What is a Psychiatric Evaluation?
Doctor Patient Communication with One-on-One Analysis
Introduction
A cornerstone of successful treatment is a good doctor patient relationship. During one-on-one analysis, where underlying issues are explored and worked through, a one-on-one analysis between doctor and patient is part of a comprehensive diagnostic evaluation.
Let's explore what patients want, the roles doctors and patients play during one-on-one analysis, different models of doctor patient relationships, and the importance of doctor patient communication. By understanding and using these concepts, one-on-one analysis can be hugely beneficial to people in treatment and lead to successful recovery.
The Importance of the Doctor Patient Relationship
Fostering a good doctor patient relationship starts at the very first meeting, which is usually an assessment session. During this initial consultation, the doctor will gather in-depth information to help make a diagnosis. The doctor will also start different therapies to support recovery. During this process, the start of a relationship is established.
The foundation of doctor care depends on good rapport and communication so that information can flow back and forth between doctor and patient. This flow includes important points crucial to effective care. When done within a good doctor patient relationship, it facilitates:1
- Gathering patient data that is used to diagnose conditions and form treatment plans
- Helping patients comply with care instructions for healing
- Finding the best ways to support the patient
- Retaining the patient who is satisfied with the relationship
It is essential that patients trust their doctors. Without trust, patients may not disclose certain information that may be crucial to diagnosing and treating their conditions. Patients who are anxious and not put at ease by their doctors may not understand what their doctors are saying, so they are missing out on important information. Trust and confidence in their doctors can also help patients regulate their emotions.
What Patients Want in a Doctor
Patients have certain expectations of their doctors. Each patient has certain convictions in various treatment methods as well as expectations about the outcome. Just as the symptoms differ from person to person for the same issues, so do their expectations. It's key to a successful doctor patient relationship for the doctor to determine what a patient wants in his or her doctor.
Generally, patients want doctors who can effectively communicate in the styles they find easiest to understand. Patients also thrive in a doctor patient relationship in which they feel they are an integral part. The benefits of effective communication include:
- Creating a good interpersonal relationship
- Facilitating the exchange of information
- Including patients in decision making
What Do Patients Say They Want?
Research studies show that patients want many things from their physicians, including:2
- Eye contact: It's key for a doctor to maintain a reasonable amount of eye contact, so the patient does not feel ignored.
- Partnership: Patients prefer doctors who work with them rather than feel things are being done to them. This means patients getting details on their conditions, treatments, and how treatment will progress from the initial assessment.
- Communication: Two-way communication between doctor and patient is important, especially during the initial consultation. Seeing a doctor for the first time, especially in the early, fragile stages of recovery, can be intimidating and sometimes scary. Patients may be entering new and unfamiliar territory, and sometimes this can interfere with understanding the doctor, or being simply overwhelmed where they can't process what the doctor is saying. Conversely, doctors may be unable to understand a patient's troubles or explanation of symptoms.
- Appointments: Patients want to get to see their doctor within a reasonable time, such as within a few days.
What's Wanted with Administrative Communication
A few added things that patients want includes:3
- 81% of patients would schedule their own appointments via the internet
- 65% of patients want transparency about healthcare costs
- 69% of patients prefer healthcare providers who use secure email for communications (which can increase the frequency of contact without more in-person visits)
One-on-One Analysis Helps the Patient and the Doctor
How a Patient Helps a Doctor During One-on-One Analysis
Patients can help their doctors in several ways so that communication flows naturally, an accurate diagnosis can be made, and treatment can progress on a timely basis. Patients can help reach these goals by:
- Being on time for all appointments
- Be able to clearly state their symptoms (a written journal can help)
- Have a history of their mental health issues and/or substance use patterns such as:
- When symptoms started
- How symptoms interfere with life, job or personal relationships
- If there are any associated symptoms that could indicate a coexisting condition
- Any prior diagnosis data
- Any prior treatments
Other ways patients can help doctors during one-on-one analysis is by:
- When interrupted, respectfully asking the doctor to stop talking and listen to concerns
- Asking the doctor what are his or her expectations
How a Doctor Helps a Patient During One-on-One Analysis
Trust
One of the most important ways a doctor can help a patient during one-on-one analysis is by building trust from the start and throughout the sessions. Trust helps a patient feel safe.
Warmth
Expressing respect and warmth is key. Also, the doctor should be genuinely interested and curious when working with a new patient.
Preconceptions
All preconceived notions about a patient should be put aside. Matters relating to cultural backgrounds or spiritual beliefs that may be important to the patient should be allowed in a free and open discussion. The patient should feel that both doctor and patient are on a joint exploration through the patient's history, life experiences and current symptoms.
Empathy
Essential to good communication during one-on-one analysis is doctor empathy. It is important for a patient to perceive that the doctor is empathetic to his or her issues and problems. It helps patients feel like they have "been heard".
Non-Verbal Cues
Doctors who communicate well non-verbally help foster positive treatment outcomes. Simple things like smiling, maintaining eye contact, keeping a relaxed and open posture, using a moderate tone of voice, and not being "in a hurry" all go a long way in helping patients during one-on-one analysis.
Three Models of Doctor Patient Relationships
In their groundbreaking article released in 1956, Szasz and Hollender presented 3 basic models of relationships between patients and doctors.4
Activity-Passivity Model
The active-passive model is based on the doctor acting upon the patient (rather than with). The patient is treated as an object. In certain situations, this model works well, such as during an emergency when the patient may be unconscious. The active-passive model also may work well when treatment delays would seriously harm someone. Consent and prolonged conversations are not present in the active-passive model.
Guidance-Cooperation Model
In this model, a physician holds the power in the relationship because of his or her advanced medical knowledge that the patient does not have. The doctor decides what is best for the patient and makes recommendations accordingly. The patient is then expected to follow these recommendations.
Mutual Participation Model
The mutual participation model sees the doctor patient relationship as an equal partnership. The patient is seen as the expert in his or her goals and life experiences, which makes patient involvement necessary for treatment development. The doctor's part is to obtain the patient's goals and to help the patient reach these goals. This model specifies that within the equal partnership is mutual dependence and engagement in activities that are satisfying to both patient and doctor.
In most one-on-one analysis situations, the mutual participation would most likely be the most effective.
The Importance of Doctor Patient Communication
Competent doctors must be able to communicate effectively with their patients. If they do not, patients can feel their emotional and informational needs are not being met. By following good communication practices with all their patients, patients can feel more comfortable and experience better recoveries.
What are the Best Doctor Patient Communication Practices?
There is a general agreement among healthcare professionals on what the best practices are for communications in a therapeutic setting:5
- Foster the relationship
- Gather information
- Provide information
- Make shared decisions
- Respond to emotions
- Enable disease- and treatment-related behavior
Research suggests that patient satisfaction with doctors depended on how the doctor behaved carrying out tasks (such as drawing out patient concerns by actively listening and providing detailed information) without being overly "bossy". Patient satisfaction increased when tasks were carried out and then feedback was requested (as in: Does the patient understand what is being discussed? Is the information compatible with the patient's cultural and spiritual beliefs?)5
Patient satisfaction increased when there were good nonverbal skills displayed by the doctor such as maintaining eye contact, high attention, and active listening.5 Also important were the doctor's demeanor and affect (such as confident responses, caring, addressing the patient's main concerns).
Research suggests that successful doctor patient communication should:5
- Be simple and straightforward
- Be specific
- Mix in some repetition
- Use as little medical jargon as possible
- Check in with the patient to make sure there is understanding
How One-on-One Doctor Patient Analysis Improves Treatment
Examples of Good Communication Leading to Good Outcomes
Studies show that good doctor patient communication skills improved outcomes for patients. Conditions related to blood pressure and blood glucose levels, headache frequency, depression, and overall general functioning improved.5
Examples of Ways Doctors Can Communicate Well
A doctor who asks open-ended questions makes it easier for the patient to give detailed replies. Open-ended questions also help the doctor seem non-judgemental.
Avoid closed-ended questions like "Do you have a good relationship with your partner?" Instead ask an open-ended question like "What kind of a relationship do you have with your partner?"
A doctor who states impressions of the patient can help open the lines of communication. A simple observation may help the patient open up. One example of stating an impression is "You seem upset with your partner today."
Another technique is when a doctor acknowledges the patient in simple terms with non-verbal communication. For example:
Patient: "I am so angry that my wife divorced me."
Doctor: "I understand." Doctor also makes eye contact and nods.
Sometimes a doctor can help a patient simply by being silent. The doctor can show support by respectfully and attentively staying quiet as the patient collects his or her thoughts. The doctor can also say, "I'm sitting quietly with you. It seems like you have something serious on your mind."
Examples of Poor Communication Leading to Poor Outcomes
Research findings suggest patients of doctors with high malpractice claims have twice as many communication complaints compared to doctors with low malpractice claims.5 Also, studies find that there is a link between poor patient and physician communication and future malpractice claims.5
A study that looked at treatment outcomes reported that out of the patients who experienced problems with their treatment, 47% reported the issues were related to communication problems.5 Some patients felt these communication breakdowns were just as damaging as traditional harmful oversights or events.5
Research also suggests that doctors who lack communication skills may not be helping their patients self-manage their chronic diseases well. Studies show that chronic diseases from addiction to nicotine or alcohol, or due to eating disorders can see positive outcomes because of good doctor patient communication. Conversely, poor communication can have adverse effects.5
Final Thoughts
Being a Better Patient
Patients can be better patients by:
- Asking the right questions
- Not leaving the session without full understanding of what the doctor explained
- Knowing their history
- Doing their homework to come equipped to the next doctor appointment
- Being honest and open
- Fostering an active partnership with the doctor
- Staying with the treatment plan
- Not expecting their doctors to "read their minds".
- Being understanding that doctors need time to arrive at a diagnosis. Sometimes this is a complex issue as there may be co-existing conditions present.
- Managing their expectations (What do patients expect to get out of the session? Medications? Referrals?)
- Coordinating health insurance benefits to ensure no breaks in service
- Being tolerant and understanding of themselves and their doctors
Being a Better Doctor
Doctors can be better doctors by:
- Showing respect by listening and responding in a kind and patient manner
- Taking the time to address patient concerns
- Being present in the moment (no distractions)
- Acknowledging patient thoughts, opinions and views. This doesn't mean the doctor agrees with everything the patient says, but rather that the doctor respects the patient's viewpoint enough to address it.
- Understanding that patients are typically scared of anything doctor-related
- Being knowledgeable in their field
Better Outcomes with One-on-One Analysis
Communication is critical at any stage of care, such as diagnosis, treatment and advice, making positive and productive conversations a necessity. Both the doctor and the patient should make efforts to have a good doctor patient relationship and always communicate effectively to help reach their desired goals and results.
Because communication between doctor and patient is critical, getting a one-on-one analysis with your doctor can improve your treatment. So, a one-on-one analysis is part of an effective comprehensive diagnostic evaluation.
Resources
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496871/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1126182/
- https://www.patientpop.com/blog/infographics/patient-experience-stats/
- https://www.upstate.edu/psych/pdf/szasz/doctor-patient-relation.pdf
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3771166/