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How can the patient-healthcare relationship be improved? Proper communication is key. – Medical workers must not be told that the patient and his family are demanding. The patient has the right to have claims, he has the right to have doubts and may have comments. He also has the right and even the obligation to ask questions – says the Rector of the Medical University of Warsaw, Prof. Zbigniew Gaciong.
- Medical workers too often shift the blame onto their patients when therapy fails. And they accuse them of being demanding – says prof. Zbigniew Gaciong.
- If the doctor is stressed by the patient’s visit and it is an emotional challenge for him, he should think it over seriously – adds the Rector of the Medical University of Warsaw.
- The doctor has to find time for the patient and his family. The interview should be conducted in a suitable place. The patient must know what is wrong with him – emphasizes prof. Gaciong.
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How to improve the patient’s relationship with the doctor?
PAP: The main emotion of patients in dealing with health care is fear. This is the result of the report of the Medical University of Warsaw, prepared jointly with the Polish Society of Medical Communication, “Strategy: Good relations between medical personnel and patients”. Patients fear the mere contact with a doctor and a collision with the health care system. Is our medical care saturated with fear? Doctors are also afraid of patients?
Prof. Zbigniew Gaciong: In the interviews conducted for the report, doctors revealed some concerns about patients. I do not think, however, that they actually occur in medical practice. In any case, my observations do not confirm this, but they are not representative of the entire community.
This may be a different view. You have been the head of the clinic for many years, now the chancellor.
It is true that my people know very well what behavior I expect from medical workers.
Meaning?
One of the priorities, which I have long pointed out, is proper communication between medical personnel and the patient.
Still a lot depends on the head of the center?
The master-apprentice model in medicine is not working as it used to be. However, there is no doubt that certain skills and patterns are passed down directly from person to person. They are more taken from life than from a book.
Doctors constantly complain about the lack of time and it’s hard not to agree with them. Are they stressed because of this, does it not affect their contact with patients?
If a doctor is stressed by a patient’s visit and it is an emotional challenge for him, he should think about it seriously.
Change of profession?
Not necessarily. He can choose specialties where contact with the patient is limited.
The report shows that our doctors underestimate the importance of a good relationship between the patient and the doctor and all medical staff for an effective therapeutic process.
This is true and it is not appropriate. Moreover, medical workers too often blame patients when treatment fails. And they accuse them of being demanding.
The patient has the right and even the obligation to ask questions
They are right?
No, they must not use that term at all. It must not be said that the patient and his family are demanding. The patient has the right to have claims, he has the right to have doubts and may have comments. He also has the right and even the obligation to ask questions. This attitude is not demanding. The patient wants the best care possible. It’s his right.
This is the first time I have heard such a firm statement from a doctor.
It must be understood that the model of care in which the doctor spoke and the patient only listened and left the office is over.
So how can we improve the patient-healthcare relationship?
Proper communication can be learned, as can many other skills. We know this from marketing and business, where everything is customer-oriented. In a store, it is not a coincidence that a specific product is on such a shelf and not another. And it is no coincidence that trade workers and salesmen behave in a certain way.
Affecting our behavior.
They are trained in this field; you know how to do it and it has been well practiced.
We are talking about manipulation.
I’m just saying that communication is influencing the behavior of other people. In the doctor’s office, I expect the patient to tell me everything important about his health. I also want him to understand what I am saying to him and accept it.
What is the most important?
Empathy, i.e. receiving emotions and listening with understanding. In short – an attitude focused on other people, showing that they are important to us. Everyone can learn this too.
But can our doctors do it?
Not. That is where the problem lies.
Some universities have trained medical students in communication techniques, but only recently. At the Medical University of Warsaw, it has been conducted since the 2018/2019 academic year. At the Medical University of Lublin a little longer.
This type of education for students had already been carried out before, we suddenly did not discover it, but it did not take place to such a large extent. There were psychology classes, for example. Now, however, it is not only about mastering certain knowledge, but also specific skills. The Collegium Medicum of the Jagiellonian University in Kraków has the so-called Objective structured exam where the student comes through the different stations where there are different simulated situations, also involving the patients.
Many practicing physicians have not received such training …
And here is a huge problem.
How to solve it?
I believe that the medical institutions that employ them should undertake the obligation to train doctors in communication or to impose certain requirements. This is the case, for example, in corporations where employees are even told how to come dressed. The appearance of the doctor is also very important, especially when dealing with patients.
Should he be in a white coat?
Yes, research shows that an apron works better than a suit.
The white coat works like a placebo, is it some form of the drug?
It is also beneficial in communicating with the patient.
The nurse must try to be polite
Okay, so the patient enters the facility …
At the very entrance, a very important role is played by the people in registration, as well as the nurses behind the glass in the emergency room.
And on the other side of the window, a crowd of nervous patients.
Yes, but the nurse still has to be polite, say “good morning”. Such a person makes the first impression, is a showcase of a given facility. It should be similar at each subsequent stage of the operation of medical facilities. This should be monitored and, if necessary, certain behaviors should be enforced. Training alone is not enough. Besides, every skill, also in communication, must be constantly practiced.
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The patient must also be required to, for example, prepare for the visit, even though he or she is in a difficult situation, is ill, suffering and does not know what awaits him.
Rather, one has to be prepared for the patient’s beliefs that are not true. We saw it during the COVID-19 vaccination pandemic. We are dealing with the breaking of chains of trust. Many people, even educated ones, do not believe what their doctors are telling them.
Does Patient Education Help?
It helps. The trouble is that you can educate only those patients who want it, and this is a select group of people. As a result, we can rotate in the same circle. One solution is information readily available to the patient, it may be a brochure on a given topic or even a leaflet available at a clinic or hospital. Simple, unambiguous and understandable.
Why has the confidence in doctors decreased so much in our country? In the ranking of trust and satisfaction with treatment among patients published by the New England Journal of Medicine, Polish doctors out of 30 countries took the penultimate place, just ahead of Our Country.
This happened along with the development of the Internet, when a lot of negative information about medical workers, lawsuits and medical errors appeared on the web. Of course, the lack of skills in communicating with patients also plays an important role. Patients are increasingly aware of treatment options and know that there are different treatment options. The physician should refer to it and explain it, present his point of view and justify it.
Trust in the doctor is also an important factor in the therapeutic process. Patients are then more motivated to treatment and better comply with medical recommendations, e.g. in long-term use of drugs.
There is no doubt about it. It is also the case that patients come to the doctor with emotional disorders manifested by somatic complaints. In such situations, a proper conversation is very important.
The doctor has to find time for the patient and his family
Many patients complain that the doctor has no time for him and that he feels neglected.
The doctor has to find time for the patient and his family. He should conduct the interview in the right place, he cannot do it in the corridor, fortunately it hardly happens anymore. It cannot be that the doctor is sitting and his interlocutors are standing. You do not need to allocate so much time for such an interview – it can be done even in a few minutes.
What is the most important for the patient?
Sense of security. The patient needs to know what is wrong with him, what treatment he can count on and where to go, for example if his condition worsens.
Doesn’t need a caregiver to guide the patient in a complex healthcare system?
In my opinion – not necessarily. This patient confusion may be due to the fact that we have procedural medicine. From the payer’s point of view, it is a very good solution, because the procedure is easy to define and evaluate. And if there are complications, for example after chemotherapy or oncological surgery, and it does not fit into the procedure, the patient is referred to the HED.
For many years, healthcare has been talking about paying for the quality of treatment.
Therefore, not only for the procedures themselves, but also for the fact that the patients do not have complications and do not return to the medical facility for this reason. But quality supervision in health care costs money.
Doctor concerned about patient complaints? How serious is this problem in our medical care?
Yes, they are afraid, and the result is what we have been observing for a long time in the United States, the so-called defensive medicine. It consists in the fact that many procedures are performed, for example, diagnostic tests, but not necessarily, but just in case. The solution to this is to introduce recommendations: what standard procedures apply in a given case. This, however, may generate additional costs for medical care.
Interviewer: Zbigniew Wojtasiński.
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