Medical Psychology Assignment
“The Sensitive and Fragile Nature of Conveying Severe News to a Patient, and how Psychology Facilitates”
- (Terminal Diagnosis or Death of a Patient)
Raghib Siddiqui Group 19E
Medical psychology is concerned in the first place with the psychological aspect of the mutual relationship and interaction of doctor and patient and relevant people from the patient’s closest environment. The psychological approach and attitude of the doctor to his patient is of utmost importance in the entire process. The main features are authority and truthfulness; esteem and respect; as well as understanding of the patient and his position. Medical psychology gives patient care a human dimension, i.e. above all, subjectivity of the patient, doctor, and their mutual relationship.
The transcendence of psychological factors of the doctor-patient relationship is given by the fact of its influence on results and quality of medical care, improvement in compliance, satisfaction and recall of physician information, and plays a fundamental role in the medical care process. The skills Listening and communication are fundamental parts to make the diagnosis and treatment. Some of these positive consequences arise from the fact that relationships are linked to emotions which have a psychological substrate. The different psychological behaviors of the patient and the doctor (such as verbal and nonverbal communication, affective behavior, beliefs, empathy, listening), symptom perception, shared decision, negotiation, information, persuasion, etc., give different types of relationship.
In doctor-patient relationship there is a modality of psychotherapy, where the treatment is based on that relationship, in which the general practitioner and the patient work together to improve psychopathological conditions through the focus on the therapeutic relationship, which brings consequences on thoughts, emotions, and behaviors. Doctor-patient relationship evaluation has to be carried out jointly by both, doctor, and patient, on the effect that both are achieving with that relationship.
In the simple routine of a doctor-patient encounter, the physician’s ability to diagnose and treat a medical condition is a major communications exchange. And body language—the gestures, postures, expressions that communicate physical, mental, or emotional states is a major part of the process.
The psychology of reading and expressing non-verbal communications plays a huge role in overall interaction between the doctor and the patient and provides a sense of reassurance which enables a mutual understanding and allows for the patient to be more comfortable when about to receive life changing news.
Eyes and Face: Maintaining eye contact communicates your attention, interest and focus on the other person. Nods signal agreement, and if the patient (or other person) is studying the floor, looking away when responding, or failing to make eye contact likely signals nervousness or lack of trust.
Arms and Shoulders: Widely recognized “arms crossed” is threatening; or rising shoulders are negatives and may be a lack of confidence, disbelief, or disapproval. Relaxed and open position of arms is a positive, receptive signal.
Speech and Tone: Clearly spoken words, delivered at an unhurried pace and a moderate tone of voice, tends to communicate warmth and self-confidence.
Composure and Calmness: Having the patient know that you are listening and taking the time for their care provides a sense of reassurance which makes a significant difference. Being in a rush gives off many non-verbal signals, which would indicate an incomplete commitment to patient care. A doctor may be seeing dozens of patients today, but a patient is only seeing one doctor—you. If you appear to be short on time, anxious to get to the next patient, or thinking about something else, your body language communicates disrespect to the patient…even when it is unintended.
Conveying Severe News
Breaking bad news is a complex and sensitive task which requires practice and a considered, tactful approach. In the case of a terminal diagnosis of a patient or having to deliver the news of the passing of a patient to their family, is a daunting task and can be very sensitive. Delivering bad news in a compassionate way can make this difficult situation easier to cope with for patients, their families, and clinicians themselves.
The ‘SPIKES’ model first introduced in 2000 as a protocol for delivering bad news to cancer patients and terminally ill patients with a definite diagnosis.
Since then, it has been adopted more widely and used by clinicians in various circumstances to communicate difficult news to patients in a way that is clear, supportive, and compassionate.
Set up
Think about what you want to say in advance. You may wish to suggest to the patient that they are accompanied by a friend or relative. Choose a time and place which will allow for privacy and quiet, considered discussion. Make sure there is enough seating in the room and turn off or mute any electronic devices so that the patient has your full attention. Establish rapport with the patient and maintain eye contact. Allow enough time for the patient and/or their relative to express their emotions and ask questions.
Perception
Use open-ended questions to determine the patient’s understanding of their condition. This will help you tailor the way you deliver the information and where you begin. Check that the patient is able and willing to hear what you will say. They may give you an opening to start the discussion, or they may try to avoid hearing what you are saying.
Invitation
Most patients will indicate that they want full information, but some may shun information as a coping mechanism. If patients do not want to hear details, you can offer to answer any questions in the future or speak to their family or friend. Use language appropriate to the patient’s level of understanding. It can help to reflect the patient’s words and body language. Avoid unnecessary jargon and euphemisms, which could impair the patient’s comprehension and create a barrier to communication. Be sensitive to how the patient is reacting and provide information at an appropriate pace.
Knowledge
Warning the patient that you have bad news may reduce the shock of disclosure. Give the patient and their friend/relative enough time and space to absorb the information and ask questions. If there is any doubt about the prognosis, explain this and the options for clarifying uncertainty. Give the patient information regarding next steps, such as follow-up appointments. If this is not possible, offer them a realistic timescale of events and reviews. The patient should also be told who will be in charge of their care and how they can contact them. Reassure the patient of ongoing support. This will help them to cope and feel less isolated. The patient and relative/friend may differ in how much information they want or require. If you sense a disparity, check that the patient is happy for you to speak to their friend/relative separately.
Empathy
Do not make assumptions about what the patient might be feeling. Encourage them to express their concerns and respect their wishes about how much information they are prepared to hear. Observe and validate the patient’s emotions and give them enough time and space to express their reactions. Remember that all patients are different.
Strategy and summary
Make sure the patient has understood by asking them to briefly summarize the main points of the conversation. Encourage them to express their concerns. Provide reading material for the patient to absorb when they are ready. Suggest that the patient note down any questions they would like to ask you at your next meeting, so you can be sure you are appropriately exploring their understanding.
Physicians can build on the following simple mnemonic, ABCDE, to provide hope and healing to patients receiving bad news:
- Advance preparation—arrange adequate time and privacy, confirm medical facts, review relevant clinical data, and emotionally prepare for the encounter.
- Building a therapeutic relationship—identify patient preferences regarding the disclosure of bad news.
- Communicating well—determine the patient’s knowledge and understanding of the situation, proceed at the patient’s pace, avoid medical jargon or euphemisms, allow for silence and tears, and answer questions.
- Dealing with patient and family reactions—assess and respond to emotional reactions and empathize with the patient.
- Encouraging/validating emotions—offer realistic hope based on the patient’s goals and deal with your own needs.
Despite the challenges involved in delivering bad news, physicians can find tremendous gratification in providing a therapeutic presence during a patient’s time of greatest need. physicians’ attitude and communication skills play a crucial role in how well patients cope with bad news and that patients and physicians will benefit if physicians are better trained for this difficult task. The limits of medicine assure that patients cannot always be cured. These are precisely the times that professionalism most acutely calls the physician to provide hope and healing for the patient.
In conclusion, for medical practitioners of all sorts, one critical issue is doctor-patient communication: how the transmission of potentially life-changing medical knowledge can best be handled. Even in low-stakes situations, understanding the psychology of a patient can provide key insights into the best motivations and methods for promoting their positive health. This is part of the bedside manner, and it is generally an under-appreciated part of the field. Good communication skills are essential for medicine and understanding psychology can truly help develop this talent.
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