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COMMUNICATION

Dr Nesif Al-HemiaryMBChB – FIBMS(Psych.)International Associate of the Royal College of Psychiatrists(UK.)

Definition

Communication is commonly defined as "the imparting or interchange of thoughts, opinions, or information by speech, writing, or signs". Although there is such a thing as one-way communication, communication can be perceived better as a two-way process in which there is an exchange and progression of thoughts, feelings or ideas (energy) towards a mutually accepted goal or direction (information).


Communication are a process whereby information is enclosed in a package and is discreted and imparted by sender to a receiver via a channel/medium. The receiver then decodes the message and gives the sender a feedback. Communication requires that all parties have an area of communicative commonality. Communication is thus a process by which we assign and convey meaning in an attempt to create shared understanding. This process requires a vast repertoire of skills in intrapersonal and interpersonal processing, listening, observing, speaking, questioning, analyzing, and evaluating.

Types of communication

There are three major parts in human face to face communication which are body language, voice tonality, and words. According to the research:55% of impact is determined by body language—postures, gestures, and eye contact, 38% by the tone of voice, and 7% by the content or the words used in the communication process .Although the exact percentage of influence may differ from variables such as the listener and the speaker, communication as a whole strives for the same goal and thus, in some cases, can be universal.

Verbal communication

Human spoken and written languages can be described as a system of symbols (sometimes known as lexemes) and the grammars (rules) by which the symbols are manipulated. The word "language" is also used to refer to common properties of languages. Language learning is normal in human childhood. Most human languages use patterns of sound or gesture for symbols which enable communication with others around them. There are thousands of human languages, and these seem to share certain properties, even though many shared properties have exceptions.

Nonverbal communication

is the process of communicating through sending and receiving wordless messages . Such messages can be communicated through gesture, body language or posture; facial expression and eye contact, object communication such as clothing , hairstyles or even architecture. Nonverbal communication plays a key role in every person's day to day life, from employment to romantic engagements. Speech may also contain nonverbal elements known as paralanguage, including voice quality, emotion and speaking style, as well as prosodic features such as rhythm , intonation and stress. Likewise, written texts have nonverbal elements such as handwriting style, spatial arrangement of words, or the use of emoticons.

Body language

Body language is a term for communication using body movements or gestures instead of, or in addition to, sounds, verbal language or other communication. It forms part of the category of paralanguage, which describes all forms of human communication that are not verbal language. This includes the most subtle of movements that many people are not aware of, including winking and slight movement of the eyebrows. In addition body language can also incorporate the use of facial expressions.


Why do we communicate?
To satisfy needs. To gain information. To manage relationships. To derive pleasure and entertainment. To get self-validation. To coordinate and manage tasks. To persuade and gain something from others.

Patient-Doctor Relationship

The quality of patient-doctor relationship is crucial to the practice of medicine. The capacity to develop an effective relationship requires a solid appreciation of the complexities of human behavior and a rigorous education in the techniques of talking and listening to people. To diagnose, manage, and treat an ill person, doctors and therapists must learn to listen. They need the skills of active listening, which means listening both to what they and the patient are saying and to the undercurrents of the unspoken feelings between them . A physician who monitors both the content of the interaction (what the patient and the doctor actually say) and the process (what the patient or the doctor mean to say) realizes that communication between two people occurs on several levels at once: what the person believes about himself or herself; what he or she wants others to believe about them; and finally who the person really is.

Rapport

An effective relationship is characterized by good rapport. Rapport is the spontaneous, conscious feeling of harmonious responsiveness that promotes the development of a constructive therapeutic alliance. It implies an understanding and trust between the doctor and the patient. Frequently, the doctor is the only person to whom the patients can talk about things that they cannot tell anyone else. Most patients trust their doctors to keep secrets, and this confidence must not be betrayed. Patients who feel that someone knows them, understands them, and accepts them find that a source of strength.

Empathy

Empathy is a way of increasing rapport. It is an essential characteristic of a doctor but it is not a universal human capacity. Although empathy probably cannot be created, it can be focused and deepened through training, observation, and self-reflection. It manifests in clinical work in a variety of ways. An empathic doctor may anticipate what is felt before it is spoken and can often help patients articulate what they are feeling. Nonverbal cues, such as body posture and facial expression, are noted. Patients' reactions to the doctor can be understood and clarified.

Patients sometimes say, How can you understand me if you haven't gone through what I'm going through?‌ however, it is not necessary to have other people's literal experiences to understand them. The shared experience of being human is often sufficient. Whether in an initial diagnostic setting or in ongoing therapy, patients draw comfort from knowing that doctors are not mystified by their suffering.

Listening skills

Greet your patient. Introduce your self. Put your patient at ease (help your patient to relax). Smile. Keep eye to eye contact. Encourage your patient to talk. Do not interrupt frequently. Reflect what you hear from the patient. summarize and ask if any thing was missed or if your patient had forget to tell something. Attend to non-verbal cues.

Open versus close ended questions

Interviewing any patient involves a fine balance between allowing the patient's story to unfold at will and obtaining the necessary data for diagnosis and treatment. Most experts agree that an ideal interview begins with broad, open-ended questioning, continues by becoming specific, and closes with detailed direct questioning.An example of an open-ended question is (Can you tell me more about that?).‌ A closed-ended question would be (How long have you been taking the medication?).Closed-ended questions can be effective in generating specific and quick responses about a clearly delineated topic. Closed-ended questions have also been found effective in assessing such factors as the presence or absence, frequency, severity, and duration of symptoms


Bio-psycho-social Model of disease
In 1977, George Engel at the University of Rochester, published a seminal paper that described the bio-psycho-social model of disease, which stressed an integrated systems approach to human behavior and disease. The bio-psycho-social model is derived from general systems theory. The biological system emphasizes the anatomical, structural, and molecular substrate of disease and its effects on the patient's biological functioning; the psychological system emphasizes the effects of psychodynamic factors, motivation, and personality on the experience of illness and the reaction to it; and the social system emphasizes cultural, environmental, and familial influences on the expression and the experience of illness. Engel postulated that each system affects, and is affected by, every other system.

Models of patient-doctor interaction

Paternalistic model. Informative model. Interpretive model. Deliberative model.

The paternalistic model.

In a paternalistic relationship between the doctor and patient, it is assumed that the doctor knows best. He or she will prescribe treatment, and the patient is expected to comply without questioning. Moreover, the doctor may decide to withhold information when it is believed to be in the patient's best interests. In this model, also called the (autocratic model) the physician asks most of the questions and generally dominates the interview. Circumstances arise in which a paternalistic approach is desirable : in emergency situations the doctor needs to take control and make potentially life-saving decisions without long deliberation. In addition, some patients feel overwhelmed by their illness and are comforted by a doctor who can take charge. In general, however, the paternalistic approach risks a clash of values. A paternalistic obstetrician, for example, might insist on spinal anesthesia for delivery when the patient wants to experience natural childbirth.

The informative model

The doctor in this model dispenses information. All available data are freely given, but the choice is left wholly up to the patient. For example, doctors may quote 5-year survival statistics for various treatments of breast cancer and expect women to make up their own minds without suggestion or interference from them. This model may be appropriate for certain one-time consultations where no established relationship exists and the patient will be returning to the regular care of a known physician. At other times, the informative model places the patient in an unrealistically autonomous role and leaves him or her feeling the doctor is cold and uncaring.

The interpretive model

Doctors who have come to know their patients better and understand something of the circumstances of their lives, their families, their values, and their hopes and aspirations, are better able to make recommendations that take into account the unique characteristics of an individual patient. A sense of shared decision-making is established as the doctor presents and discusses alternatives, with the patient's participation, to find the one that is best for that particular person. The doctor in this model does not abrogate the responsibility for making decisions, but is flexible, and is willing to consider question and alternative suggestions.

The deliberative model

The physician in this model acts as a friend or counselor to the patient, not just by presenting information, but in actively advocating a particular course of action. The deliberative approach is commonly used by doctors hoping to modify injurious behavior, for example, in trying to get their patients to stop smoking or lose weight.

Transference and counter-transference

Transference : is generally defined as the set of expectations, beliefs, and emotional responses that a patient brings to the patient-doctor relationship. They are based not necessarily on who the doctor is or how the doctor acts in reality but, rather, on repeated experiences the patient has had with other important authority figures throughout life.

Counter-transference:

Just as the patient brings transferential attitudes to the patient-doctor relationship, doctors themselves often have counter-transferential reactions to their patients. Counter-transference can take the form of negative feelings that are disruptive to the patient-doctor relationship, but it can also encompass disproportionately positive, idealizing, or even eroticized reactions to patients. Just as patients have expectations for physicians (for example, competence, lack of exploitation, objectivity, comfort, and relief);physicians often have unconscious or unspoken expectations of patients. Most commonly, patients are thought of as good patients if their expressed severity of symptoms correlates with an overtly diagnosable biological disorder, if they are compliant with treatment, if they are emotionally controlled, and if they are grateful. If those expectations are not met, the patient may be disapproved of and experienced as unlikable, unworkable, or bad.

THANK YOU




رفعت المحاضرة من قبل: Mostafa Altae
المشاهدات: لقد قام 5 أعضاء و 78 زائراً بقراءة هذه المحاضرة








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