Importance of building rapport with Patient Party Author Dr. Indu Arneja

Doctor-Patient Communication

 

Building quick rapport with the patient is one of the initial prerequisites of any professional relationship.  It lays the foundation stone of the therapeutic alliance.

Incidentally, studies suggest that we don’t make much effort to build rapport with the patients and their families as we believe that the patient is here for treatment and our primary responsibility is to only treat the patient.

This is true to an extent but let us remember that building rapport with them makes our task easy.  Building rapport creates much needed familiarity and comfort between the two parties.  It helps win patient’s trust and confidence.  It facilitates and fosters our treatment by aligning the patient with us.  Patients start listening and agreeing more with us.

The primary objective of building rapport is to earn patient’s cooperation and compliance for our treatment to work.  For e.g. many of the procedures like inserting I/V cannula, passing Ryle’s tube etc., are very painful and uncomfortable but if we have good rapport with the patient, it becomes easy to do the procedure as the patient would listen to you and cooperate.  Studies also suggest that building rapport improves treatment adherence.

Contrary to our misperception, building rapport does not require time, it requires INTENTION.  Simple gestures like making eye contact, greeting the patient, smiling when appropriate and speaking in a non-aggressive tone are some of the good ways to build rapport with the patient.  These small gestures go a long way in facilitating your job and earn patient’s cooperation.

Building rapport also reduces aggressive reactions and prevents violence in healthcare.  Studies suggest that the doctors and treating team are less likely to experience aggression when they are able to create familiarity and build rapport with the patient party.


Some simple and quick ways to build rapport with the patients-

1.    Making eye contact as soon as the patient enters
2.    Greeting the patient / responding to the patient’s greetings
3.    Attending to patient’s comfort by showing the place to sit
4.    Obtaining/confirming the patient’s name and the attendant
5.    Introducing self (if meeting for the first time)
6.    Starting with small talk before the big talk (e.g. who is this with you or where are you from)
7.    Demonstrate attention and interest in attending the patient by limiting interruptions and distractions.
8.    Accepting the legitimacy of a patient’s views and feelings, without being judgemental.
9.    Using empathy to communicate understanding and appreciating the patient’s feelings or predicament
10.   Expressing concern, understanding,  and willingness to help the patient
11.   Dealing sensitively with embarrassing and disturbing topics.
12.   Respecting patient’s privacy and confidentiality.

Building rapport may seem a waste of time and unnecessary to some of us but it is also a great safety tool for the rainy days.  Creating familiarity and building rapport goes a long way in controlling aggressive reactions and violence.  Most importantly, you win the confidence of the patient for a life-time.  It facilitates and fosters treatment by creating a good work environment for everyone. It does not require time, it requires intention.  My question to you is – Do you have it?

 

About: Dr. Indu Arneja is Founder-Director of Indian Institute of Healthcare Communication, A pioneer in the field of Healthcare Communication in India
She has conducted around 1500 Clinical Communication programs for doctors, nurses and other healthcare professionals in more than 100 hospitals and medical colleges across the country.

She is an external assessor for NQAS, Ministry of Health and Family Welfare and NABH (IRCA), QCI, India.

She is a core group member of Advisory Board on Health and Mental Health for Nation Human Rights Commission.

She is also a visiting faculty to some of the very prestigious organization like IIM Ahmedabad, Delhi Judicial Academy, Maulana Azad Medical College, Delhi University, IGNOU and PHFI.  She has over 30 years of experience in the field of health and training.

She is a regular invitee at National and International Conferences.  Recently, she was invited to attend Annual Summit on "Patient Experience and Empathy" by Cleveland Clinic, Ohio, USA, 2019.  She has been awarded scholarship to attend a prestigious communication course ‘ENRICH’ organized by Academy of Healthcare Communication at Pittsburgh, USA in 2019.

She regularly conducts webinars for national and international audiences. She has conducted multiple webinars for Anschutz Medical Campus, Colorado, US.
She has a YouTube channel in her name Dr. Indu Arneja and has an on-going series under the titles - "Heart to Heart talk with Dr. Indu Arneja" and "Master Stroke with Dr. Indu Arneja".

#hospital #hospitals #accreditation #nabh #jci #treatment #medicine #medicationerros #patient #patientengagement #patientsafety #patientsrights #communication #patientcommunication  #effective #right #doctors #family #relatives #technology #medicalpractitioners #nursing #nursingcare #healthcareworkers
 

Communication in Healthcare is not just about niceties! By Dr. Indu Arneja

Friends,

Patient Communication

According to a report by Joint Commission International (JCI) (2013), communication failure is the lead cause of medical errors.  The Report reveals that 70-80% of errors in patient care are the result of communication failure.  It is because all interactions in patient care are based on communication.  It could be with the patient, their family members or with other healthcare professionals.  Communication has become a cornerstone of quality healthcare and patient satisfaction.  Still communication is not considered an essential skill in patient care.  

The biggest hurdle in accepting communication skills as an integral part and parcel of patient management is the thought process that considers communication as just simple niceties and basic courtesies in handling patients.  There is no doubt that we need to be courteous and well behaved with the patient and their family but that is not the end of it.  Communication in healthcare is a lot more than that.  Communication in healthcare is not just about niceties, it is about the serious communication that happens between the healthcare professionals and the patients, where the patient has a set of information about his health and disease that needs to be collected in a systematic manner and a set of information that the healthcare professionals including doctors, nurses and other caretakers that they need to share with the patient in a manner that the patient understands it and is able to apply it to recover from the illness and regain health.  

Patient care is teamwork.  

Sharing the Treatment Plan

A lot of information about the patient’s medical condition is shared amongst the team members managing the patient.  The team includes consultants, residents, nurses, technicians and other paramedics.  This exchange of information is also a part of the clinical communication.  A major chunk of the errors in patient care are the result of communication failure amongst the healthcare professionals.  Careful, accurate, systematic, and timely exchange of information is the basis of quality healthcare.  So, in nutshell, clinical communication is an exchange of health related information either with the patients and their family or with the fellow healthcare professionals and is not just about niceties.

Communication with a patient is not the regular communication between two healthy individuals.  This is the communication between a trained and qualified healthcare professional and a person (patient), who is not feeling well, who is in need of help, and who is seeking your attention, care and advice.  In such a situation, communication can not be a simple exchange of conversation.  It has to be a mindful effort from the healthcare professional to proactively connect with the patient, understand his/her health needs and meet them in the best possible manner.

There are a lot of communication opportunities with the patients and their families like collecting patient history, informing and explaining about the diagnosis, discussing about the options available to treat an illness and the pros and cons of each treatment modalities.  Each of this communication requires understanding of quick ways of building rapport, getting all important health related information in the shortest span of available time, winning patients’ trust to reach a mutually acceptable treatment plan and answering patient’s queries in a manner to create patient satisfaction.  There is a huge knowledge differential between the treating doctor and the patient.  The treating doctor is expected to acknowledge this gap and make sure to design the communication in a manner that is understandable to the patient.  This requires the knowledge and understanding of principles of communication and effective tools to communication.  Clinical communication is learning and practicing all about it.

Patients may have unrealistic expectations from the treating doctor or the treatment modality.  It is helpful to be aware of these expectations and how to help them accept realistic expectations.  All this needs understanding of the fact, how the human mind does not accept anything less than the best and how to fine tune it to match with the reality.  This is the negotiation and persuasion aspect of communication and is required in everyday handling of patients.

At multiple times the communication with the patient is very sensitive in nature and requires real experience in terms of handling challenging situations like asking personal sensitive information, taking sexual history, communicating with suicidal patients, communicating with rape and abuse victims, informing about treatment failure or medical error, handling aggressive patient, or breaking bad news like serious diagnosis, or announcing death.  Managing these communications require training and experience and these are part and parcel of healthcare communication.  Understanding, learning, practicing and demonstrating these skills need training.

In an average stay of 3 to 4 days, a patient’s information exchanges 50 to 60 hands.  A lot of errors in patient care are the result of internal communication failure.  When two or multiple healthcare professionals with different educational, professional, and experience backgrounds work together, there is a risk of miscommunication or missed communication.  Unless you have standardized ways of communicating to bring uniformity and minimize the impact of individual difference in communicating, lapses are bound to happen.  Most of these lapses in the care of patients, leading to fatal consequences are the result of communication failure amongst the healthcare professionals.  Clinical communication is all about learning and practicing communication protocols to prevent these errors, and ensure continuity of care, patients’ safety and quality health outcomes.

Communication needs of patients have changed drastically over the last couple of decades.   Today, they wish to know their disease and actively participate in choosing treatment options considering their suitability as well.  They don’t want to be a mute spectator of their treatment planning and management.   It is time that we respect patients’ autonomy and give it due importance without compromising the clinical goals.  Involving the patient in decision making, answering their queries, addressing their concerns and acknowledging their experiences is the basis of modern medicine practices.  Now the patient is an important team member in healthcare delivery.  Engaging them in planning and management of their health condition is a definite way to create patient satisfaction and would also enhance professional satisfaction of the care providers.  After all, the purpose of all our actions is creating happiness and satisfaction.

Considering these facts in the background, it is time we realize the importance of clinical communication in providing quality healthcare including continuity of care, patient safety and patient satisfaction and take these skills seriously!

Dr. Indu Arneja is Founder Director of Indian Institute of Healthcare Communication, A pioneer in the field of Healthcare Communication in India
She has conducted around 1500 Clinical Communication programs for doctors, nurses and other healthcare professionals in more than 100 hospitals and medical colleges across the country.

She is an external assessor for NQAS, Ministry of Health and Family Welfare and NABH (IRCA), QCI, India.  Is a core group member of Advisory Board on Health and Mental Health for Nation Human Rights Commission.

She is also a visiting faculty to some of the very prestigious organization like IIM Ahmedabad, Delhi Judicial Academy, Maulana Azad Medical College, Delhi University, IGNOU and PHFI.  She has over 30 years of experience in the field of health and training.

She is a regular invitee at National and International Conferences.  Recently, she was invited to attend Annual Summit on "Patient Experience and Empathy" by Cleveland Clinic, Ohio, USA, 2019.  She has been awarded scholarship to attend a prestigious communication course ‘ENRICH’ organized by Academy of Healthcare Communication at Pittsburgh, USA in 2019.

She regularly conducts webinars for national and international audiences. She has conducted multiple webinars for Anschutz Medical Campus, Colorado, US.  She has a YouTube channel in her name Dr. Indu Arneja and has an on-going series under the titles - "Heart to Heart talk with Dr. Indu Arneja" and "Master Stroke with Dr. Indu Arneja".

arnejaindu@gmail.com
www.iihcglobal.com

#hospital #hospitals #treatment #medicine #patient #communication #effective #right #patientsrights #doctors #relatives #family #accreditation #technology nabh #jci #technology #patientcommunication  #patientengagement #medicalpractitioners #nursing #nursingcare

 

 

India Going Full Steam Ahead

The Prime Minister of India, Mr. Narendra Modi is giving what people were all the time desirous of.  He has given so many mantra’s and people are lapping it up happily.  He is showing the people of India that there is hope.  There is hope for a better life, hope for a good environment to live in, hope for prosperity and economic progress.  People are fed up of living within financial constraints.  The world has become aspirational about India and what I can do it it explores and nurtures it own potential, its demographic dividend, its natural resources and putting to good use the educational institutions and institutes of higher learning.  While the India’s rich have aspirations to conquer and dominate the world stage, the poor want to do more than just survive.  They want to have a share of the prosperity and rightfully so.

The Prime Minister’s mantras are not new but their coinage is effective.  It throws a spell and people are falling in awe.  But if you take a deep look, they have a lot of meaning attached to it.  Speed, Skill and Scale was one which describes the way India should go ahead if it has to, forget the outer world and become and economic superpower, help India’s population to prosper internally.  Even if they do business internally within India with this mission, they will achieve great heights.  This mission statement has lot of deeper meaning to it because we have now got very used to the “Chalta hai” (it’s okay, who cares) kind of attitude.  

The “Chalta hai”, attitude indicates that: 

1. It’s okay, we will do it at our own pace. The deadline given to customer is not important.
2. It's okay to compromise on the materials than that shown or assured to the client; 
3. It's okay to compromise on the quality, fit and finish. A cover up job will hide the defects and customer will not come to know about it;
4. It's okay to compromise on the workmanship. (there are too many customers and we have to expedite delivery.)  We will never hire the required manpower to complete the job and therefore, the final product will not be anywhere close to the original or sample that was shown to the client, based on which the order was received.
5. It's okay to do some additional cheating - you go back on the agreed terms.  If delivery was promised, you refute the terms and tell the customer that he has to collect the delivery from the workshop or the factory.

The basic premises is that the customer will never know what we have not given him and since he is in dire need of the product, he will not have time to return the product or goods and therefore, we do not have to worry about anything.  Also, if the customer if very keen on adherence to the terms, we do not expect him to to be our repeat customer in any case because we don't want such troublesome customer, so any poor quality product or service will do, and so on.  

This "Chalta Hai" attitude has to change first and foremost, and has to change fast.  If not, it will affect our image at the global level.  It already has created a negative impact and Indian's are considered as no compromising on quality, fit and finish. 

 

The other impact will be that people will seek products from foreign countries which will discourage domestic production and lead to outflow of valuable foreign currency.  Indians have earlier been crazy about Japanese, British and American products.  Then for a brief period we saw a demand for Indian products rise and now worldwide, Chinese products have conquered the market.  Name the product and you will see a Chinese product.  The consequences of low share of domestic production has domino effect are many and countries like the USA and some other western countries and seeing the consequences of having low local manufacturing industry.

Combined with the “Make in India” Mantra, the “Speed, Skill and Scale” concept have the potential to take India to the next level in terms of its own economic progress.  The market in India is huge and products that are manufactured in India will be consumed here itself.  So finding a market for products and consumption is not an issue at all.  

Manufacturing has to pick up and for that to happen, the government must ease the norms for doing business.  In the coming days, it would be interesting to see how the plans unfold.  Much has been said about what should be done and what has not been done.  But now is the time for the government machinery to work together, iron out the differences, work in synergy with each other.  The Prime Minister must ensure that the Speed, Scale and Skill mantra must start from the government departments first.  The scale is there in terms of the huge number of employees (here we will not question their performance), the format and structure is there.  They need to deliver things with SPEED.  How the Prime Minister brings in accountability of the government agencies will be interesting to see.  The PM and his office may have control over the Central Government ministries and they may be able to drive it in mission mode, but when it comes to the machinery at the State and Municipal level, it may collapse completely.

I am left wondering as to why previous governments could not think of all these simple aspects all the while they were in office. India could have achieved so much progress by now.  These kind of confidence building activities do not require legislative procedures and the opposition would have been easily floored.  

This gives rise to another aspect about application of creativity in political field has become very important.  Creativity was the domain of artists in the field of fine arts, advertising and related fields of mass communication.  The Prime Minister has shown that just by being creative, so much can be dreamt of first and then achieved.  There is positivity in the environment, stock market is bullish, globally oil prices are on the decline, whole price index and inflation seem to be steadying or maintaining ground, people are talking about it and there is positive energy flowing all around.  

Although so far nothing on the ground level has changed yet but people are hoping that it will, very soon.

Indians are looking up with hope for a better tomorrow.


Sarfaraz Lakhani
Calibre Creators
www.calibrecreators.com