ارتباط پزشک و بیمار

1. ارتباط پزشک و بیمار دكتر محمد رضا فياضي بردبار دانشيار روان پزشكي دانشگاه علوم پزشكي مشهد مهر 1391 Mohammad Reza Fayyazi Bordbar MD

2. تعریف ارتباط • فرآیند ارسال و دریافت پیام Mohammad Reza Fayyazi Bordbar MD

3. اجزاء ارتباط • پیام • فرستنده • گیرنده • وسیله ارسال پیام • بازخورد • شرایط و محیط ارسال پیام (موانع و محدودیتها- قواعد و هنجارها وعرف -دانش مشترک-رخدادهای پیشین-انتظارات) Mohammad Reza Fayyazi Bordbar MD

4. انواع ارتباط • کلامی مربوط به کلمات بیان شده و دیگر اصواتی هستند که اطلاعات و معنی را می رسانند . • غیر کلامی انتقال اطلاعات و احساسات بدون استفاده از كلمات ارتباط غيركلامي است. در اين ارتباط تمام رفتارها، علايم و اشيا باعث مبادله پيام مي شوند. Mohammad Reza Fayyazi Bordbar MD

5. میزان تاثیر گذاری پیامها درکدام جزء ارتباط بیشتر است؟ • محتوای کلام؟ Mohammad Reza Fayyazi Bordbar MD

6. تأثیر پیام 8 تا 13% کلامی35% به تن صدا و لحن آن و 55% غیرکلامیاست .انتقال پیام 35%کلامی و 65% غیرکلامی است Mohammad Reza Fayyazi Bordbar MD

7. پروسودی (آهنگ) کلام Mohammad Reza Fayyazi Bordbar MD

8. ظاهر فيزيكيPHYSICAL APPEARANCE Mohammad Reza Fayyazi Bordbar MD

9. طرز قرار گرفتن POSTURE Mohammad Reza Fayyazi Bordbar MD

10. Mohammad Reza Fayyazi Bordbar MD

11. Mohammad Reza Fayyazi Bordbar MD

12. حرکات وعلایم دست: Mohammad Reza Fayyazi Bordbar MD

13. Mohammad Reza Fayyazi Bordbar MD

14. Mohammad Reza Fayyazi Bordbar MD

15. بيان چهرهFacial Experssions Mohammad Reza Fayyazi Bordbar MD

16. Mohammad Reza Fayyazi Bordbar MD

17. تماس چشمی Mohammad Reza Fayyazi Bordbar MD

18. لمس و تماس بدنيTOUCH Mohammad Reza Fayyazi Bordbar MD

19. وقتCLOCK Mohammad Reza Fayyazi Bordbar MD

20. محيطENVIRONMENT Mohammad Reza Fayyazi Bordbar MD

21. فاصله (حریم)DISTANCE Mohammad Reza Fayyazi Bordbar MD

22. Mohammad Reza Fayyazi Bordbar MD

23. نقش مودالیته های حسی در ارتباط • مودالیته بینایی • مودالیته شنوایی • مودالیته بساوایی Mohammad Reza Fayyazi Bordbar MD

24. Mohammad Reza Fayyazi Bordbar MD

25. تفاوتهای مردان و زنان Mohammad Reza Fayyazi Bordbar MD

26. Mohammad Reza Fayyazi Bordbar MD

27. Doctor Patient Relationship Mohammad Reza Fayyazi Bordbar MD, Psychiatrist Mashhad University of Medical Sciences,

28. The Importance of Doc-Pt Relationship The secret of the careof the patient is caringfor the patient. Francis Peabody Whether or not the patients are satisfied with their visits to the doctors is influenced more by interpersonal factors - the perception that the doctor is concerned, caring, and understanding - than by technical competence. Kaplan and Sadock’s Synopsis of Psychiatry, 2005

29. Is there any problem with doctor-patient communication? • 54% of patients’ complaints are not elicited by physicians (Stewart et. al., 1979) • 45% of patients’ concerns are not elicited • In 50% of consultations doctor and patient did not agree on main presenting problem (Starfield et. al.,1981)

30. Some of the doctors’ mistakes about the relationship • Overestimation of compliance • Belief that talk is unimportant “chatter” • Jargon language • Talking to vs. with patients • Yes or no questions • Patient questions dis-preferred • Fantasizing that they can be their patient’s savior. • Over-involvement with patients • Not leaving patients’ problems behind in the office or the hospital • Using patients as substitutes for intimacy or relationship that may be missing in their personal lives

31. Models of Doctor-Patient Interaction • The Paternalistic (autocratic) model • The Informative model • The Interpretive model

32. The role of physician in different models • The Paternalistic (autocratic) model: doctor as a guardian • The Informative model: doctor as a technical expert • The Interpretive model: doctor as a counselor or advisor* Emanual ans Emanual, JAMA, 1992; 267(16) 2221-226

33. Which approach is superior? None! A talented sensitive physician will have different approaches with different patients and indeed may have different approaches with the same patient as time and circumstances vary. Example: a patient with cancer

34. The Bio-Psycho-Social ModelA more comprehensive understanding of disease and treatment(George Engel, 1977)

35. Bio-psycho-social model The importance of the BPS model is more prominent in dealing with chronic conditions such as hypertension or diabetes, which are more affected by multiple aspects of personality and the social environment than short term treatment of an infection.

36. Rapport Definition: Spontaneous, conscious feeling of harmonious responsiveness that promotes the development of a constructive therapeutic relationship. Rapport inclines understanding and trust between doctor and patient.

37. Developing rapport encompasses six strategies: • Putting patient and interviewer at ease • Finding patient’s pain and expressing compassion • Evaluating patient’s insight and becoming an ally. • Showing expertise • Establishing authority as physicians and therapists • Balancing the roles of empathic listener, expert, and authority * Othmer E, Othmer Sc, The Clinical Interview Using DSM-IV. Washington, DC; American Psychiatric Press; 1994.

38. Transference and Countertransference

39. Specific techniques

40. Problem patients

41. Mohammad Reza Fayyazi Bordbar MD

42. حرفه ای گری در ارتباط آسیب های احتمالی مشاور Mohammad Reza Fayyazi Bordbar MD

43. با آرزوی آرامش Mohammad Reza Fayyazi Bordbar MD