| Abstract|| |
Effective interaction and communication between doctor and patient is a central clinical function that cannot be delegated. Besides, the information and evidence which is generated by a proper interaction and communication, to individualize and tailor the treatment for each patient of Hepatitis B, the way patients' perceive their connection with their physician significantly influences their sense of satisfaction and level of concern about their health. A good effective, empathic physician-patient communication leads to improved patient compliance, better clinical outcomes and reduction in "doctor-shopping" and malpractice litigations. It has now been established that problems in doctor-patient interaction and communication are extremely common and adversely affect patient management. It has been repeatedly shown that the clinical skills needed to improve these problems can be taught and that the subsequent benefits to medical practice are demonstrable, feasible on a routine basis, and enduring. Improvement in the care of hepatitis B patients, it is essential that patient physician interaction is optimal in view of the prolonged duration of therapy and uncertainty of outcome of therapy in these cases. This unique essay sheds light on the strategies which the physicians need to adopt to improve patient physician interaction.
Keywords: Chronic Hepatitis B, communication, information management physician-patient relations, professional-patient relationship
|How to cite this article:|
Choudhuri G. Patient physician interaction. Hep B Annual 2010;7:86-93
Research has shown that the way patients perceive their connection with their physician significantly influences their sense of satisfaction and level of concern about their health. In the fast-paced managed-care environment, relationship-building conversations can get lost in the pressure to perform. The demands of keeping abreast of the latest medical-treatment approaches can overshadow the need to practice and improve communication skills. A good effective, empathic physician-patient communication leads to improved patient compliance, better clinical outcomes and reduction in "doctor-shopping" and malpractice litigations.
For a successful and humanistic encounter at an office visit, one needs to be sure that the patient's key concerns have been directly and specifically solicited and addressed. To be effective, the clinician must gain an understanding of the patient's perspective on his or her illness. Patient concerns can be wide ranging, including fear of death, mutilation, disability; ominous attribution to pain symptoms; distrust of the medical profession; concern about loss of wholeness, role, status, or independence; denial of reality of medical problems; grief; fear of leaving home; and other uniquely personal issues. Patient values, cultures, and preferences need to be explored. Gender is another element that needs to be taken into consideration. Ensuring key issues are verbalized openly is fundamental to effective patient-doctor communication. The clinician should be careful not to be judgmental or scolding because this may rapidly close down communication. Sometimes the patient gains therapeutic benefit just from venting concerns in a safe environment with a caring clinician. Appropriate reassurance or pragmatic suggestions to help with problem solving and setting up a structured plan of action may be an important part of the patient care that is required. Counselling around unhealthy or risky behaviors is an important communication skill that should be part of health care visits. Understanding the psychology of behavioral change and establishing a systematic framework for such interventions, which includes the five A's of patient counselling (assess, advise, agree, assist, and arrange) are steps toward ensuring effective patient-doctor communication. Historically in medicine, there was a paternalistic approach to deciding what should be done for a patient: the physician knew best and the patient accepted the recommendation without question. This era is ending, being replaced with consumerism and the movement toward shared decision-making. Patients are advising each other to "educate yourself and ask questions". Patient satisfaction with their care, rests heavily on how successfully this transition is accomplished. Ready access to quality information and thoughtful patient-doctor discussions is at the fulcrum of this revolution. 
Improving care of Hepatitis B Patients
One of the major challenges in a government hospital is the unavoidable huge crowd, people come from far and have to wait for 4 to 5 hours, so often they don't come back. This makes the follow up difficult especially in research and drug trials. There are six main steps for Improving care of Hepatitis B Patients
- Generating referrals
- Making the 1 st visit comfortable
- Ensuring follow up
- Keeping data
- Community outreach programs
- Networking with physicians.
The first contact, the interview, is very important, apart from data gathering, a relationship should be build and then education and counselling can go simultaneously. Otherwise the whole interview doesn't become very useful. So the first visit should be made easy by having a helpline, one dedicated department in which there is a cell number given to a person. So if they take a fixed time appointment, they come in and they don't have to wait long and they are assisted in registration. Patients should be allowed to ask questions. It is important to note down the contact details of the patient, including his number.
First visit should be used for the following purposes:
- Data gathering ( 60-70% of diagnosis)
- Relationship building
- Educating and counseling.
| Approach to Patient|| |
Communication between a physician and his or her patient is a critical component of medical care delivery. The quality of communication affects patient satisfaction and health outcomes. Managed care has heightened the awareness of communication because of the direct links among communication, outcomes, and malpractice liability.  How the doctor approaches the patient is very important. A discussion with the patient, taking his inputs and then choosing the therapy makes the patient comfortable. The seating arrangement is also an important thing to be considered. It's not a good idea to have the patient to sit across the table. It actually divides the doctor and patient. When patient is sitting on the side, helps to generate a sense of partnership that we're fighting the common problem, that's Hepatitis B [Figure 1]. To change the health system at all, much less to create a medical system which maximally utilizes self-help and mutual help and which encourages an active rather than a passive role for the patient, will require radical deprofessionalization. Doctors have to expand radically the use of community health aides; to spread medical knowledge to patients and to non-physician health workers; to minimize the social distance between doctors and patients.
As is natural, patients are worried and concerned about their health and health problems. Doctors are required to examine the patient for his ailment, come at a diagnosis and treatment plan which must be explained to the patient of his relative/attendant in very simple language. The health promotion team should realize this and know that an informed patient is more likely to handle the stress and need for self-care that is part of any treatment. The health promotion team should urge the patients to consider the benefit of becoming a truly informed patient by devoting careful and ongoing attention to the details of his/her care.
For this purpose, the health promotion cell should undertake the following tasks for its patients:
- Health Assessment Card
- Patient Information Brochures
- Patient Awareness Lectures.
(a) The Health Assessment Card
OPD assistant should specially be recruited for the purpose of guiding the patients and helping them to evaluate their physical and health status. This service will be an effective tool in patient-care. A health assessment card has also been formulated for these patients so that both the clinicians and the patients can have a record of their health status as and when they visit the OPD (including follow-ups). These anthropometric measurements and biochemical values are also critical while prescribing medications to these patients. The health assessment card can be effectively used to evaluate the health status of the patients [Figure 2].
(b) Patient Information Brochures
Patient Information Brochures about the various diseases and procedures/operations should be developed and printed so as to enable the patients to gain more knowledge about the disease they suffer from or the procedure they are about to undergo. They should also contain information regarding the prevention, diet and treatment procedures for the disease. These brochures should be specially formulated in an easy to understand language that can be easily comprehended by a layman [Figure 3].
(c) Patient awareness lectures
There should be patient awareness lectures. It should not be just a lecture but a group consultation. Lectures should be taken through very simple slides or a movie so that looking at them, patients ask questions and clarify doubts [Figure 4].
The community outreach programs are more for generating referrals than maintaining follow-up. There should be World Hepatitis B Awareness Day, vaccination camps, etc so that the people can be made aware of these communicable disease [Figure 5].
| Conclusion|| |
Effective interaction and communication between doctor and patient is a central clinical function that cannot be delegated. Most of the essential diagnostic information arises from the interview, and the physician's interpersonal skills also largely determine the patient's satisfaction and compliance and positively influence health outcomes. Such skills, including active listening to patient's concerns, are among the qualities of a physician most desired by patients. Increasing public dissatisfaction with the medical profession is, in good part, related to deficiencies in clinical communication. Sufficient data have now accumulated to prove that problems in doctor-patient interaction and communication are extremely common and adversely affect patient management. It has been repeatedly shown that the clinical skills needed to improve these problems can be taught and that the subsequent benefits to medical practice are demonstrable, feasible on a routine basis, and enduring. 
Financial support and sponsorship
Conflict of interest
There are no conflicts of interest.
| References|| |
Teutsch C. Patient-doctor communication. Med Clin North Am. 2003 Sep;87(5):1115-45.
Levinson W. In context: physician-patient communication and managed care. Med Pract Manage. 1999 Mar-Apr;14(5):226-30.
Koyama T. Effective doctor-patient interaction and communication: psychiatric point of view. Hokkaido Igaku Zasshi. 1994 Sep;69(5):1081-5.
Prof. Gourdas Choudhuri
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]