Chapter 13: Health

Communication

Putting the Patient Back into Physician-Patient

Interactions

Health Communication

The process by which one person The process by which one person stimulates meaning in the mind(s) of stimulates meaning in the mind(s) of another person (or persons) through another person (or persons) through verbal, nonverbal, and mediated verbal, nonverbal, and mediated messages specifically related to the messages specifically related to the physical and psychological wellbeing physical and psychological wellbeing of another person (or persons).of another person (or persons).

Types of Health Communication

Basic Model of Health Communication

The Receiver in Health

Communication

Types of Patient Communication

• Verbal

• Nonverbal

• Mediated

VerbalCommunication

What a patient actually What a patient actually tells her or his physician.tells her or his physician.

NonverbalCommunication

• Directly – When a patient shows a health practitioner what is wrong.

• Indirectly – Testing that allows a health practitioner to learn information about the patient.

MediatedCommunication

• Interacting with physicians in online support groups.

• E-mailing a physician during internet office hours.

• Asking questions on health websites like WebMD.

Health Locus of Control

Page 402 in the Book

Interpreting Your Score

Scores should be between 16 and 80. Participants who score above 48 have an internal locus of control.

Participants below 48 have an external locus of control.

Internal LOC

People who have an internal People who have an internal health locus of control believe health locus of control believe that the state of their health is that the state of their health is largely impacted by their own largely impacted by their own behaviors.behaviors.

External LOC

People who have an external People who have an external health locus of control believe health locus of control believe that fate, not personal choices, that fate, not personal choices, causes them to be unhealthy.causes them to be unhealthy.

BIG IDEA

For effective health For effective health communication to occur, communication to occur, patients must take patients must take responsibility and control responsibility and control of the medical interview.of the medical interview.

Utilizing the Patient Information Sheet

(p. 289)

Information Your Physician

Needs

Actual Reason for Coming (ARC)

Why have you decided to Why have you decided to come see a physician? come see a physician?

Physical Symptoms

Physical symptoms refer to any symptoms that can either be felt by the patient or easily seen by both the patient and physician.

Psychological Symptoms

Any change in mood, Any change in mood, emotional stability, or emotional stability, or thought process that is thought process that is not explained by normal not explained by normal daily living. daily living.

List of Current Medication

Any medication that you are taking (both prescription and over the counter).

Alternative Forms of Medication and Therapy

For example: osteopathy, chiropracty, Chinese medicine, acupuncture, magnet therapy, cranial therapy, vitamins, muscle enhancers, yoga, etc…

Information to Take Away from Your Physician

Tests & Procedures Conducted

• Let’s you keep track of what was Let’s you keep track of what was done to you and when it done to you and when it happened.happened.

• Gives you a way to cross Gives you a way to cross reference your bill when it comes.reference your bill when it comes.

Diagnosis & Prognosis

Diagnosis – What is Wrong with you.Prognosis – What your physician thinks will happen next.

Medication &/or Treatment PrescribedWhat does your physician want you to take (and how)?

What does your physician want you to do?

Side Effects

What kinds of things should What kinds of things should you look out for as warning you look out for as warning signs that the signs that the medication/treatment is medication/treatment is causing damage?causing damage?

How Long Should I Wait?

Different medications and Different medications and treatments take different treatments take different amounts of time to work. amounts of time to work. You need to know how long You need to know how long to wait.to wait.

Date and Time of Next

Appointment

Five Key Points for Patients in

the Medical Interview

If you don’t understand

your physician,

ASK!!!

Don’t hide any details from

your Physician.

Own your appointment, you’ve paid

for it.

Always get a copy of test results and

procedure notes for your own records.

Take Control of Take Control of Your Health!!! Your Health!!!

Physician Credibility

Growth in Medical Research

In 2002 alone, there were 522,943 articles published in some 4,600 medical journals catalogued by PubMed.

There is an abundance of medical research being conducted!

The Bad

1999-2003• 1999 – 473,044• 2000 – 512,226• 2001 – 518,741• 2002 – 522,943 • 2003 – 100,001

–As of March 24, 2003

That’s a total of 2,126,955

Articles in just 5 years

According to the PubMed Website1, they have over 12 million citations dating back to the 1960s.

So the last five years accounts for 18% of all of those citations.

To stay up-to-date with the current medical literature, you would have to read about 6,000 research articles a day.

How many minutes did you spend last week reading about your patients?2

Stage of CareerRange of median reading times

% who reported NO reading in the last week

Medical students 60-120 min 0%

House officers 0-20 min up to 75%

Senior house officers 10-30 min up to 15%

Attendings 10-90 min up to 40%

Senior Attendings 10-45 min up to 15%

Consultants graduating since 1975

15-60 min up to 30%

Consultants graduating pre-1975

10-45 min up to 40%

Medical Knowledge with Years Since Graduation3

Patient Satisfaction & Perceived Quality of

Medical Care

Pages 399 & 400 in the Textbook

Fear of Physician (p. 401)

• Richmond, Smith, Heisel, and McCroskey (2002) found a positive relationship between communication apprehension and Fear of Physician.

• Richmond, Smith, Heisel, and McCroskey (1998) also found that people who had high levels of anxiety while communicating with their physicians tended to have lower levels of satisfaction and reported lower levels of quality of medical care.

Gender & Health Comm• In a study by Hall and Roter (2002), the

researchers found that both male and female patients tend to talk more with female physicians than with male physicians.

• Female patients engage in more verbal communication with their physicians when compared to male patients (Wallen, Waitzkin, & Stoeckle, 1979; Waitzkin, 1984, 1985).

• Hall, Roter, and Katz (1988) found that physicians also communicate more nonverbally with female patients than they are with male patients.

• One suggested reason for this disparity is that females in the U.S. culture are more likely to take on the role of a sick patient because it is socially acceptable for a woman to show sickness in our culture, but not for men (Hohmann, 1989).

Physician Communication

Medical Interview

• The process a physician uses where he or she asks a patient questions and the patient responds with answers related.

Physician Communication:SOAP and SOAP-ER

• Subjective

• Objective

• Assessment

• Plan

• Education (for Patient)

• Return to Clinic

In two different articles found in the Journal of the American Medical Association (JAMA) it was found that physicians with good communication skills had fewer patient complaints and lawsuits (Hickson, Federspiel, Pichert, Miller Gauld-Jaeger, & Bost, 2002; Levinson, Roter, Mullooly, Dull, & Frankel, 1997).

Some Research Findings on Physician

Communication

• Wrench and Booth-Butterfield (2004) noted that a patient’s perception of a physician’s credibility impacts a patient’s likelihood of complying with her or his physician’s prescribed treatment/medication.

• Richmond, Smith, Heisel, and McCroskey (2002) found that physicians who are both highly assertive or highly responsive are seen as credible physicians.

• Richmond et al. (2002) found that a physician’s level of responsiveness positively related to a patient’s level of satisfaction and perception of the quality of medical care, but assertiveness did not.

• Levinson, Roter, Mullooly, Dull, and Frankel (1997) found that physicians who use humor during the medical interview were less likely to face malpractice lawsuits and had more satisfied patients.

• Wrench and Booth-Butterfield (2004) found that patients who perceived their physicians as humorous also perceived their physicians as being more credible on all three levels of credibility (competence, trustworthiness, and caring/goodwill).

• Gaberson (1991) found that patients who were exposed to humorous messages before an operation had lower levels of anxiety before the operation and higher post operation recovery rates.

• Richmond, Smith, Heisel, and McCroskey (2001) found that that a physician’s level of nonverbal immediacy positively impacted patient satisfaction and perceptions of the quality of medical care while decreasing an individual’s fear of communication with a physician.

• Richmond et al. (2001) study found that patients who perceived their physicians as more nonverbally immediate also were more satisfied and reported higher perceptions of the quality of medical care they received.