Factors to Develop a Doctor-Patient Relationship

Factors to Develop a Doctor-Patient Relationship Patients and Health care Professionals need to communicate about many different aspects of health and illness. With reference to a specific example, outline the factors that the health professionals would need to consider when preparing to discuss this issue with a patient. The medical consultation is considered to be one of the most important phases in the care of a patient (Bennet, 1979; Beck et al., 2001). Especially in long term illnesses, health care professionals have a close relationship with their patients; the main reason is because of the nature of this relationship itself, as they are both involved in illness in their own different ways (Bennet, 1979; Ong et al., 1995; Pendleton Hasler, 1983; Molleman et al., 1984; Morrison, 1994; Usherwood, 1999). Through this relationship, health professionals and patients are constantly exchanging information (Ong et al., 1995; Morrison, 1994; Usherwood, 1999); patients are the ones who experience illness and discomfort, and are seeking for both care (feeling that health care professionals know and understand them) and cure (need to define the health problem), (Stimson Webb, 1975; Usherwood, 1999; Ong et al., 1995), whereas health professionals are the ones with the knowledge, experience and the ability to help patients (Bennet, 1979; Messer Meldrum, 1995; Usherwood, 1999). Therefore, physicians and patients are interdependent and influence each other during their interactions (Stimson Webb, 1975; Bennet, 1979; Ong et al., 1995; Pendleton Hasler, 1983; Leigh Reiser, 1985). In order to have a functional doctor-patients relationship, an effective medical consultation and better health outcomes, good communication between physicians and patients is required (Ong et al., 1995; Stewart, 1995). As research indicates, the need for good communication is greater when it is between physicians and patients with fatal medical diseases, such as cancer (Molleman et al., 1984; Ong et al., 1995; Ong et al., 1999). Therefore, health professionals’ role is even more important, since they will need to be prepared for the consultation. Before their meeting, both patients and health care professionals have expectations and anticipations for the consultation and of course are preparing for their face to face interaction (Stimson Webb, 1975; Leigh Reiser, 1985). Health professionals have several subjects to consider and be prepared for, before any cancer consultation, such as medical information that need to be discussed during their interaction with cancer patients , but also factors that may influence their between interaction and communication (Stimson Webb, 1975; Faulkner Maguire, 1994). To begin with, the first factor that health care professionals should consider and be prepared for, before the meeting, is the patients’ emotional state, which can affect both the course and outcome of a consultation (Faulkner Maguire, 1994). The patients’ mood is influenced by numerous factors, such as their current medical condition and experience of illness, their personal information, such as age, culture, education or even the received support from their social networks (Faulkner Maguire, 1994; Suinn VandenBos, 2000; Lin et al., 2003). Bearing all these factors in mind, physicians should understand that working with cancer patients can be challenging and emotionally difficult (Faulkner Maguire, 1994). Although physicians cannot foresee their patients’ mood for their upcoming consultation, they can be prepared for different scenarios and think of different strategies of how to professionally handle difficult situations and yet provide the best quality care (Faulkner Maguire, 1994). First of all, one of the most difficult aspects when consulting with a patient is the breaking of bad news or having to answer difficult questions, for example questions regarding life expectancy and death (Buckman, 1984; Faulkner Maguire, 1994). When informing cancer patients about the severity of their condition, the amount of information to be shared with the cancer patient, depends on the patient himself, for example, cancer patients are often unaware of their condition or patient does not want to be informed about the severity of his/hers condition (Faulkner Maguire, 1994; Maguire, 1999). Nevertheless, the approach which is used to present bad news to the cancer patient, is extremely impor tant, since it can influence not only their way of coping with the psychological impact of the cancer, but also it can influence their future adjustment to both the cancer and the treatment (Fallowfield et al., 1990). According to Fujimori and Uchitomi (2009), when patients receive bad news, they want afterwards, their physicians to be supportive as this can help them relieve their emotional distress. Therefore, it is important for health care professionals to consider whether their patient would like to know about the severity of their condition and be prepared not only to inform their patients but also to listen to their concerns and support them. Furthermore, when patients are dealing with a new unknown and therefore frightening situation, they are hoping that through the consultation their need for information will be covered and that they would be able to ask questions and get answers from their physician (Molleman et al., 1984; Faulkner Maguire, 1994). Most of the times, the questions asked from cancer patients are awkward and often reflect the patients’ fears and worries, but also indicate that the patient is thinking and is troubled by the idea of death (Faulkner Maguire, 1994). Even though answering these difficult questions can be challenging for health care professionals, it is important to make sure that patient’s need for information is established. Giving information to cancer patients, is an indication that physician is paying attention and understands their needs, and therefore help reduce feelings of uncertainty and fear (Molleman et al., 1984). Another difficult situation which health care professionals must be prepared to face is their patient’s psychological mood (Faulkner Maguire, 1994). It is very common that cancer patients may be withdrawn and often overwhelmed with feelings of hopelessness and helplessness or even experience anger, which is often a form of defense mechanism (Maguire et al. 1993; Faulkner Maguire, 1994). However, it is essential that patients’ psychological condition is assessed if it is consider dangerous for the patients’ condition (Maguire et al. 1993; Faulkner Maguire, 1994). Moreover, before meeting with cancer patients, practitioners need to bear in mind that they both arrive at the meeting with different knowledge and skills (Leigh Reiser, 1985). During consultations physicians may use medical jargon, which is difficult to be understood by cancer patients (Bennet, 1979; Leigh Reiser, 1985). According to Leigh and Reiser (1985), there is the risk that patients may jump to their own conclusions through what they believe they heard or what they understood physicians told them. As a result, the use of medical definitions may lead to unwanted non-communication and misinterpretation between physicians and patients (Leigh Reiser, 1985; Fallowfield Jenkins, 1999; Chapman et al., 2003). Even when patients are properly informed about their conditions, and their options, it is often difficult for the patients to remember all the information they were given, due to the complexity of these information (Kessels, 2003). As mention by Kessels (2003), the use of written language may help improve to remember and better understand the information given during a consultation. Therefore, it would be useful if health care professionals have prepared or found some leaflets or even written down essential information and instruction (when medication is required), that may help their patients. Thus, health professionals need to be prepared to explain the condition to the patient and be as specific as possible, with the use of nontechnical language, but more importantly to ensure that their patient has understood and has received sufficient information (Leigh Reiser, 1985; Faulkner Maguire, 1994; Ong et al., 1995). Furthermore, health care professionals do not interact and talk only to their patients; most of the times during a consultation a member of the family or a close friend are also present to support the cancer patient but also to get information about the condition of their loved ones (Labrecque et al., (1991); Delvaux et al., 2005). Even though family and friends can influence the way a patient understands and experiences illness (Usherwood, 1999; Delvaux et al., 2005) and are usually involved in decision making, their opinions and views are often not considered (Dowsett et al., 2000). However, with the possibility of the presence of a relative, health care professionals need to consider how the course and outcome of the consultation may be affected, as well as how to treat possible unwanted behavior on behalf of the relative. There are only a few studies, examining the possible negative effects of the presence of a relative during a cancer consultation. Though, a research conducted b y Labrecque et al., (1991) showed that, cancer patients who had a consultation with a family member present were less satisfied with that meeting. Furthermore, physicians are often unable to handle a three person consultation, due to the difficulties that arise from this situation (Delvaux et al., 2005), as it requires special skills that are difficult to practice and the interaction is often more stressful than a normal doctor-patient consultation (Bragard et al., 2006). When a relative is present, the health care professional has to consider not only the needs of the cancer patients but the needs of the relative as well (Delvaux et al., 2005; Lienard et al., 2008). As the research by Labrecque et al., (1991) showed, when a family member was present, consultations lasted longer and the health care professionals were likely to share more information, however they showed more emotional support to cancer patients when they were not accompanied by a relative. Even though each consultation differs and may require more time, these findings show the need for consistency in the information giving (always according to the needs of the patient) and support provided to the cancer patient, regardless the presence of a relative. It essential, before the consultation, for the physician to be prepared to share information, consult and be supportive, whether his patient is alone or not. To conclude with, the communication and consultation between health care professionals and cancer patients are challenging and often emotionally difficult for both (Faulkner Maguire, 1994; Bragard et al., 2006). Though, health professionals are trained and have acquired both knowledge and skills to cope with difficulties, they might face while working with cancer patients (Faulkner Maguire, 1994). More research can be conducted, in order to examine the complexity of the doctor-patient relationship and how it is affected by the patient’s psychological condition or the presence of a relative, how the patients benefit from a good doctor-patient relationship and an effective consultation and finally how the health care professionals can prepare for consultation with cancer patients. REFERENCES Bragard, I., Razavi,, D., Marschal, S., Delvaux, N., Libert, Y., Reynaert, C., Boniver, J., Klatstersky, J., Scalliet, P., Etienne, A. M., (2006). Teaching communication and stress management skills to junior physicians dealing with cancer patients: a Belgian Interuniversity Curriculum. Support Care Cancer, 14, 454-461. Beck, R. S., Daughtridge, R., Sloane, P. D., (2002). Physician-Patient Communication in the Primary Care Office: A systematic Review. Journal of the American Board of Family Practice, 15, 25-38. Bennet, G., (1979). Patients and their doctors: The journey through medical care. London: Bailliere Tindall. Buckman, R., (1984). Breaking bad news: why is it still so difficult? British Medical Journal, 288, 1597-1599. Chapman, K., Abraham, C., Jenkins, V., Fallowfield, L., (2003). Lay Understanding of Terms used in Cancer Consultation. Psycho-Oncology, 12, 557-566. Delvaux, N., Merckaert, I., Marchal, S., Libert, Y., Conradt, S., Boniver, J., Etienne, A. M., Fontaine, O., Janne, P., Klastersky, J., Melot, C., Reynaert, C., Scalliet, P., Slachmuylder, J. L., Razavi, D., (2005). Physicians’ Communication with a cancer patient and a relative. Cancer, 103(11), 2397-2411. Dowsett, S. M., Saul, J. L., Buttow, P. N., Dunn, S. M., Boyer, M. J., Findlow, R., Dunsmore, J., (2000). Communication styles in the cancer consultation: Preferences for a patient-centered approach. Psycho-Oncology, 9, 147-156. Fallowfield, L. J., Hall, A., Maguire, G. P., Baum, M., (1990). Psychological Outcomes of different treatment policies in women with early breast cancer outside a clinical trial. BMJ, 301,575-580. Fallowfield, L., Jenkins, V., (1999). Effective Communication skills are the Key to Good Cancer Care. European Journal of Cancer, 35(11), 1592-1597. Faulkner, A., Maguire, P., (1994). Talking to Cancer Patients and their Relatives. Oxford: Oxford University Press. Fujimori, M., Uchitomi, Y., (2009). Preferences of Cancer Patients regarding communication of bad news: A systematic literature review. Japanese Journal of Clinical Oncology, 39(4), 201-216. Kessels, R. P. C., (2003). Patients’ memory for medical information. Journal of the Royal Society of Medicine, 96, 219-222. Labrecque, M. S., Blanchard, C. G., Ruckdeschel, J. C., Blanchard, E. B., (1991). The impact of family presence on the physician-cancer patient interaction. Social Sciences Medicine, 33(11),1253-1261. Leigh, H., Reiser, M. F., (1985). The Patient: Biological, Psychological, and Social Dimensions of Medical Practice (2nd ed.). London: Plenum Medical Book Company. Lienard, A., Merckaert, I., Libert, Y., Delvaux, N., Marchal, S., Boniver, J., Etienne, A. M., Klastersky, J., Reynaert, C., Scalliet, P., Slachmuylder, J. L., Razavi, D., (2008). Factors that influence cancer patients’ and relatives’ anxiety following a three-person medical consultation: impact of a communication skills training program for physicians. Psycho-Oncology, 17, 488-496. Lin, C. C., Lai, Y. L., Ward, S. E., (2003). Effect of Cancer Pain on Performance Status, Mood States, and Level of Hope Among Taiwanese Cancer Patients. Journal of Pain and Symptom Management, 25(1), 29-37. Maguire, P., (1999). Improving Communication with Cancer Patients. European Journal of Cancer,35(10), 1415-1422. Maguire, P., Faulkner, A., Regnard, C., (1993). Managing the anxious patient with advanced disease a flow diagram. Palliative Medicine, 8, 76-81. Messer, D., Meldrum, C., (1995). Psychology for Nurses and Health Care Professionals. London: Prentice Hall/Harvester Wheatsheaf. Molleman E., Krabbendam, P. L., Annyas, A. A., Koops, H. S., Sleufer, D. T., Vermey, A., (1984). The Significance of the Doctor-Patient relationship in coping with cancer. Social Sciences Medicine, 18(16), 475-480. Morrison, P., (1994). Understanding Patients. London: Bailliere Tindall. Ong, L. M. L., De Haes, J. C. J. M., Hoos, A. M., Lammes, F. B., (1995). Doctor-Patient communication: A review of the literature. Social Science Medicine, 40(7), 903-918. Ong, L. M. L., Visser, M. R. M., Lammes, F. B., De Haes, J. C. J. M., (2000). Doctor-Patient communication and cancer patients’ quality of life and satisfaction. Patient Education and Counseling,41, 145-156. Pendleton, D., Hasler, J., (1983). Doctor-Patient Communication. London: Academic Press, INC. Stewart, M. A., (1995). Effective Physician-Patient Communication and Health Outcomes: A Review. Canadian Medical Association Journal, 152(9), 1423-1433. Stimson, G., Webb, B., (1975). Going to See the Doctor: The Consultation Process in General Practice. London: Routledge Kegan Paul Ltd. Suinn, R. M., VandenBos, G. R., (2000). Cancer Patients and their Families: Readings on Disease Course, Coping and Psychological Interventions. Washington DC: American Psychological Association. Usherwood, T., (1999). Understanding the Consultation: Evidence, Theory and Practice. Buckingham: Open University Press.