Effective communication.pdf

EFFECTIVE COMMUNICATION PREPARED BY NESMA GAMAL ELSHEIKH LECTURER OF GERIATRIC AND GERONTOLOGY MEDICINE  IMPORTANCE OF EFFECTIVE COMMUNICATION Effective Communication Is An Essential Skill In General Practice Consultations. Effective Communication Is An E...

EFFECTIVE COMMUNICATION PREPARED BY NESMA GAMAL ELSHEIKH LECTURER OF GERIATRIC AND GERONTOLOGY MEDICINE  IMPORTANCE OF EFFECTIVE COMMUNICATION Effective Communication Is An Essential Skill In General Practice Consultations. Effective Communication Is An Essential Part Of Building And Maintaining Good Physician-patient And Physician- colleague Relationships. These Skills Help People To Understand And Learn From Each Other, Develop Alternate Perspectives, And Meet Each Others' Needs. It Is The Heart And Art Of Medicine. The Art Of Communication The Development Of Effective Skills And Finding A Style Of Communication That Suits The Clinician And Produces Benefits For Both Patient And Doctor.  IMPORTANCE OF EFFECTIVE COMMUNICATION Effective Doctor-patient Communication Is A Central Clinical Function In Building A Therapeutic Doctor-patient Relationship, This Is Important In The Delivery Of High-quality Health Care. The Core Clinical Skills In The Practice Of Medicine, With The Ultimate Goal Of Achieving The Best Outcome And Patient Satisfaction, Much Patient Dissatisfaction And Many Complaints Are Due To Breakdown In The Doctor-patient Relationship. A Doctor's Communication And Interpersonal Skills Encompass The Ability To Gather Information In Order To Facilitate Accurate Diagnosis, Counsel Appropriately, Give Therapeutic Instructions, And Establish Caring Relationships With Patients.  IMPORTANCE OF EFFECTIVE COMMUNICATION Communication Skills In A Healthcare Setting Include The Way You Use To: 1. Explaining Diagnosis, Investigation And Treatment. 2. Involving The Patient In The Decision-making. 3. Communicating With Relatives. 4. Communicating With Other Health Care Professionals. 5. Breaking Bad News. 6. Seeking Informed Consent/Clarification For An Invasive Procedure Or Obtaining Consent For A Post- mortem. 7. Dealing With Anxious Patients Or Relatives. 8. Giving Instructions On Discharge. 9. Giving Advice On Lifestyle, Health Promotion Or Risk Factors.  COMPONENTS OF EFFECTIVE COMMUNICATION Effective Communication Has Three Basic Components- Verbal Deals With The Content Of The Message Including Selection Of The Words Verbal Component (Content) Is Important And It Includes Information About The Nature, Course And Prognosis Of The Disease; Various Treatment Options Available; Nature, Cost And Yield Of The Investigations And Risks/Benefits Of Invasive Procedures. Non- Verbal Includes Body Language Like Posture, Gesture, Facial Expression And Spatial Distance It also include The Use Of Pictures, Icons, And Symbols Although Nonverbal Component Of The Communication Is Frequently Considered Less Important, Literature Suggest That It Significantly Influences Important Outcomes Like Patient’s Satisfaction, Adherence To Advices And Clinical Outcome Paraverbal.. Includes Tone, Pitch, Pacing And Volume Of The Voice. While Communicating  COMPONENTS OF EFFECTIVE COMMUNICATION Most Of Us Focus On The Verbal Component That Constitutes Only Ten Percent Of The Message Delivered Whereas Non-verbal And Paraverbal Components Contribute Ninety Percent Of The Total Message Delivered.  WHO WILL WE COMMUNICATE WITH Building COMMUNICATION SKILLS Among Doctors Enables Them To Communicate Effectively With Patients, Relatives And Colleagues In Different Circumstances As: Communication with Patient Doctor Colleagues Relationship Consultation And Compliant Management Bad News Difficult Delivery Encounters Communicating With Patient And Their Relative  GOAL OF Doctor-patient effective Communication The 3 Main Goals Of Current Good Doctor-patient Communication Are Creating 1. Good Interpersonal Relationship 2. Facilitating Exchange Of Information 3. Including Patients In Decision Making So This Lead To Improve Quality Of Medical Service Giving To The Patient  BENEFITS OF EFFECTIVE COMMUNICATION Benefits for the patient A. Help Regulate Patients‘ Emotions B. Facilitate Comprehension Of Medical Information C. Allow For Better Identification Of Patients' Needs, Perceptions, And Expectations D. Stop The Need For Unnecessary Investigations And Reveal Psychological Causes For Physical Symptoms. E. Prevent The Patient Returning With Unresolved Problems. In The Manual Of Mental Health F. Better Adherence To Treatment, Improved Follow Up  BENEFITS OF EFFECTIVE COMMUNICATION Benefit For Both Doctors And Patients 1. A More Patient-centered Encounter Results In Better Patient As Well As Doctor Satisfaction. A. Satisfied Patients Are Less Likely To Lodge Formal Complaints Or Initiate Malpractice Complaints. B. Satisfied Patients Are Advantageous For Doctors In Terms Of Greater Job Satisfaction, Less Work-related Stress, Reduced Burnout, Improve Personal Well-being For The Doctors. 2. Improve Outcomes For Patients And Doctors A. Despite All The Technological Advances Of Recent Decades, Caring, Compassionate, Healing Doctors Remain The Best Therapeutic Tool In Medicine. B. The Ability Of A Doctor To Provide Comfort Through Their Words Is A Fundamental Component Of Good GoodCare. Medical communication can improve outcomes for patients and doctors and deserves C. Australian Statistics equal Revealimportance as developing That Almost Two-thirds clinical Of The knowledge Problems andDone So Without Managed Were Pharmacological Treatment.. procedural skill. an effective patient-centered model does not take more time.  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 1. Learn To Listen To The Patients Patiently 2. Create Patient Comfort Before Starting Formal Interview With Patient 3. Conducting Medical Interview With The Patient 4. Communicating With The Attendants 5. Handling Patient In Different Situations I. During Consultation And Complain Management II. During Bad News Delivering III. Managing Difficult Encounters  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 1. Learn To Listen To The Patients Patiently Listening Is Extremely Important In Creating A Trustworthy Doctor-patient Relationship Which Is A Prerequisite For Therapeutic Success It Is An Active Process That Involves Imbibing All The Information Expressed Verbally Or Nonverbally By The Patient. It Is A Major Part Of Communication Process. It Helps In Better Understanding Of The Patient’s Problem And Finding Better Decisions. Motives The Goal Of Listening Is, Also, To Delve Into The Physical, Social And Emotional Impact Of These Problems On The Patient’s Quality Of Life So As To Provide Holistic Care And Satisfaction.  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 1. Learn To Listen To The Patients Patiently Some Of The Communication Strategies That May Help The Doctor To Improve Listening Skills Are: 1. Make The Patient And The Attendant Comfortable. Never Have Discussions While Walking In The Corridors. 2. Show Interest In What The Patient Is Saying With non verbal clue as Your Mannerism, Body Language And Active Involvement Like Leaning Towards The Patient, Open, Attentive Posture, Eye Contact 3. Mannerism Like Patting Shoulder, Holding Hands Or Nodding May Convince The Patient That You Care For Them And Have Understood His/ Her Problem. 4.Be Careful Not To Interrupt Him/Her When He/She Is Expressing Something. 5. While Concluding, One Must Ask The Patient If He Would Like To Add Something More  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 2. Create Patient Comfort Before Starting Formal Interview With Patient Win Patient’s Confidence In The First Interaction Even Before Starting Formal Interview. First Impression Is Extremely Crucial And Instrumental For Building Doctor-patient Relationship. The Major Determining Factor For This First Impression Is Not What The Doctor Says But How The Doctor Says It. Place Where You Communicate With The Patient Is Important (Private And Comfortable To The Patient)  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 2. Create Patient Comfort Before Starting Formal Interview With Patient Some Of The Practice Points Are Listed Below : 1. Respect The Patient’s Confidentiality And Maintain Privacy. 2. Be The First One To Greet The Patient. ❑ Do Not Wait For The Patient To Speak Because Some Patient Will Interpret Your Reticence As Indifference. ❑ Shake Hands And Introduce Yourself Wherever Feasible And Socially Acceptable. 3. Be Prepared And Know The Patient’s Name. ❑ Address A Patient By His/Her Name Whenever Required. ❑ Do Not Fumble For Name After The Patient Is In The Room. ❑ If It Is An Old Case, Greet Him And Ask Him How He Is. 4. Establish Eye Contact And Maintain It At Reasonable Intervals. 5. Put The Patient At Ease. ❑ Some Patients May Be Nervous, So Begin With A General Non-medical Inquiry In Order To Develop A Comfortable Scenario For The Patient.  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 3. Conducting Medical Interview With The Patient The Medical Interview Is An Opportunity For The Doctor To Understand The Patient’s Problems And Learn Its Psychosocial Bearing. Simply Writing A Prescription Has Got No Value And Is Actually Wastage Of Time And Energy Unless It Is Adequately Honored By Patients. It Is Extremely Important, Especially In Cases With Chronic Illness, Where Good Communication Skill Is Useful In Allaying Anxiety And Motivating The Patient For Good Compliance Regarding Advices. The Interview Should Be Patient Centric Rather Than Disease Centric It Is Vital That The Patient’s Interview Is Conducted To Achieve Three Essential Goals That Is ❑ Gathering Of Information, ❑ Building A Healthy Doctor-patient Relationship ❑ Education Of The Patient  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 3. Conducting Medical Interview With The Patient Some Of The Very Important Practical Advices Are: 1. Pay Attention To ❑ Both The Verbal And Non-verbal Clues From The Patient ❑ And Explore Whenever There Is Any Discrepancy Between The Two. ❑ The Physician Should Be also Alert About His Own Non-verbal Clues Like Body Language, Gestures, Eye- contact. 2. Always Provide Information On What The Patient Wants To Know And Promptly Respond To The Patient’s Reaction. 3. Discuss Nature, Course And Prognosis (Both Short & Long Term) Of The Disease, Treatment Options Available And Necessity Of The Investigations.  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 3. Conducting Medical Interview With The Patient Some Of The Very Important Practical Advices Are: 4. Discuss In Detail Regarding Necessity And Feasibility Of Expensive Investigations And Drugs And Their Effect On Main Course And Outcome Of Disease. 5. Involve The Patient In The Decision Making. The Treatment Plan Must Conform To The Patient’s Understanding, Beliefs, Cultural Values And Concerns. 6. Put Additional Efforts In Motivating Patients Regarding Adherence To Lifestyle Modifications. 7. Always Comprehend Details In Simple Language. The Use Of Medical Jargons And Abbreviations Can Have A Negative Effect.  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 4. Communicating With The Attendants Communicating With The Attendants Assumes Great Importance Especially When Patient Is Critically Ill Or Admitted In ICU. Tips That Will Definitely Improve One’s Ability To Communicate: 1. Talk About And Appreciate The Efforts Made By Them. 2. Most Of The Attendants Surfs Internet And Gather Lots Of Information. Try To Satisfy Their Queries By Giving Better References. 3. Always Explain The Dynamic Nature Of Disease. This Is Especially Important For Critically Ill Patients.  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 4. Communicating With The Attendants Tips That Will Definitely Improve One’s Ability To Communicate. 4. Second Opinion Should Be Sought Proactively. ❑ This Is Important Not Only In Patient Management When One Is In Doubt ❑ But Also Helpful In Building Attendant’s Confidence. One Will Be More Convinced And Ready To Accept Bad Outcome If The Same Fact Is Explained By More Than One Consultants. 5. Never Express Shock. Try To Convince That All Efforts Are Being Made To Bring Situation Under Control Or Will Be Controlled. 6. Consent Taking Is Very Important Part Of Counselling. Never Neglect This  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 5. Handling Patient In Different Situations I. During Consultation And Complaint Management Knowledge ❑ Know How To Structure The Interview To Identify The Patient’s: 1. Concern/ Problem List /Priorities 2. Expectation 3. Demonstrate An Understanding Of The Need For Offering Choices 4. Acceptance  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 5. Handling Patient In Different Situations I. During Consultation And Complaint Management Skill ❑ Listening To Patients ❑ Encouraging Open Communication About Treatment Preferences, Discussing Management Options, ❑ Allowing Patients To Ask Questions ❑ Ensuring Understanding And Being Aware Of Language, Cultural And Communication Issues. (Spoken And Written) ❑ Use Open Questions Followed By Appropriate Closed Questions. ❑ Use Familiar Language.  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 5. Handling Patient In Different Situations I. During Consultation And Complaint Management ▪ Skill ❑ Give Clear Information And Feedback To Patients And Share Information With Relatives When Appropriate ✓ Involving Patients In Decisions ✓ Respecting Patients Views ❑ Reassure ‘Worried Well’ Patients. ❑ Manage Dissatisfied Patients / Relatives. ❑ Anticipate Potential Problems. ❑ Act With Honesty And Sensitivity And Promptly. ❑ Be Prepared To Accept Responsibility  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 5. Handling Patient In Different Situations I. During Consultation And Complaint Management ❑ There Is Not Simply One Way Doctors Should Communicate To Be Effective, But There Are Several Guidelines. ❑ Developing And Incorporating These Skills Is An Ongoing Journey And A Lifelong Process Of Refining This Art. ❑ Guidelines Emphasize The Importance Of Verbal And Non-verbal Communication Skills To Build A Shared Understanding. Verbal Cues Include Beginning The Consultation By Encouraging The Patient To Tell Their Story Without Interruption Then Asking Further, Open-ended Questions To Continue To Bring Out Additional Issues Or Concerns.  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 5. Handling Patient In Different Situations I. During Consultation And Complaint Management ❑ Empathy Is Another Essential Skill. Promotes Professional Satisfaction For The Clinician And Allows More Effective Care, As Patients Are More Likely To Be Open With An Empathetic Doctor. Development Of Trust And Ensuring Understanding Of The Patient’s Story And Psychosocial Factors Of Health Utilizing These Skills Will Enable Good Communication And Promote An Effective And Therapeutic Patient–doctor Relationship.  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 5. Handling Patient In Different Situations II. During Bad News Delivering ❑ Bad News Means Any Information That Has A Potential To Have Devastating Influence On One’s Life. ❑ However, It’s Impact Is Highly Dependent On The Recipient’s Expectation And Understanding ❑ Disclosing Bad News Is A Complex Communication Art ❑ That Not Only Involves Verbal Component Of Actual News Breaking ❑ But Also Includes Empathetic Response Of The Doctor To Tackle The Reaction. ❑ Poor Communication Skills Of An Inexperienced Clinician Can Ruin The Goal Of Providing Support To The Patient And Eliciting Patient’s Collaboration For Future Treatment.  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 5. Handling Patient In Different Situations II. During Bad News Delivering Knowledge ❑ Know How To Structure The Interview And Where It Should Take Place. ❑ Be Aware Of The Normal Bereavement Process And Behavior. ❑ Have Awareness Of Organ Donation Procedures And Role Of Local Transplant Coordinators ❑ Discuss DNR ,advance Directive And End Of Life Care.  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 5. Handling Patient In Different Situations II. During Bad News Delivering. Skill Be Able To Break Bad News In Steps Appropriate To The Understanding Of The Individual And Be Able To Support Distress. Use Familiar Language. Encourage Questions. Maintain Appropriate Hope Whilst Avoiding Inappropriate Optimism. Act With Empathy, Honesty And Sensitivity.  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 5. Handling Patient In Different Situations II. During Bad News Delivering. THE SIX-STEP PROTOCOL FOR DELIVERING BAD NEWS  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 5. Handling Patient In Different Situations III. Managing Difficult Encounters Approximately 15% Of The Doctor-patient Interactions Were Labelled As “Difficult” Encounters Difficult Encounters May Occur When ❑ A Patient May Present With Misleading Information From Internet And Pose Challenging Situation Leading To Professional Burnout Of The Physician ❑ Poor Communication Skills And Psychosocial Attitudes Along With Lesser Job Satisfaction Among The Doctors May Also Be Contributory ❑ Argumentative And Manipulative Patients Or Patients With Certain Behavioral Issues. ❑ Difficult Encounters, Also, Occur Due To Circumstances Like Language, Cultural And Time Barriers.  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 5. Handling Patient In Different Situations III. Managing Difficult Encounters Following Strategies Have Been Found To Be Useful In Maintaining A Healthy Therapeutic Relationship With Specific Type Of Patients. ❖ Dependent Patients- ❑ They Demand More Of The Personal Time From The Doctor Making Him Resentful. Thus, It Is Essential To Maintain A Professional Well Established Boundary. ❑ Involving The Patient In Decision Making Is Helpful. ❑ Assure Him That He Will Not Be Abandoned/Neglected And Will Be Given Full Attention In Subsequent Visits Also. ❖ Demanding Patients- ❑ They Are Often Aggressive And Do Not Want To Go Through The Stepwise Assessments Or Treatment. ❑ In Such A Situation The Doctor Should Avoid Judgmental Approach And Empathetically Ensure The Patient That He Will Get The Best Medical Care And There Is No Need To Show Anger.  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 5. Handling Patient In Different Situations III. Managing Difficult Encounters Following Strategies Have Been Found To Be Useful In Maintaining A Healthy Therapeutic Relationship With Specific Type Of Patients. ❖ Manipulative Patients- ❑ These Attention Seekers Who Have Been Rejected Previously Often Revisit The Doctor In Cycles Of Help-seeking/Rejecting Treatment And Do Not Improve Despite Appropriate Advice. ❑ Their Firm Belief That His/Her Health Cannot Improve Puts The Doctor In Doubt About His Own Diagnosis And Treatment. ❑ The Doctor Should Be Empathetic And Listen To His Problems Attentively While Sharing Frustration Over Poor Outcomes. ❑ The Doctor Must Reformulate The Treatment Plan With The Patient After Having Set Limitations Over Expectations.  STRATEGIES TO PROVIDE EFFECTIVE COMMUNICATION 5. Handling Patient In Different Situations III. Managing Difficult Encounters Following Strategies Have Been Found To Be Useful In Maintaining A Healthy Therapeutic Relationship With Specific Type Of Patients. ❖ Self-destructive Patients – ❑ Some Patients With An Underlying Anxiety Or Depression Are Often Hopeless About Their Ailment And Fear Failures. ❑ The Health Problem Persists Despite Adequate Counselling And Management. ❑ The Patient Continues Self-destructive Habits And The Doctor Considers Himself Ineffective And Responsible For Patient’s Lack Of Progress. ❑ The Doctor Should Set Realistic Expectations And Recognize The Fact That Complete Resolution Is Limited. ❑ The Doctor Should Try To Delve Into The Reasons For Non-adherence To Therapy (Money, Time Or Family Support) And Offer Or Arrange For Psychological Support.  BARRIERS FACING EFFECTIVE COMMUNICATION THERE ARE MANY BARRIERS TO GOOD COMMUNICATION IN THE DOCTOR-PATIENT RELATIONSHIP, Doctors Patients  BARRIERS FACING EFFECTIVE COMMUNICATION I. Doctors 1. Burden Of Work 2. Fear Of Litigation 3. Fear Of Physical Or Verbal Abuse 4. Doctors Do Not Give Enough Heed To The Importance Of Keeping Patients Adequately Informed 5. Language Barrier 6. Human Failings Like Stress, Tiredness Or Lack Of Time Are Major Contributing Factors In An Overburdened Setting.  BARRIERS FACING EFFECTIVE COMMUNICATION I. Doctors 7. Deterioration Of Doctors' Communication Skills ❑ Communication Skills Tend To Decline As Medical Students Progress Through Their Medical Education, And Over Lose Their Focus On Holistic Patient Care. ❑ The Emotional And Physical Brutality During Internship And Residency, Suppresses Empathy ❑ Lack Of Insight Due To Inadequate Knowledge And Training In Communication Skills. ❑ Non-verbal Components Of The Communications Are Frequently Neglected 8. Miscommunication ❑ The Doctor-patient Interaction Is A Complex Process, And Serious Miscommunication Is A Potential Pitfall,. ❑ These May Affect The Choices Regarding Their Treatment And End-of-life Care, Which Can Have A Significant Influence On The Disease.  BARRIERS FACING EFFECTIVE COMMUNICATION I. Doctors 9. Doctors' Avoidance Behavior ❑ Doctors Avoiding Discussion Of The Emotional And Social Impact Of Patients' Problems Because a) It Distressed Them When They Could Not Handle These Issues b) They Did Not Have The Time To Do So Adequately. ❑ This Situation Negatively Affected Doctors Emotionally And Tended To Increase Patients' Distress. ❑ This Avoidance Behavior Could Delay And Adversely Impact Their Recovery. 10. Discouragement Of Collaboration ❑ Physicians Have Been Found To Discourage Patients From Voicing Their Concerns And Expectations As Well As Requests For More Information. ❑ Patients Can Feel Disempowered And May Be Unable To Achieve Their Health Goals. ❑ Lack Of Sufficient Explanation Results In Poor Patient Understanding, Lack Of Consensus Between Doctor And Patient May Lead To Therapeutic Failure.  BARRIERS FACING EFFECTIVE COMMUNICATION II. Patients 1. Anxiety And Fear 2. Unrealistic Patient Expectations. 3. Resistance By Patients Patients Have Recognized That They Are Not Passive Recipients And Are Able To Resist The Power And Expert Authority That Society Grants Doctors. Social Relations, And Structural Constraints May Be The Most Influential Factors In Health Care.  STEPS TO MANAGE BARRIERS FACING EFFECTIVE COMMUNICATION 1. Communication Training ❑ Doctors Are Not Born With Excellent Communication Skills, As They Have Different Innate Talents. ❑ Communication Skills Training Has Been Found To Improve Doctor-patient Communication. ❑ The Improved Behaviors May Lapse Over Time. ❑ They Can Understand The Theory Of Good Doctor-patient Communication, Learn And Practice These Skills, And Be Capable Of Modifying Their Communication Style If There Is Sufficient Motivation And Incentive For Self-awareness, Self-monitoring, And Training 2. Curriculum And Education In Communication Skills ❑ Ongoing Education In Communication Skills Is Very Important Throughout Undergraduate And Postgraduate Medical Education 3. Collaborative Communication ❑ Collaborative Communication Is A Dynamic Relationship, Involving The 2-way Exchange Of Information. ❑ Doctors Should Collaborate With Their Patients To Provide The Best Care Because ❑ This Requires The Doctors To Discuss Treatment Choices To Patients And Share The Responsibility With Them. ❑ Care Options Taking Into Account Patient Expectations, Outcome Preferences, Level Of Risk Acceptance, And Any Associated Cost To Maximize Adherence And To Assure The Best Outcome.  STEPS TO MANAGE BARRIERS FACING EFFECTIVE COMMUNICATION 4. Conflict Management ❑ Conflict Is Often A Challenging Situation As It Can Evoke Feelings Of Helplessness, Frustration, Confusion, Anger, Uncertainty, Failure, Or Sadness. ❑ 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 Problems To Be Turned Into A Clinical Success. ❑ In Addition To Minimizing Avoidance Behavior, Which Prevents Patients From Expressing Opinions 5. Health Beliefs ❑ Beliefs And Values Affect The Doctor-patient Relationship And Interaction. ❑ Divergent Beliefs Can Affect Health Care Through Competing Therapies, Fear Of The Health Care System, Or Distrust Of Prescribed Therapies. ❑ This Perception Gap May Negatively Affect Treatment Decisions And Therefore May Influence Patient Outcomes Despite Appropriate Therapy. ❑ Patient Beliefs And Values Are Influenced By Social And Behavioral Factors  Communication with Colleagues  COMMUNICATION WITH COLLEAGUES Junior Doctors Including Postgraduate Students, Fellows And Interns Along With Nursing And Supportive Staffs Are Part Of The Team. ❑ It Is Important To Keep Them United And Motivated. Following Principles Should Be Followed: 1. Never Talk Low About Your Colleagues Or Scold Residents, Fellows Or Other Students In Front Of Patients Or Attendants. One Should Be Extremely Cautious While Asking Questions From Junior Residents On Rounds. Patient May Feel Insecure In Absence Of Senior Consultants Who May Not Present At All The Time. This May Also Create Doubts In The Minds Of Patients Even If Junior Residents Prescribe Drugs For Common Complaints.  COMMUNICATION WITH COLLEAGUES Following Principles Should Be Followed: 2. A System With Effective Teamwork Can Improve The Quality Of Patient Care And Reduce Workload Among Healthcare Professionals Nurses, Paramedical Staffs And Other Supporting Staffs should Make Them Realize That They Are A Part Of The Team And Their Role And Responsibility Is Also Important. 3. as regard junior staff. Teach Them The Basics & Principles Of Management Of Commonly Encountered Diseases In Your Ward to keep Them Motivated. Never Delay To Give Appreciation And Dare To Give Positive Criticism.  COMMUNICATION WITH COLLEAGUES Know how To Write A Problem Orientated Letter & Discharge Summary ❑ To Communicate With Members Of The Multidisciplinary Team Or GP Or Doctor At Nursing Home 1. Use Appropriate Language. 2. Select An Appropriate Communication Method. ❑ This aim to provide adequate information to the patient during transfer so this 1. will improve patient health and speed recovery 2. Prevent repetition of investigation  REFERENCES JENNIFER FONG HA, AND NANCY LONGNECKER(2010):DOCTOR-PATIENT COMMUNICATION: A REVIEW. OCHSNER J. 2010 SPRING; 10(1): 38–43. EMMA WARNECKE : THE ART OF COMMUNICATION, VOLUME 43, NO.3, MARCH 2014 PAGES 156-158 J CLIN DIAGN RES. 2015 MAR; 9(3): JE01–JE04. HOW CAN DOCTORS IMPROVE THEIR COMMUNICATION SKILLS?