Patient Provider Communication

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    • 00:02

      [MUSIC PLAYING][Patient Provider Communication]

    • 00:11

      JAY BAGLIA: Hi, my name is Jay Baglia,and I'm at DePaul University in Chicago,Illinois. [Jay Baglia, Assistant Professor of HealthCommunication, DePaul University]So in today's tutorial, we're goingto look at patient-provider communication.And there's three aspects of thatthat we're going to cover today.One, the history of physician-centeredcommunication or the tendency for physiciansto drive the communication.The second thing we're going to look atis how there's been an evolution or transition to moreof a patient-centered approach.

    • 00:36

      JAY BAGLIA [continued]: And then the third thing we're going to look atis the ways in which health care institutions have enacteddifferent strategies to improve patient-provider communication.[Building a relationship]The relationship between a physician and a patientis one of unequal power.[The unequal power dynamic]You can look at the sort of hierarchy, socioeconomically,of patients and physicians, but also think about the factthat the patient is the one without the informationabout their disease.

    • 01:04

      JAY BAGLIA [continued]: The physician holds the power and the knowledgeabout that disease and the treatment options.And furthermore, at a much more base level,the physician remains dressed and the patient is undressed.The patient is sitting and the physician is standing.All of these elements contribute to a power dynamicthat is unequal.So I'd like you to think about your relationshipwith your physician.

    • 01:26

      JAY BAGLIA [continued]: Chances are the quality of that relationshipis defined, in no small part, by how you perceivethe communication goes between your primary carephysician and yourself.[Physician centered communication]In the physician-centered model, physiciansdo most of the talking, are prone to interruptions,and begin and end the conversation.

    • 01:48

      JAY BAGLIA [continued]: At the same time, patients are alsoknown to acquiesce to the positionand rarely will try to guide the conversation.So how do you recognize physician centeredness.Well, the physician or the nurse or the health care providerwill most likely be issuing directivesor, otherwise, telling you what to dorather than starting with a dialogue or waysin which the two of you can arrive mutually at a decision.

    • 02:15

      JAY BAGLIA [continued]: Physician centeredness also contains a phenomenonknown as blocking where the physician steersthe patient away from certain topics or categoriesthat that physician or the nurse or the health care providermay find uncomfortable.And in addition to blocking empathy or blocking an approachto the patient that acknowledges their fears,the physician-centered model, by using blocking,really maintains the physician's agendaand not the patient's agenda.

    • 02:47

      JAY BAGLIA [continued]: [Patient-centered approach]If we look at the patient-centered approach,there's a collaborative model, whichhappens when the physician and the patientor the health care provider and the patientmake mutually satisfying decisions basedon an equal exchange of informationand an honest exchange of information.So the patient needs to provide as much informationas the physician needs to make a diagnosisand recommend treatment options, and the physician hasto listen to the patient's concerns,maybe about treatment options but also about the patient'sown fears about a particular diagnosis.

    • 03:20

      JAY BAGLIA [continued]: So how do we move from a physician-centered modelto a patient-centered model?Well, one of the tools that helpsus understand the difference between a physician-centeredapproach and a patient-centered approachis the difference between the biomedical lensand the bio-psychosocial lens.In the biomedical lens, which has historicallybeen the lens favored by health care professionals,the disease is very focused and specificand is confirmed through lab results and observationand blood tests and things like that.

    • 03:51

      JAY BAGLIA [continued]: The story of the disease is told through the patient's chart,which houses all that information about lab results.Juxtapose the biomedical lens with the bio-psychosocial lensin which the focus of the illness is not specific,it's rather diffuse.For the patient, the experience of being illis highly subjective with issues relatedto relationships and work and one's own fear of mortalityall coming together to inform how that patient dealswith that illness.

    • 04:26

      JAY BAGLIA [continued]: So the biomedical lens, while useful and is certainlybased on solid science, doesn't reallybring into account the patient's perspective.[Patient characteristics]So let's talk a little bit about some patient characteristics.One, for example, is that patientsare, as has already been discussed,often frustrated by physicians' communication styles,specifically things like interruptionsand not being heard.

    • 04:51

      JAY BAGLIA [continued]: Another patient characteristic is the factthat patients and physicians are oftentalking at what's called cross purposes.That the physician is thinking about the disease in this way,and the patient is thinking about the disease in this way.Sometimes this difference is calledthe voice of medicine verses the voiceof the life-world, a couple of phrasesthat Elliot Mishler coined in the early 1980s.

    • 05:16

      JAY BAGLIA [continued]: A third aspect of patient centerednessthat needs to be addressed is that patients don't alwaysknow what questions to ask.They often are sort of overwhelmed by their fearof the disease and what the physician is suggestingwith regard to treatment options and don't always feelthe agency to ask questions.

    • 05:36

      JAY BAGLIA [continued]: And so part of patient centerednessis both for the patient to be prepared with questionsand for the physician to provide some spacefor that patient to ask questions and havesome of their fears and concerns alleviated.Finally, many patients, particularly patientsof an older generation, really dobuy into the power differential and assumethat the physician is doing what they're supposed to doand that the care that's being providedis as good as can be expected.

    • 06:09

      JAY BAGLIA [continued]: So when we look at patient satisfaction scores, whichare often a part of a survey result,patients are most satisfied when they feel listened toand, especially, when physicians can eliminate jargon.[How changes and improvements are being implemented]The final part of this tutorial will look, specifically,at some of the strategies that hospital systems and healthcare institutions are providing for both patientsand physicians to improve the likelihoodof a patient-centered transactioncollaboration taking place.

    • 06:41

      JAY BAGLIA [continued]: [Culture and diversity]In the United States, the diversityof patients and caregivers has become greater and greater,especially in the last 25 years.And so culture is an important thingto consider when we talk about patient centeredness.It's very complex, and culture has both internal and externalfeatures.

    • 07:01

      JAY BAGLIA [continued]: External features of culture wouldbe, for example, the language or the accentthat someone has in their speech patterns, clothing, foodpreferences.But internally, there are also aspects of culturelike philosophies and beliefs.It's important to recognize that because of the diversityof patients in American culture, physicians and caregivers needto know about the concept of stigmainsofar as some cultures stigmatize certain diseasesmore so than others.

    • 07:37

      JAY BAGLIA [continued]: [Health literacy]Another aspect that improves patient centerednessis an acknowledgement of health literacy as a componentin treatment options.Health literacy is not the same as literacy or numeracy, whichare the degree to which people understand and can read wordsand language or understand numbersin complicated, or not so complicated,mathematical formulas.

    • 08:01

      JAY BAGLIA [continued]: Health literacy refers to the ways in which patientsunderstand their health issue.Sometimes it also includes an understandingof the sort of pharmaceutical components of their treatmentoptions, how many pills to take in a day,and even really understanding some basic biological systemsthat, unfortunately, are not well knownby the vast majority of the population.

    • 08:27

      JAY BAGLIA [continued]: And so physicians and nurses are beingtrained to recognize aspects or the degree to whicha patient is health literate.[Ask me 3 program]OK.So one other very concrete strategythat hospitals are utilizing is what's called the Ask Me 3Program.And this is sponsored by the National Patient SafetyFoundation.

    • 08:47

      JAY BAGLIA [continued]: And Ask Me 3 is just a series of three questionsthat patients can be encouraged to ask so that they canget information about their disease thatis very specific to them.[Ask me 3: What is my main problem?]So the first question is, what is my main problem?In other words, a physician may present a patientwith a diagnosis that they don't really understand.

    • 09:09

      JAY BAGLIA [continued]: So what is my main problem?What is my body doing?[Ask me 3: What do I need to do?]So the second question is, what do Ineed to do, which refers to the treatmentplan the physician has recommended,whether it's lifestyle alterationor a pharmaceutical drug or an exerciseprogram or a dietary change.Those questions are specific and concreteand should yield answers that the patient understands.

    • 09:33

      JAY BAGLIA [continued]: Third, why is it important for me to do this,connects the diagnosis of the disease with the treatmentoptions.[Ask me 3: Why is it important for me to do this?]So the patient can see the link between what the physician hasidentified as the chief complaint and the treatmentoption that will hopefully allow the patientto improve their health.[Key points History of the physician centered modelTransition to patient centered model Patient characteristicsChanges and improvements Cultural-centered communicationHealth literacy Ask me three program]So in this tutorial, we've talked about three things.

    • 09:59

      JAY BAGLIA [continued]: We've talked about the history of physician centerednessand what some of the pitfalls areof a physician-centered model.We transition to the value of a patient-centered approachto patient-provider communication,and we closed with some examples, health literacy,cultural-centered communication, and the Ask Me3 Program that are strategies thatare designed to improve communicationbetween physicians and patients.

    • 10:23

      JAY BAGLIA [continued]: The most important thing about this tutorial, I think,is the understanding for the listenerthat your provider is your choice.And if you're not connecting with your health care provider,you really should think about looking elsewhere.

Patient Provider Communication

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Jay Baglia discusses the power dynamics of the physician-patient relationship, then explains how medicine is shifting from physician-directed and patient-centered communication.

SAGE Video Tutorials
Patient Provider Communication

Jay Baglia discusses the power dynamics of the physician-patient relationship, then explains how medicine is shifting from physician-directed and patient-centered communication.

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