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HUMAN APPROACH TO PATIENT CARE: NEED TO GIVE SOFT SKILLS TO MEDICOS. LT GEN NK PARMAR, PVSM, AVSM, VrC , VSM( Retd ). Medical profession distinct Nobility of profession and conduct Service to humanity High standard of medical ethics. Health care is a complex issue

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HUMAN APPROACH TO PATIENT CARE: NEED TO GIVE SOFT SKILLS TO MEDICOS


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    1. HUMAN APPROACH TO PATIENT CARE: NEED TO GIVE SOFT SKILLS TO MEDICOS LT GEN NK PARMAR, PVSM, AVSM, VrC, VSM(Retd)

    2. Medical profession distinct • Nobility of profession and conduct • Service to humanity • High standard of medical ethics

    3. Health care is a complex issue • Expectations of the society • Standard and norms of behavior inherent in the medical practice • Code of conduct & Hippocratic oath for self regulation

    4. Dilution of conduct and ethics over the years – Erosion of faith & trust • Doctor-patient relationship under serious stress • Commercialization & dehumanization • Erosion of doctor patient relationship • Doctors now subject to regulations

    5. Rapid strides in medicine and technology • Rapidly transforming social milieu • Doctors need to rediscover the value of soft skills and expertise • Rise above levels which we now consider routine

    6. Modern Day Physician No greater opportunity, responsibility or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering, the physician needs technical skill, scientific knowledge and human understanding..... tact, sympathy and understanding are expected of the physician, for the patient is no mere collection of symptoms, signs, disordered functions, damaged organs and disturbed emotions. The patient is human, fearful and hopeful, seeking relief, help and reassurance. Harrison’s Principles of Internal Medicine 1950

    7. Expectations :Doctor & Delivery of Appropriate Care • Care with technological competencies of modern treatment • Expertise in the communication and interpersonal needs of the patient at a time when she/he may feel more vulnerable

    8. What patients value • Medical Care Value • Features of service • Performance • Reliability • Service Value • Service delivery • Training of staff • Consulting service • Continuity of care • Personnel Value • Competence • Courtesy • Credibility • Communication • Responsiveness • Image Value • Experience • Environment • Events • Symbol & media

    9. Duties of a doctor • Patients must be able to trust doctors with their • lives & health • Care of patient - first concern • Good standard of practice and care • Respect the dignity of patient Textbook of Medicine : Davidson

    10. Human Relations • Human relations are all pervasive • These begin with individuals, cut across the boundaries of various disciplines, societies and even nations

    11. Human Approach As early as 1859 Florence Nightingale emphasized the importance of Human approach to patient care in her book titled as “Notes on Nursing and Hospitals”

    12. Importance of Human skill M A N A G E M E N T L E V E L Executive Middle Middle First line Skill Mix

    13. Staff – Patient Relationship • Why staff patient relationship is so important ? • Health Psychologist view is that when a patient falls sick he : • Develops a particular behavior known as Illness behavior • Assumes a Sick Role • Develops Hospitalization Stress

    14. The “patients” are unique because they… • Seek services out of necessity rather than choice… • Have little knowledge of medical expertise, expected costs & treatment outcomes… • Are often intimidated & confused by the complexity & dynamics of the health care setup…

    15. Illness behavior(1/2) • This develops due to: • Response to physical symptoms • Psychological factors associated with the disease • There is wide variation in illness behavior exhibited by the individuals

    16. Illness behavior(2/2) • Illness behavior is : • Attention seeking • It changes outlook towards life • Patient may develop hypochondriasis • Various studies indicate “Co-morbidity of Psychological and physical disorder “ Cohen, Journal of Health psychology 1995 (14)

    17. Sick role • Patient assumes a sick role i.e., they tend to regress emotionally when sick • It depends on several demographic and socio-cultural factors like : • Age / sex • Socioeconomic status • Culture and ethnicity • Individual attributes Can Med Assoc J 1997;157[4]:393-4

    18. Behaviors and Roles(1/2) • Listening/Hearing • I get the feeling you are worried about something • Not listening/Hearing • Any fever? Jaundice? TB? Indigestion • Clarity • There’s slight inflammation in your kidneys causing red blood cells to leak out in the urine • Jargon • You have IgA nephropathy causing microscopic haematuria Textbook of Medicine : Davidson

    19. Behaviors and Roles(2/2) • Calm • Ok, can I just ask you to go over those symptoms again ? • Anger, irritation • As long as you continue to smoke, I’m really wasting my time . • Praise • Well done, you’ve lost 10 kg & your blood pressure is down. • Thank you doctor, for your good work. • Criticism • You can’t expect to lose weight if you eat 4000 calories a day. • I’ve been waiting 30 minutes out there, doctor.

    20. Effect of Hospitalization(1/5) • Hospitalization leads to: • Stress and anxiety • Institutionalization - patient has to follow the routine of the hospital • Depersonalization – He has to obey the instructions of staff • Loss of autonomy – Has no personal freedom

    21. Effect of hospitalization(2/5) • There is loss of social role of patients, may be as head of family • His privacy is compromised • Hospital systems – traditionally treats them as cases and not as human beings

    22. Effect of hospitalization(3/5) • The distressing effect of hospitalization is further compounded due to : • Problems due to behavior of staff • Staff communication • Patient communication

    23. Effect of hospitalization(4/5) • The stress can lead to slow recovery of patients • The only buffers to address this aspect of care are the soft skills of treating staff which are so often ignored. Training and practice of these skills can greatly contribute towards the speedy recovery of patients European Journal of Psychotherapy and counseling: April 2001, Vol 4

    24. Effect of hospitalization(5/5) • A comparison of three large surveys on patients, revealed that issues like privacy, dignity, sensitivity to feelings, treatment as an individual, and clarity in communications were of paramount importance to patients. BMJ 1996;313:841-844 (5 October)

    25. What are Soft Skills?(1/2) • Soft skills is a sociological term relating to a person's “EQ”(Emotional Intelligence Quotient) • The cluster of personality traits, social graces, communication, language, personal habits, friendliness and optimism that characterize relationships with other people

    26. What are Soft Skills?(2/2) • Soft skills are essentially people skills : the non-technical, intangible, personality specific skills that determine one’s strengths as a leader, listener, negotiator, conflict mediator and a humane doctor

    27. Soft skills – essential ingredients

    28. Soft skills – attributes(1/2) • Strong work ethics • Positive attitude • Good communication skills • Time management abilities • Problem-solving skills • Team spirit & Team building

    29. Soft skills – attributes(2/2) • Observe etiquettes • Self-confidence • Ability to accept and learn from criticism • Flexibility/Adaptability • Working well under pressure

    30. Inculcating Soft Skills • By making small changes in one’s behavior and showing genuine interest in patient care, like expressing : • I understand … • I precisely understand your problem…  • I assure you… • I’m sure it’s terrible… • Don’t worry… • In case of any problem, you can always get in touch with me… • We’ll definitely make an effort to…

    31. What soft skills achieve in patient care • Make patient comfortable and improve confidence • Improve doctor patient relationship • Enhance client satisfaction • Improve the image of hospital

    32. Soft skills are not “why and what of care” Soft skills focus on “How of Care”

    33. Communication Issues A vital component of soft skills & its implications …

    34. Historical Perspective

    35. Communicationskill(1/2) Communication skills form the corner stone Every human being has to essentially and effectively communicate Effective communication is the hallmark of one’s education

    36. Communicationskill(2/2) • The following must be demonstrated in communication • Respect • Genuineness • Empathy • Voice Skills • Body Language

    37. Communicationskills help : • To diagnose and treat disease • To establish and maintain a therapeutic relationship • To offer information and educate

    38. Communication(1/2) • A study in USA found that • Physicians who don’t listen get sued more, at least in USA • Among primary care physicians, those who never had a malpractice suit were shown to be far better communicators than their law suit prone peers

    39. Communication(2/2) • Communication effectiveness depends upon • Word • Phrases • Sentence structure • Sentence clarity • Para language : Rate of speech, diction, tone, rhythm and volume

    40. PoorCommunication Effects • Doctor not listening or not appearing to listen, not letting people speak • Doctor using jargon • Doctor talking down to the patient

    41. Basic steps of the medical interview • Preparing for listening • Setting • Greetings • Your posture • Questioning • Closed questions • Open questions • Biased questions • Listening actively • Let the patient speak • Encourage patient to talk • Tolerate short silence • Listen to buried question. • Showing that you have heard • Repetition • Reiteration • Reflection • Responding

    42. Communication leads for paraphrasing • and assuring mutual understanding • From your point of view… • It seems you… • You think… • What I hear you saying is… • Do you mean…? • I am not sure I understand what you mean; is it..? • I get the impression… • Correct me if I’m wrong, but…

    43. Emotional Intelligence • Ability, capacity, skill to identify, assess and manage emotions of one’s self, of others and of groups • Perceiving emotions in faces, voices • Understanding emotions- ability to comprehend emotions, language & to appreciate relationships among emotions

    44. Non Verbal behavior • Gestures • Facial Expressions • Eye contact • Body language • Positioning

    45. The art of listening “ We are the talking tribes. The tongue is the most mobile structure of the human body. To be human is to speak. To be abundantly human is to speak freely and fully. The converse of this is a profound truth, also: that the good listener is the best physician for those who are ill in thought and feeling.” Wendell Johnson, Your Most Enchanted Listener

    46. Listening(1/3) • Anthony Alessandra identified four types of listeners : • Non listener • Marginal listener • Evaluative listener • Active listener