DEVELOPING

COMMUNICATION SKILLS
BETWEEN DOCTOR-PATIENT

3 OCTOBER 2013
Penelitian menyatakan 70% kesalahan di
dunia kerja adalah hasil dari komunikasi yang
buruk…..
Verbal
Pesan yang
kita
kirimkan
s i
7%
ik a
u n
3V o m
K
Vokal
Suara yang
kita sampaikan
38 %
Visual
Bahasa
tubuh kita
55 %
COMMUNICATION

PERCEPTION
SEEING FROM THE OTHER SIDE?
 DEFINITION

“Process of exchanging information

between 2/more people; each person will
give meaning to symbolic messages
through media”

?
 COMMUNICATION PRINCIPLES
1. Two way
2. Having meaning and connection
3. Symetrical/complementary
4. Everyone is communicating
BASIC PRINCIPLE IN
COMMUNICATION

The way we
What we do is The way we
deliver the
start
communicating message
communication
determines the influence how
result the message is
received and
understood
 Verbal Communication


Meaning
•
Denotative
•
Connotative

Vocabulary

Pacing

Intonation

Clarity and brevity Timing and relevance (waktu
dan relevansi)
Potter and Perry (1987)
 Non Verbal Communication


Communicating two different messages

Performance

Expression

Emotion

Touch

Distance
- intimate distance (45 cm or less)
- personal distance (18 inch to 1.5 m)
- social distance (1.5 m to 18 m)

Clue

Potter and Perry (1987)

 Activity 1
•
Ask a colleague to tell you about something in
which they are really interested. Alter the way
in which you lean as they talk and ask them to
give you their personal impression
•
Write down:
– what feeling (s) that person was experiencing
– what attitudes they seemed to convey
– your reactions to them

10/3/13 10
 Evidence Based result
•
What is the most important factor in effective
communication?
– Body language 58%
– Tone of voice 35%
– Words use 7%

Source: Population Council. 2005. A Client-centered Approach to

Reproductive Health. A Trainer’s Manual. Islamabad, Pakistan.

10/3/13 12
WHY DO YOU LEARN ABOUT
COMMUNICATION?
Communication in Health Setting

Hospital:
Unique and complex setting
•
Medical
•
Care
•
Medical support
•
Administrative support

•
General: patient and non patient
•
Special: patient
 MEANING OF DISEASE
•
Obstacles on everyday lives
•
Causing anxiety, anger, and frustration
•
Dis – ease
•
Punishment
•
Unsought product
•
Anything else?? …..
 PATIENT IN HOSPITAL
•
Outpatient
•
Hospitalized
•
Emotional
•
Afraid
•
Disoriented
•
Depressive
•
Disturbed
•
Difficult
•
Before/after operated
•
Addicted to operation
 BACKGROUND
•
Communication between doctor-patient is one of the
most imperative competency need to be addressed

•
It determines the successful of helping behavior
provided by doctor

•
Communication in health setting has become
‘neglected’ topic
 BACKGROUND
•
Some doctors do not have ‘time’ to talk to the
patients
– Depth of information
– Influence the diagnosis, planning and treatment

•
Patient: different status (superior-inferior)
– Being afraid of asking and answering questions
 COMMUNICATION BETWEEN
DOCTOR-PATIENT
•
Doctor-patient can both play as
resource/sender and receiver of information
interchangeably
•
Patient as a sender of information
•
Doctor as a sender of information
•
Doctor has RESPONSIBILITY to make sure that
patient understands what has been explained
•
Doctor MUST BE PROACTIVE
 EXAMPLE

“Kalau dia panas, berikan obatnya.”

 COMMUNICATION
HAMBATAN BARRIERS
DALAM BERKOMUNIKASI

Language Physical

Social
Values/
Culture
Perception
Receiver

a l
e nt ing
m s h
d g u
P
Ju
 COMMUNICATION BETWEEN
DOCTOR-PATIENT by Kurzt (1998)
•
Disease centered communication style/ doctor-
centered communication style:
1) Diagnosis
2) Relating to signs and symptoms

•
Illness centered communication style/patient-
centered communication style
1) Based on patient’s experience about the illness
2) Including opinion, concerns, hopes of the patient
 Therapeutic Communication

•
Professional communication between health
practitioners and patients
•
Therapeutic relationship that facilitates the
positive development of the patient
•
Understanding each other
racteristics of Therapeutic Communicati

1) Genuineness

Realising patient’s attitude

Accepting patient’s negative feeling
1) Warmth

1) Empathy
MMUNICATION PRINCIPLES BETWEEN DOCTOR-PA

C
Complete
A Accurate
R Rapid

E Empathy
 THEREFORE ….
•
Building trust and hope
•
Openness
•
Understanding
 Empathy

1) A physician cognitive capacity to

understand patient’s needs
2) An affective sensitivity to patient’s
feelings,
3) A behavioral ability to convey
empathy to patient.
 Empathy
•
Level 0: Bylund & Makoul (2002)
1) Doctor refuses patient’s point of view
2) Doctor makes an opposing statement, as a sign of
disagrement

•
Level 1:
1) Doctor captures patient’s point of view while
doing things, such as writing, standing behind
patient’s back, preparing tools, etc
 Empathy
•
Level 2: Bylund & Makoul (2002)
1) Doctor recognizes patient’s point of view implicitly
•
Level 3:
1) Doctor respects patient’s opinion
2) Asking for further patient’s concerns
•
Level 4:
1) Confirming based on patient’s information
•
Level 5:
1) Sharing feelings and experience
 Activity 2
•
Organize yourself into groups of three (a
doctor, a woman, and an observer)
•
The person playing as a woman should take 5
minutes to make up situation about health
problems and pregnancy. Write down some
notes to help you remember the story
•
Doctor tries and shows active listening skills
through the use of body language, gestures,
sounds and repeating back what has been said
to you
10/3/13 30
•
The observer should provide comments on
any aspects the doctor shows and how she/he
can improve upon
•
Change roles

10/3/13 31
•
Video 2
Tips of Effective Communication

1. Stop talking
2. Comfortable situation
3. Being attentive
4. Pay attention to ‘noise’
5. Being emphatic
6. Being patient
7. Emotionally controlled
8. Being calm
9. Asking questions
10. Avoid interrupting
 Example
Clien (Cl): ‘I don’t want to have a baby with
Down Syndrome”
Counselor (Co): ‘What do you mean?’
Bisa dijelaskan maksud Anda?
Cl: ‘I just don’t think I could handle it’
Co: ‘Are you telling me that you would want to
terminate the pregnancy’
Cl: ‘Well, I’m not sure’
Co: ‘Where does this feeling that you ‘couldn’t
handle it’ come from?’
10/3/13 34
 Example
Co: ‘Well, is it coming from you or from your
family?’
Cl: ‘Well, I guess from them’
Co: ‘Do they have to live with the consequences
of this decision, or do you?’
Cl: ‘Well, it will affect them, too’
Co: ‘But can they really tell you what to do?’
Cl: ‘No, I guess not’
Co: ‘So, let me ask you, what do you want to
do?’
10/3/13 35
 IMPORTANT
•
Being culturally competent health
professionals
•
Understanding the culture of medicine is
important in developing attitude toward
health
TERIMA KASIH