitude.
ReferencesBentley, S. (1997). Benchmarking listening behaviors: Is effective listening what the
speaker says it is? International Journal of Listening. 11, 1997, pp. 51-69. Bud, B. (2006). Communication Skills that Heal: A Practical Approach to a New
Professionalism in Medicine. Seattle: Radcliffe.DiMatteo, M. R., Lepper, H., and Croghan, T. (2000, Jul. 24). American Medical
Association. Retrieved from http://stressandimmunity.osu.edu/Img/Pubs/107.pdfDiNicola, M. R. and DiMateo, D. D. (1982). Achieving Patient Compliance: Psychology of
the Medical Practitioner's Role. Riverview, MI: Motor City Books.Gebhardt, M. (2011, May). Communication matters. American Academy of
Orthopaedic Surgeons Now. Volume 5 (5). Retrieved from http://www.aaos.org/news/aaosnow/may11/managing5.asp
Halley, R. (1997). And Then I Was Surprised by What You Said: The importance of love and listening on community. Columbia, MO: Kaia.
Hickson, G., Federspiel, C., Pichert, J., Miller, C., Gauld-Jaeger, J., and Bost, P. (2002). Patient Complaints and Malpractice Risk. JAMA. Vol. 287(22): 2951-2957.
Korsch, M. and Harding, C. (1998). Intelligent Patient's Guide to the Doctor-Patient Relationship: Learning How to Talk So Your Doctor Will Listen. New York: Oxford University Press.
ReferencesLivingston, R. (2011). Advanced Public Speaking: Dynamics and Techniques. Xlibris.Martin, L., Summer, L. W., Haskard, K. DiMatteo, M. R. (2005, Sept.) The challenge
of patient adherence. Dove Medical Press Limited. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661624/
Marvel, K. Epstein, R, Flowers, K. and Beckman, H. (1999). Soliciting the Patient's Agenda: Have We Improved? JAMA. Vol. 281(3): 283-287.
Meldrum, H. (2011). The Listening Practices of Exemplary Physicians. The International Journal of Listening. Vol. 25 (3): 145 - 160.
Neil, J. F., Urban, S., Collier, V., Weiner, J., Polite, R., Davis, E., and Boyer, E. G. (2002, Dec, 17). Journal of General Internal Medicine. Vol. 17(12). 914 - 922.
Research Partnership. (n.d.). Maximizing patient adherence by leveraging the patient/physician/pharma relationship. Retrieved from http://www.researchpartnership.com/uploadFiles/files/Freethinking-adherence.pdf
Roter, D. and Hall, J. (2006). Doctors Talking with Patients/Patients Talking with Doctors: Improving Communication in Medical Visits, 2nd ed. Westport, CT: Praeger.
Contact
• I have sped through the processes of communication that is a matrix of complex ideas.
• If you would like more information, please e-mail me at [email protected].
• I will gladly send you my notes for this workshop.
• Thank you so very much for your attention.
