The nature of patient-provider communications

Who can be considered healthcare providers?

Advanced practice nursing:
- Nurse practitioners – sees their own patients, provides routine medical care, prescribes treatment, monitors progress of chronically ill patients and sees walk-in patients (ALL UNDER THE SUPERVISION OF AN ATTENDING PHYSICIAN)
- Certified nurse midwives
- Clinical nurse specialists
  - Has specialties (surgical nurses, pedia, ICU, etc.)
- Certified registered nurse anesthetists
  - Relatively new in the US, none in the Philippines
  - Can cover if there is shortage in anesthesiologists
Physician assistants
- 2 year post-college program
- 1st year courses are the same as medical students, 2nd year courses are Clinical Rotations with direct patient contact
- requires at least 2 years of college and experience in health care before acceptance
- Good alternative to med school because med school is expensive and too long
- Didactic, lecture-based
- Advantage: requires at least 2 years of college

“Issues” with other healthcare providers

Not popular in the Philippines
Redundancy of other health care professions such as psychiatrists, general practitioners, internists, etc.
Cannot practice on their own – needs to be “attached” to private medical practitioner
- Need someone to cosign med orders, etc.

Nature of Patient-Provider Relations

Judging quality of care
- Quality of care is often judged based on the MANNER IN WHICH CARE IS DELIVERED
  - How you deliver the diagnosis and how you establish rapport is important
- If the provider is warm and/or friendly, patients often see them as “nice and competent”.
- If provider is cold or aloof, patients see them as distant and incompetent.
- Strike a balance between direct and gauge how straightforward you could be
Patient consumerism: Doctors are no longer seen as “all-knowing”; patients have increasingly adopted a consumerist or “patient as customer” attitude towards their health care.
Setting: Average visit lasts 12 to 15 minutes and patients are interrupted not even 23 seconds into their history.

Structure of the Healthcare Delivery System (in US; pretty same in the Philippines but not well-developed)

Private, fee-for-service-care: paid for out of pocket by patient
- Usually called private patients
HMO (Health Maintenance Organization): employees and employers have an agreed upon monthly rate, and employees are entitled to use health services at either no cost or a greatly reduced rate. Employees/patients must be pre-approved in order to see a “within-network” specialist or non-emergency provider.
Preferred Provider Organizations: Network of doctors offers members a discounted rate, members do not need pre-approval to visit an in-network specialist

Provider behaviors that contribute to faulty communication

Overuse of jargon
Baby Talk
Nonperson treatment
- Instead of talking to the patient directly, the doctor will talk to the parents
Patient stereotypes: Black, Hispanic patients; Elderly, Sexism, Psychological symptoms
- Can come from both the patient and the healthcare providers

Patients’ contributions to faulty communication

Patient characteristics: neuroticism, anxiety
- Neurotic: extremely pessimistic
- Highly anxious: they may project that anxiety unto you
Patient knowledge
- Explain why their side/knowledge is wrong and why your side is right
- Show concrete evidence to support your claim
Patient attitude towards symptoms: consider patient’s embarrassment, emphasis on symptoms that produce pain or limit movement
- Embarrassed: usually any kind of mental illness because of stigma (also cultural)
- pain/limited movement: harder to deal with

Improving patient-provider communication

2-way training
- Patients need to be able to express how they feel, their symptoms
- Always take into consideration how you’re coming across
  - Can the patient understand you without dumbing it down?
Information-Motivation-Behavioral Skills Model of health behavior: One needs the right information, the motivation to adhere, and the skills to perform the behavior.

The patient in the hospital setting

Cure: responsibility of the physician; goal is to restore patient to good health
Patient Care: orientation of the nursing staff; humanistic side of medicine; goal is not only to restore patient to good health, but also to help patient keep their emotional and physical states in balance.
Maintaining the Core of the hospital: responsibility of hospital administration; ensures smooth functioning of the system as well as the flow of resources, services, and personnel.

Special issues in patient-provider relations

Burnout of providers
- More patients than providers
When the patient is a child – Best practice is to prepare BOTH the patient and their parents. Ensure the hospital environment is as caring as possible.

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Psychology

Health Psychology: Patient-Provider Relations

The nature of patient-provider communications

Who can be considered healthcare providers?

Advanced practice nursing:
- Nurse practitioners – sees their own patients, provides routine medical care, prescribes treatment, monitors progress of chronically ill patients and sees walk-in patients (ALL UNDER THE SUPERVISION OF AN ATTENDING PHYSICIAN)
- Certified nurse midwives
- Clinical nurse specialists
  - Has specialties (surgical nurses, pedia, ICU, etc.)
- Certified registered nurse anesthetists
  - Relatively new in the US, none in the Philippines
  - Can cover if there is shortage in anesthesiologists
Physician assistants
- 2 year post-college program
- 1st year courses are the same as medical students, 2nd year courses are Clinical Rotations with direct patient contact
- requires at least 2 years of college and experience in health care before acceptance
- Good alternative to med school because med school is expensive and too long
- Didactic, lecture-based
- Advantage: requires at least 2 years of college

“Issues” with other healthcare providers

Not popular in the Philippines
Redundancy of other health care professions such as psychiatrists, general practitioners, internists, etc.
Cannot practice on their own – needs to be “attached” to private medical practitioner
- Need someone to cosign med orders, etc.

Nature of Patient-Provider Relations

Judging quality of care
- Quality of care is often judged based on the MANNER IN WHICH CARE IS DELIVERED
  - How you deliver the diagnosis and how you establish rapport is important
- If the provider is warm and/or friendly, patients often see them as “nice and competent”.
- If provider is cold or aloof, patients see them as distant and incompetent.
- Strike a balance between direct and gauge how straightforward you could be
Patient consumerism: Doctors are no longer seen as “all-knowing”; patients have increasingly adopted a consumerist or “patient as customer” attitude towards their health care.
Setting: Average visit lasts 12 to 15 minutes and patients are interrupted not even 23 seconds into their history.

Structure of the Healthcare Delivery System (in US; pretty same in the Philippines but not well-developed)

Private, fee-for-service-care: paid for out of pocket by patient
- Usually called private patients
HMO (Health Maintenance Organization): employees and employers have an agreed upon monthly rate, and employees are entitled to use health services at either no cost or a greatly reduced rate. Employees/patients must be pre-approved in order to see a “within-network” specialist or non-emergency provider.
Preferred Provider Organizations: Network of doctors offers members a discounted rate, members do not need pre-approval to visit an in-network specialist

Provider behaviors that contribute to faulty communication

Overuse of jargon
Baby Talk
Nonperson treatment
- Instead of talking to the patient directly, the doctor will talk to the parents
Patient stereotypes: Black, Hispanic patients; Elderly, Sexism, Psychological symptoms
- Can come from both the patient and the healthcare providers

Patients’ contributions to faulty communication

Patient characteristics: neuroticism, anxiety
- Neurotic: extremely pessimistic
- Highly anxious: they may project that anxiety unto you
Patient knowledge
- Explain why their side/knowledge is wrong and why your side is right
- Show concrete evidence to support your claim
Patient attitude towards symptoms: consider patient’s embarrassment, emphasis on symptoms that produce pain or limit movement
- Embarrassed: usually any kind of mental illness because of stigma (also cultural)
- pain/limited movement: harder to deal with

Improving patient-provider communication

2-way training
- Patients need to be able to express how they feel, their symptoms
- Always take into consideration how you’re coming across
  - Can the patient understand you without dumbing it down?
Information-Motivation-Behavioral Skills Model of health behavior: One needs the right information, the motivation to adhere, and the skills to perform the behavior.

The patient in the hospital setting

Cure: responsibility of the physician; goal is to restore patient to good health
Patient Care: orientation of the nursing staff; humanistic side of medicine; goal is not only to restore patient to good health, but also to help patient keep their emotional and physical states in balance.
Maintaining the Core of the hospital: responsibility of hospital administration; ensures smooth functioning of the system as well as the flow of resources, services, and personnel.

Special issues in patient-provider relations

Burnout of providers
- More patients than providers
When the patient is a child – Best practice is to prepare BOTH the patient and their parents. Ensure the hospital environment is as caring as possible.