Illness Behavior &

Dr - Pt Relationship

Illness Behavior

• 20% of the

patients neglect

their illness

I am a patient

I am weak

I need help

Causes of Denial of Illness

It is not

easy for

the

patient to

show his

weakness

Doctor’s authority

Illness BehaviorFactors Affecting Illness Behavior

Gender

Age

Race

Learned behavior

Accessibility to health services

Symptom presentation

Lay beliefs

Social Class

Previous experience

Trigger factors Locus of control

Factors Affecting Illness

Behavior

Symptoms :

• severity of the symptom

• Patient ideas & understanding about the symptom

• Patient previous experience with this symptom

Factors Affecting Illness Behavior

Accessibility to Medical services

Physical barriers can make health

facilities difficult to reach

H

Factors Affecting Illness Behavior

Previous experience with health services

???

Bureaucratic barrier can make

health services difficult to obtainH

Illness BehaviorLearned behavior

Somatic

complain

Inappropriate reaction (Pt. Family & Dr.)

Somatic fixation

Trigger Factors

Another Interpersonal Crisis

Trigger FactorsEffect of the Problem on Pt. Activity

Trigger Factors

Pressure from Family or Friends

The setting

of arbitrary

deadline

or putting limit

Trigger Factors

Illness Behavior Final Message & Conclusions

Doctors need to understand illness behavior

for proper understanding of their patients

Doctors need to explore & acknowledge

patient’s believes & worries

Communication Skills

Objectives:Objectives: To improve your skills in exploring and

acknowledgement of patient’s thoughts and

feelings.

To increase your awareness about your

patients’ verbal and nonverbal cues.

To help you to develop new communication

skills in order to deal with your patients’ cues.

Communication Skills

Exercise 4

• Write down three words that best describe the way you want to be perceived by your patients:

 1)……… 2) ………… 3)……….

 • Write how can you use your communication

skills to convey this message?

1)                 ……………..........

2)                 ……………..........

2)                 ……………..........

Who is Who is the the

patientpatient?!?!

Awareness of Patients’ verbal and Nonverbal

Cues

Classification of

Communication Skills

Verbal communications

Nonverbal communications

Communication Skills

Verbal communications

• How to formulate questions

• Discussion , explanation & Advice

• Understanding pt. verbal cues

Verbal communications

How to formulate questions

• Direct Qs (Yes or No)

• Suggestive Qs

• Why Qs

• Many Qs at a time

• Indirect Qs (Open-ended Qs)

Communication Skills Nonverbal communications

1 - Body language &

Facial expression

2 - Appearance

3 - Touch

4 - Paralanguage

5 - Body bubble

6 - Environment

Verbal communication for tilling

information , but nonverbal

communication for negotiation

• Verbal communication

• nonverbal communication

Reference: (McCaskey 1979 )Rakel

• 10% of communications

• 90% of communications

Nonverbal Communication is an universal language

Mind & Body

Body Language

Facial Expression

Appearance

Body Language

Hand to face Expression

Body Language

Hand Expression

Body Language

Hand Expression

Body Language

Body Posture

Body Posture

Body Language

Touch

The effect of touchThe effect of touch

CommunicationsParalanguage

• Velocity

• Volume

• Tone

• Pause

• Others

Body Language

Body Bubble

????

Body Bubble

15 - 46 cm 46 cm - 1.2 m 1.2 m - 3.6 m More then 3.6

Public zoneSocial zonePrivate

zone

Intimatezone

Communications

Environment

Dr.

Pt.

Couch

CommunicationsEnvironment

CommunicationsEnvironment

Discuss the advantage of this style of

communications

???

Doctor - Patient Relationship

Doctor - Patient Relationship

Doctors - Patient Relationship

Why doctors need to have a positive relationship with their pt. ???

How dose this relationship start & how it progress ???

What are the skill needed to build a positive relationship ???

Doctors - Patient Relationship

Why ???

• For the patient care &

satisfaction

• For doctor satisfaction

• For effective use of

resources

Doctors - Patient Relationship

Doctors - Patient Relationship

Patient positive role

Doctors - Patient Relationship

How ???

• Professional relationship

• personal relationship

• Intimate relationship

To Establish & To Maintain Dr-Pt Relationship

• Welcoming the Patient

• Showing respect

To Establish & To Maintain Dr-Pt Relationship

“ Don’t waste my time , just say yes or no”

The ability The ability

toto listenlisten

Doctor - Patient Relationship

Understanding

&Empathy

Review of

Consultation

Models

Hospital Model of Consultation

Computerized chick lest of history taking

A case of 2

weeks headache

Complete history, physical Examination & Investigations ?!

Psychosocial component of the

physical problems

.

Byrne & Long 1976

Patient Centered Doctor CenteredConsultation Consultation

Use of pt’s knowledge and experience

SilenceClarification

Listening Interpretation

Reflection

Use of doctor’s special skills and knowledge

Analyzing Gathering

Probing Information

The Real Reason for Consultation

Failure to explore the

real reason of

patient problem is

the main

reason of

consultation failure

(Byrne & Long 1976)

The Expanded Model of Consultation

Management of

Presenting Problem

Management of

Continuous Problem

Modification of Help

Seeking Behavior

Opportunistic health

Promotion

(Stott & Davis 1979)

Modification of Help

Seeking

Behavior

• The child as the presenting complain

• Frequent attender

• Somatic patient

Modification of Help

Seeking Behavior

• Sick Role

• Secondary gain

Modification of Help Seeking Behavior

• Denial

• Poor Compliance

Modification of Help Seeking

Behavior

• Hidden agenda

• Displacement

Pendleton 7 Tasks

1. To define the real reasons for pt attendance

2. To consider other problems

3. To choose with the pt. appropriate action for

each problem

4. To achieve a share understanding

5. To involve pt. in the management

6. To use time & resources effectively

7. To establish & maintain Dr.-pt. relationship

Patient’s Ideas :

Patient’s Concern :

Patient’s Expectation

Explanation

Skills Needed To Explore the Real Reasons for Pt. Attendance

• Open ended questions

• Indirect questions

• Use of silence

• Recognition of pt cues

• Immediate response to

pt. cues

• Confrontation

• Reflection

• Probing

• Summarization

Pendleton Third Task

With the patient to choose an

appropriate action for each problem.

Why

With the patient to choose an

appropriate action for each problem

• Patient responsibility

• Patient compliance

Pendleton Fourth Task With the patient to achieve shared

understanding of the problem

Doctor Patient

Knowledge Questions

Doubts Theories

Experience

KnowledgeQuestions

DoubtsTheories

Experience

Pendleton Fourth TaskWith the patient to reach Shared

Understanding of the Problem

The patient has the right to

know all important

details

Pendleton Fifth TaskTo involve patient in the

management

Pendleton Sixth TaskTo use time & resources

appropriately

Pendleton Seventh

Task

To Establish & Maintain Dr.-Pt.

Relationship

Final Message & Conclusions

• A lot of practice is needed to be able adopt

the proper consultation model