Referring to the Example of Kyle and Mixed Messages in the Work File Review
Ochsner J. 2010 Jump; ten(1): 38–43.
Dr.-Patient Communication: A Review
Jennifer Fong Ha
*Sir Charles Gairdner Hospital, Nedlands, Western Australia
†Royal Perth Infirmary, Perth, Western Australia
‡Academy of Western Australia, Nedlands, Western Commonwealth of australia
Nancy Longnecker
‡University of Western Commonwealth of australia, Nedlands, Western Australia
Abstract
Effective doctor-patient communication is a central clinical function in building a therapeutic doctor-patient relationship, which is the heart and art of medicine. This is of import in the delivery of high-quality health care. Much patient dissatisfaction and many complaints are due to breakdown in the doctor-patient human relationship. Withal, many doctors tend to overestimate their ability in communication. Over the years, much has been published in the literature on this important topic. Nosotros review the literature on doctor-patient communication.
Keywords: Benefits, communication, medico-patient relationship, review, strategies
INTRODUCTION
"Medicine is an art whose magic and artistic ability take long been recognized as residing in the interpersonal aspects of patient-physician human relationship."ane
A doctor'southward communication and interpersonal skills embrace the ability to gather information in gild to facilitate accurate diagnosis, counsel appropriately, requite therapeutic instructions, and institute caring relationships with patients.2–4 These are the core clinical skills in the do of medicine, with the ultimate goal of achieving the best outcome and patient satisfaction, which are essential for the constructive delivery of wellness care.5,6
Basic communication skills in isolation are bereft to create and sustain a successful therapeutic doctor-patient relationship, which consists of shared perceptions and feelings regarding the nature of the problem, goals of treatment, and psychosocial support.2,7 Interpersonal skills build on this bones communication skill.2 Appropriate communication integrates both patient- and doctor-centered approaches.iv
The ultimate objective of any doc-patient communication is to improve the patient'due south health and medical intendance.two Studies on doctor-patient communication have demonstrated patient discontent even when many doctors considered the communication adequate or even fantabulous.eight Doctors tend to overestimate their abilities in communication. Tongue et al9 reported that 75% of the orthopedic surgeons surveyed believed that they communicated satisfactorily with their patients, only just 21% of the patients reported satisfactory advice with their doctors. Patient surveys have consistently shown that they want better advice with their doctors.2
The principles of patient-centered medicine engagement back to the ancient Greek school of Cos.10 Notwithstanding, patient-centered medicine has not ever been common practice. For example, in the 1950s to 1970s, most doctors considered it inhumane and detrimental to patients to disclose bad news because of the bleak treatment prospect for cancers.eleven,12 The medical model has more recently evolved from paternalism to individualism. Data exchange is the dominant communication model, and the health consumer movement has led to the current model of shared decision making and patient-centered advice.6,7,13–15
BENEFITS OF EFFECTIVE Advice
Constructive doctor-patient advice is a cardinal clinical office, and the resultant advice is the heart and art of medicine and a central component in the delivery of health care.vii,eight,16 The 3 main goals of current md-patient advice are creating a practiced interpersonal relationship, facilitating substitution of data, and including patients in decision making.four,7,xi,17 Effective medico-patient communication is adamant by the doctors' "bedside style," which patients approximate as a major indicator of their doctors' general competence.1
Proficient doctor-patient communication has the potential to aid regulate patients' emotions, facilitate comprehension of medical information, and allow for better identification of patients' needs, perceptions, and expectations.4,vii,17 Patients reporting skilful communication with their medico are more probable to be satisfied with their care, and especially to share pertinent data for accurate diagnosis of their problems, follow advice, and adhere to the prescribed treatment.one,6,7,nine,14,16,18–23 Patients' agreement with the physician about the nature of the treatment and need for follow-upwardly is strongly associated with their recovery.10
Studies take shown correlations between a sense of control and the ability to tolerate pain, recovery from affliction, decreased tumor growth, and daily functioning.16,20,24 Enhanced psychological adjustments and better mental wellness have also been reported.6,10,16,25,26 Some studies accept observed a decrease in length of hospital stay and therefore the cost of individual medical visits and fewer referrals.i,27
A more patient-centered come across results in meliorate patient as well as doctor satisfaction.i,v–7,nine,13,15,18,nineteen,22,25,26,28–30 Satisfied patients are less probable to society formal complaints or initiate malpractice complaints.1,5,nine,19,22,28 Satisfied patients are advantageous for doctors in terms of greater job satisfaction, less work-related stress, and reduced burnout.4,26
THE PROBLEMS
There are many barriers to proficient communication in the doctor-patient relationship, including patients' feet and fear, doctors' burden of work, fear of litigation, fright of physical or verbal corruption, and unrealistic patient expectations.31
Deterioration of Doctors' Advice Skills
It has been observed that communication skills tend to decline as medical students progress through their medical education, and over fourth dimension doctors in preparation tend to lose their focus on holistic patient intendance.32 Furthermore, the emotional and physical brutality of medical training, particularly during internship and residency, suppresses empathy, substitutes techniques and procedures for talk, and may fifty-fifty issue in derision of patients.32
Nondisclosure of Information
The doctor-patient interaction is a complex process, and serious miscommunication is a potential pitfall, especially in terms of patients' understanding of their prognosis, purpose of intendance, expectations, and interest in handling.12 These important factors may affect the choices patients make regarding their treatment and terminate-of-life care, which tin have a significant influence on the illness.33 Good communication skills proficient past doctors immune patients to perceive themselves as a full participant during discussions relating to their health.10 This subjective experience that influences patient biology is the "biology of self-confidence" described by Sobel, which emphasized the critical role of patients' perception in their healing process.34
Doctors' Abstention Beliefs
There are reported observations of doctors fugitive discussion of the emotional and social impact of patients' problems because it distressed them when they could not handle these bug or they did not have the time to do so fairly. This state of affairs negatively afflicted doctors emotionally and tended to increase patients' distress.26 This abstention behavior may result in patients existence unwilling to disclose issues, which could filibuster and adversely touch on their recovery.26
Discouragement of Collaboration
Physicians have been constitute to discourage patients from voicing their concerns and expectations equally well as requests for more information.32 This negative influence of the doctors' behavior and the resultant nature of the dr.-patient communication deterred patients from asserting their demand for data and explanations.32 Patients can feel disempowered and may be unable to achieve their health goals.32 Lack of sufficient explanation results in poor patient understanding, and a lack of consensus betwixt medico and patient may lead to therapeutic failure.32
Resistance past Patients
Today, patients accept recognized that they are non passive recipients and are able to resist the power and practiced potency that society grants doctors.35 They can implicitly and explicitly resist the monologue of information transfer from doctors past actively reconstructing expert information to assert their ain perspectives, integrate with their noesis of their own bodies and experiences, equally well equally the social realities of their lives.35 Beingness circumspect to social relationships and contexts will ensure that this information is received, and about importantly, acted on.35 Lee and Garvin35 asserted that inequality, social relations, and structural constraints may be the most influential factors in health intendance. This was illustrated in their study when female person patients from a lower socioeconomic demographic in the Appalachian region of the United States modified communication to avoid sun exposure and, past taking into account societal pressures that equated tanned skin with dazzler, continued tanning despite knowledge of the risks associated with sunday exposure and skin cancer (Figure). The study by Lee and Garvin35 demonstrates the need to take into account social factors in the production, dissemination, and use of cognition.
Instance of influences that a patient takes into account on the doctor'south advice.
STRATEGIES FOR IMPROVEMENT
Communication Skills
Advice skills involve both way and content.36 Attentive listening skills, empathy, and apply of open-ended questions are some examples of skillful communication. Improved doctor-patient communication tends to increase patient involvement and adherence to recommended therapy; influence patient satisfaction, adherence, and health care utilization; and improve quality of intendance and health outcomes.7,37
Breaking bad news to patients is a complex and challenging communication task in the practice of medicine.12 Relationship building is especially important in breaking bad news.17 Important factors include understanding patients' perspectives, sharing information, and patients' noesis and expectations.12,38 Miscommunication has serious implications, as it may hinder patients' agreement, expectations of treatment, or involvement in handling planning.12 In addition, miscommunication decreases patient satisfaction with medical care, level of hopefulness, and subsequent psychological adjustment.12
Baile et al12 reported that patients often regard their doctors every bit one of their about important sources of psychological back up. Empathy is ane of the most powerful means of providing this support to reduce patients' feelings of isolation and validating their feelings or thoughts equally normal and to exist expected.
Communication Preparation
Doctors are not born with first-class communication skills, every bit they have different innate talents. Instead they can understand the theory of skillful dr.-patient communication, larn and exercise these skills, and exist capable of modifying their advice style if there is sufficient motivation and incentive for self-awareness, self-monitoring, and training.11,25 Communication skills training has been found to improve doctor-patient communication.39,forty However, the improved behaviors may lapse over time.28 It is therefore important to practice new skills, with regular feedback on the acquired behavior.28 Some accept said that medical education should go beyond skills training to encourage physicians' responsiveness to the patients' unique experience.10
Collaborative Communication
Collaborative advice is a reciprocal and dynamic relationship, involving the 2-style commutation of information.41 In an ideal world, doctors should interact with their patients to provide the best care considering doctors tend to make decisions based on quick assessments, which may be biased.41 This requires the doctors to take fourth dimension or set up opportunities to offer and discuss treatment choices to patients and share the responsibility and control with them.seven,11 Successful data substitution ensures that concerns are elicited and explored and that explanations of treatment options are balanced and understood to allow for shared decision making.7,11,14,42 In this approach, the doctor facilitates word and negotiation with patients and the treatment options are evaluated and tailored to the context of the patients' situation and needs, rather than a standardized protocol.vii,11,42 Care options need to exist collaborative between doctor and patient, taking into account patient expectations, issue preferences, level of risk acceptance, and whatsoever associated cost to maximize adherence and to assure the best consequence.32
Conflict Management
Feudtner41 described situations in pediatric palliative care in which the crusade of conflicts was frequently not expressed. The root source was ofttimes unspoken and thus unclear or unknown to one or even both parties, which generated feelings of discord. Conflict is frequently a challenging situation as it can evoke feelings of helplessness, frustration, confusion, acrimony, uncertainty, failure, or sadness.11 The doctor should recognize these feelings and develop skills to identify problematic responses in the patient or themselves to de-escalate the situation and enable the relationship issues to be turned into a clinical success.eleven
In addition to minimizing avoidance behavior, which prevents patients from expressing opinions, effective doctor-patient advice should involve productive conversation, which involves understanding of both parties' perspectives, by shifting from a perspective that is rigidly certain of i'south belief to a more than exploratory approach that strives to understand the situation from another perspective.41 Recognizing the touch of patient reciprocation of advice and affect in a medical visit is important as it may assist create positive exchanges to defuse negative patterns.25
Health Beliefs
Beliefs and values bear on the doc-patient relationship and interaction.9 Divergent beliefs can affect health care through competing therapies, fear of the health intendance system, or distrust of prescribed therapies.37 This perception gap may negatively affect treatment decisions and therefore may influence patient outcomes despite appropriate therapy.17 Although doctors use a biomedical model to understand illness, patient beliefs and values are influenced by social and behavioral factors too as biological science or anatomy.17
It is important to identify and address perceived barriers and benefits of handling to better patient adherence to medical plans by ensuring that the benefits and importance of treatment are understood.17 Doctors should understand patients' functional significant of disease, as well as the relationship meaning and symbolic meaning, followed by a summary of this data and telling the patient the problem from the md'southward perspective and, finally, request the patient to summarize what was said.17 Agreement between md and patient is a fundamental variable that influences outcome.17
Patients construct their own version of adherence according to their personal globe views and social contexts, which tin result in a divergent expectation of adherence exercise.9,13,xv Good doctor-patient communication is a mechanism used to proceeds an understanding of patients' social context, expectations, and experience.9,13,42 With collaborative advice, a particular condition, perspective, or fact tin be identified, allowing for a view from a dissimilar perspective, drawing attention for a better cess and the subsequent handling.41 In this model, effective doctors acknowledge and respect patients' rights to make decisions and choices.13
LIMITATIONS AND Hereafter DIRECTIONS
Clinical research will guide improvements in determining best practice. Randomized controlled trials are able to effectively control bias and chance in evaluating efficacy. Withal, this is easier said than done in terms of investigations of communication. A majority of the studies reported in this review were cross-sectional.7 However, medico-patient relationships are frequently long term, involving multiple visits, and this may limit the generalizability of the studies.
The approaches used in assessing md-patient communication and health outcomes in the literature are shown in the Table.seven,30 Behavioral and observational components involve recordings to evaluate the actual medical encounter and analyze information technology in social club to code behavior based on one of the observational instruments with respect to task and socioemotional behaviors.7,fourteen,xxx The patients' perception measures are assessed via surveys to rate frequency, occurrence, or other elements of physician beliefs.7,14,43 Patients' perceptions may have a greater affect on their own outcomes than doc behavior, only their perceptions are subjective and bailiwick to bias, and patients may be influenced by other factors such every bit their wellness status and state of mind and may not accurately reflect the reality of the consultation.vii
Approaches in Assessment of Doctor-Patient Communication
Comparisons betwixt studies are difficult as numerous tools are available simply no single tool is completely satisfactory. Different studies use combinations of different tools for this reason. In addition, items are generated for measurement of patient perceptions without predefined categories of doctors' behaviors.seven
Qualitative measures, although difficult to gauge, tin can provide a deeper understanding of patients' subjective perceptions. Clinically the almost easily quantified outcomes are physiological measures, but these may non be possible in many surgical or chronic illnesses.19 They are also highly specific and may contribute minimally to an agreement of the patient's overall wellness.19 Satisfaction is a complex notion with many determinants and is used as the ultimate outcome of the delivery of health care services as it is a proxy for health, and its rating provides useful information virtually the structure, procedure, and outcomes of care.21,44 Morss et al, as quoted by Alazri and Neal,21 reviewed 21 relevant qualitative studies and found that the domains used to assess patient satisfaction with care included availability of the physician, coordination in a multidisciplinary team, competence, advice and relationships, ability to provide information and educate patients, responsiveness to emotional needs of patients, power to provide holistic care, and ability to support patients' decision making. Satisfaction contributes to better medical outcomes through fulfillment of patients' values and expectations.21 Patients who experience good processes and outcomes of care are more satisfied and therefore more likely to continue maintaining the existing md-patient relationship.21
The chief independent predictors of satisfaction take been patients' perceptions of communication and partnership, and a positive md approach.27 Satisfaction strongly predicts compliance with treatment and medical outcomes in acute disease.27 However, its use in medical interviews to relate to patient-centeredness may exist inaccurate as its scales include subscales on communication.27
A bulk of the literature ofttimes uses patient satisfaction and adherence to determine the efficacy of the doctor-patient human relationship.7,39 The ability to generalize is limited, depending on, among other things, the size and representative nature of the specific population studied.7,36 Satisfaction needs to be investigated with a tightly defined and homogenous instance mix to explore crusade and effect of various factors on physician-patient communication.27 In add-on, the Hawthorne effect (awareness that one is beingness observed and evaluated) is difficult to avoid in observational studies and may bear upon beliefs.5,45
CONCLUSION
"The patient will never intendance how much you know, until they know how much yous care." (Terry Canale in his American University of Orthopaedic Surgeons Vice Presidential Address9)
Dr.-patient advice is a major component of the process of wellness care.46 Doctors are in a unique position of respect and ability. Hippocrates suggested that doctors may influence patients' wellness.19 Constructive doctor-patient communication tin can exist a source of motivation, incentive, reassurance, and support.19,47 A good doctor-patient human relationship tin can increase job satisfaction and reinforce patients' self-confidence, motivation, and positive view of their health condition, which may influence their health outcomes.xix,47
Virtually complaints about doctors are related to issues of communication, non clinical competency.9,29,42 Patients want doctors who can skillfully diagnose and treat their sicknesses likewise as communicate with them finer.32
Doctors with amend advice and interpersonal skills are able to detect problems earlier, tin can foreclose medical crises and expensive intervention, and provide better support to their patients. This may pb to higher-quality outcomes and better satisfaction, lower costs of care, greater patient agreement of wellness issues, and better adherence to the treatment process.29,32 In that location is currently a greater expectation of collaborative conclusion making, with physicians and patients participating every bit partners to achieve the agreed upon goals and the attainment of quality of life.32
REFERENCES
1. Hall J. A., Roter D. L., Rand C. Southward. Communication of affect between patient and physician. J Health Soc Behav. 1981;22((1)):18–xxx. [PubMed] [Google Scholar]
2. Duffy F. D., Gordon G. H., Whelan G., et al. Assessing competence in communication and interpersonal skills: the Kalamazoo Ii report. Acad Med. 2004;79((six)):495–507. [PubMed] [Google Scholar]
3. van Zanten M., Boulet J. R., McKinley D. W., DeChamplain A., Jobe A. C. Assessing the communication and interpersonal skills of graduates of international medical schools equally function of the United States Medical Licensing Exam (USMLE) Step 2 Clinical Skills (CS) Test. Acad Med. 2007;82((10 Suppl)):S65–S68. [PubMed] [Google Scholar]
4. Brédart A., Bouleuc C., Dolbeault Southward. Doctor-patient communication and satisfaction with care in oncology. Curr Opin Oncol. 2005;17((14)):351–354. [PubMed] [Google Scholar]
5. Brinkman Westward. B., Geraghty S. R., Lanphear B. P., et al. Effect of multisource feedback on resident communication skills and professionalism: a randomized controlled trial. Arch Pediatr Adolesc. 2007;161((i)):44–49. [PubMed] [Google Scholar]
6. Henrdon J., Pollick Yard. Continuing concerns, new challenges, and next steps in doctor-patient communication. J Os Joint Surg Am. 2002;84-A((ii)):309–315. [PubMed] [Google Scholar]
7. Arora North. Interacting with cancer patients: the significance of physicians' communication behavior. Soc Sci Med. 2003;57((5)):791–806. [PubMed] [Google Scholar]
8. Stewart M. A. Constructive md-patient communication and health outcomes: a review. CMAJ. 1995;152((ix)):1423–1433. [PMC gratis article] [PubMed] [Google Scholar]
nine. Tongue J. R., Epps H. R., Forese L. L. Communication skills for patient-centered care: research-based, easily learned techniques for medical interviews that benefit orthopaedic surgeons and their patients. J Bone Joint Surg Am. 2005;87:652–658. [Google Scholar]
10. Stewart M., Brown J. B., Donner A., et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49((9)):796–804. [PubMed] [Google Scholar]
11. Lee S. J., Dorsum A. L., Block S. D., Stewart Due south. K. Enhancing doctor-patient advice. Hematology Am Soc Hematol Educ Program. 2002;1:464–483. [PubMed] [Google Scholar]
12. Baile West. F., Buckman R., Lenzi R., Glober 1000., Beale E. A., Kudelka A. P. SPIKES—a six-step protocol for delivering bad news: application to the patient with cancer. Oncologist. 2000;5((4)):302–311. [PubMed] [Google Scholar]
13. Sawyer Southward. K., Aroni R. A. Sticky issue of adherence. J Paediatr Child Health. 2003;39((1)):two–5. [PubMed] [Google Scholar]
14. Kindler C. H., Szirt 50., Sommer D., Häusler R., Langewitz W. A quantitative analysis of anaesthetist-patient communication during the pre-operative visit. Anaesthesia. 2005;60((1)):53–59. [PubMed] [Google Scholar]
15. Middleton S., Gattellari 1000., Harris J. P., Ward J. E. Assessing surgeons' disclosure of risk information before carotid endarterectomy. ANZ J Surg. 2006;76((vii)):618–624. [PubMed] [Google Scholar]
sixteen. Roter D. L. Doctor/patient communication: transmission of information and patient effects. Md Land Med J. 1983;32((four)):260–265. [PubMed] [Google Scholar]
17. Platt F. W., Keating Chiliad. N. Differences in physician and patient perceptions of simple UTI symptom severity: understanding the advice gap. Int J Clin Prac. 2007;61((2)):303–308. [PubMed] [Google Scholar]
18. Harmon G., Lefante J., Krousel-Wood M. Overcoming barriers: the role of providers in improving patient adherence to antihypertensive medications. Curr Opin Cardiol. 2006;21((iv)):310–315. [PubMed] [Google Scholar]
19. Kaplan S. H., Greenfield Due south., Ware J. E., Jr Assessing the effects of medico-patient interactions on the outcomes of chronic disease. Med Care. 1989;27((3 Suppl)):S110–S127. [PubMed] [Google Scholar]
twenty. Greenfield South., Kaplan Southward., Ware J. East., Jr Expanding patient interest in care. Effects on patient outcomes. Ann Intern Med. 1985;102((four)):520–528. [PubMed] [Google Scholar]
21. Alazri K. H., Neal R. D. The clan between satisfaction with services provided in chief care and outcomes in Type 2 diabetes mellitus. Diabetes Med. 2003;20((6)):486–490. [PubMed] [Google Scholar]
22. O'Keefe M. Should parents appraise the interpersonal skills of doctors who care for their children? A literature review. J Paediatr Child Health. 2001;37((half-dozen)):531–538. [PubMed] [Google Scholar]
23. Chen Due west. T., Starks H., Shiu C. Southward., et al. Chinese HIV-positive patients and their healthcare providers: contrasting Confucian versus Western notions of secrecy and support. ANS Adv Nurse Sci. 2007;30((4)):329–342. [PMC gratuitous article] [PubMed] [Google Scholar]
24. Greenfield Due south., Kaplan S. H., Ware J. Due east., Jr, Yano E. M., Frank H. J. Patients' participation in medical care: effects on claret sugar command and quality of life in diabetes. J Gen Intern Med. 1988;three((five)):448–457. [PubMed] [Google Scholar]
25. Roter D. L., Hall J. A., Aoki Y. Physician gender effects in medical advice: a meta-analytic review. JAMA. 2002;288((6)):756–764. [PubMed] [Google Scholar]
26. Maguire P., Pitceathly C. Primal communication skills and how to learn them. BMJ. 2002;325((7366)):697–700. [PMC free article] [PubMed] [Google Scholar]
27. Footling P., Everitt H., Williamson I., et al. Observational written report of effect of patient centredness and positive arroyo on outcomes of general practice consultations. BMJ. 2001;323((7318)):908–911. [PMC free commodity] [PubMed] [Google Scholar]
28. Brown J. B., Boles Yard., Mullooly J. P., Levinson W. Effect of clinician communication skills training on patient satisfaction: a randomized, controlled trial. Ann Intern Med. 1999;131((11)):822–829. [PubMed] [Google Scholar]
29. Ballyhoo G. B., Allen J., Cooper D., Head J. O. Personality differences between doctors and their patients: implications for the teaching of communication skills. Med Educ. 2004;38((2)):177–186. [PubMed] [Google Scholar]
30. Hall J. A., Roter D. 50., Katz Due north. R. Meta-assay of correlates of provider behavior in medical encounters. Med Intendance. 1988;26((7)):657–675. [PubMed] [Google Scholar]
31. Fentiman I. S. Communication with older breast cancer patients. Breast J. 2007;thirteen((4)):406–409. [PubMed] [Google Scholar]
32. DiMatteo M. R. The role of the dr. in the emerging health care environment. Westward J Med. 1998;168((v)):328–333. [PMC free commodity] [PubMed] [Google Scholar]
33. The A. M., Hak T., Koëter G., van Der Wal G. Bunco in doctor-patient communication about imminent expiry: an ethnographic study. BMJ. 2000;321((7273)):1376–1381. [PMC free article] [PubMed] [Google Scholar]
34. Sobel D. Southward. Rethinking medicine: improving health outcomes with toll-effective psychosocial interventions. Psychosom Med. 1995;57((3)):234–244. [PubMed] [Google Scholar]
35. Lee R. Grand., Garvin T. Moving from information transfer to information exchange in wellness and health intendance. Soc Sci Med. 2003;56((three)):449–464. [PubMed] [Google Scholar]
36. Chiò A., Montuschi A., Cammarosano S., et al. ALS patients and caregivers communication preferences and data seeking behaviour. Eur J Neurol. 2008;15((one)):55–sixty. Epub 2007 Nov 14. doi:10.1111/j.1468-1331.2008.02143.x. [PubMed] [Google Scholar]
37. Diette G. B., Rand C. The contributing role of health-care communication to health disparities for minority patients with asthma. Chest. 2007;132((5 Suppl)):802S–809S. [PubMed] [Google Scholar]
38. Parker South. M., Clayton J. Grand., Hancock K., et al. A systematic review of prognostic/stop-of-life communication with adults in the avant-garde stages of life-limiting illness: patient/caregiver preferences for the content, way, and timing of data. J Pain Symptom Manage. 2007;3((one)):81–93. [PubMed] [Google Scholar]
39. Harms C., Young J. R., Amsler F., Zettler C., Scheidegger D., Kindler C. H. Improving anaesthetists' communication skills. Anaesthesia. 2004;59((ii)):166–172. [PubMed] [Google Scholar]
40. Bensing J. M., Sluijs E. M. Evaluation of an interview training course for full general practitioners. Soc Sci Med. 1985;xx((seven)):737–744. [PubMed] [Google Scholar]
41. Feudtner C. Collaborative communication in pediatric palliative care: a foundation for problem-solving and conclusion-making. Pediatr Clin North Am. 2007;54((five)):583–607. [PMC free article] [PubMed] [Google Scholar]
42. Minhas R. Does copying clinical or sharing correspondence to patients result in better care? Int J Clin Prac. 2007;61((8)):1390–1395. [PubMed] [Google Scholar]
43. Hagihara A., Tarumi K. Doctor and patient perceptions of the level of doctor explanation and quality of patient-doctor communication. Scand J Caring Sci. 2006;xx((ii)):143–150. [PubMed] [Google Scholar]
44. Ware J. Due east., Jr, Davies A. R. Behavioral consequences of consumer dissatisfaction with medical care. Eval Program Plann. 1983;six((3–4)):291–297. [PubMed] [Google Scholar]
45. Girón M., Manjón-Arce P., Puerto-Barber J., Sánchez-García East., Gómez-Beneyto Thou. Clinical interview skills and identification of emotional disordes in primary care. Am J Psychiatry. 1998;155((four)):530–535. [PubMed] [Google Scholar]
46. Suarez-Almazor Thousand. Eastward. Patient-doctor advice. Curr Opin Rheumatol. 2004;sixteen((two)):91–95. [PubMed] [Google Scholar]
47. Skea Z., Harry V., Bhattacharya S., et al. Women's perceptions of decision-making about hysterectomy. BJOG. 2004;111((ii)):133–142. [PubMed] [Google Scholar]
Articles from The Ochsner Journal are provided here courtesy of Ochsner Clinic Foundation
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096184/
0 Response to "Referring to the Example of Kyle and Mixed Messages in the Work File Review"
Post a Comment