Clinician Patient Communication and Its Role in Disease Management- An Overview

Introduction

Communication is an exchange of information. A clinician’s interpersonal skills are very important in establishing a rapport with the patient. A good rapport is the foundation of the clinician-patient relationship. It facilitates correct diagnosis, appropriate counseling, and treatment for the patients. Moreover, patient satisfaction is paramount in successful disease management.

What Are the Problems Encountered During Clinician-Patient Communication?

Various obstacles can occur in a good clinician-patient relationship.

Clinician Factors:

• Communication Skills: The clinician’s communication skills hold a significant impact on the clinician-patient relationship. Patient preferences must be considered foremost over the clinician’s jurisdiction. It has been noted that a clinician’s interpersonal skills decline over time. It may be due to the harsh medical training, particularly during internship and residency. Negative or nonverbal clinician communication drives the patient into a ‘good character’ to avoid clinician resentment.
• Avoidance: Clinicians sometimes avoid the emotional aspect of the patient’s problem due to personal reasons. It leads to increased patient distress. Further, it makes the patients reluctant in disclosing their problems, delaying their recovery. Also, clinicians have increased workloads. This might be another reason for avoidance.
• Unconscious Bias: Unconscious bias is a stereotype about certain individuals. It happens outside the clinician’s realization.
• Fear of Litigation: Litigation implies legal action. Clinicians are conscious of the same and practice ‘defensive’ medicine to avoid litigation. Moreover, there is a fear of physical abuse.

Patient Factors:

• Nondisclosure of Information: If a patient withholds important information from the clinician, it can undermine appropriate care. It can even lead to patient harm. The most common reasons for the same are not wanting to be judged or being embarrassed. This behavior is seen more in women.

• Resistance: Manypatients modify a clinician's information to claim their own perspectives, despite awareness regarding the risks. It is due to the fact that patients recognize they are not passive recipients. The patient’s anxiety and fear of treatment are added reasons.

• Unrealistic Patient Expectations: Patients’ expectations for quality healthcare are increasing. In rare cases, where the patients have completely unrealistic expectations, it is critical to treat them with empathy.

• Limited Language Proficiency (LLP): LLP patients are thought to be ‘communication-vulnerable.’ Many patients have LLP. LLP patients are observed to experience less patient-centered care and lower-quality communication. Studies also report fewer healthcare visits of such patients.

• Low Health Literacy: It depicts problems with oral communication, reading, writing, new learning, and following medical instructions. Individuals with low health and numerical literacy report poor healthcare compared to highly proficient ones.

• Low Digital Literacy: The twenty-first century is a digital book. Recent trends in healthcare favor electronic communication. It is especially true in the post COVID phase. Increased use of mobile devices, applications, and the wide use of information technology for healthcare induces digital disparities. Rural populations and poor people have limited digital literacy, making is another reason for poor communication and health outcomes.

What Are the Benefits of an Effective Clinician Patient Relationship?

A clinician-patient communication plays a central role in healthcare. The main aims of effective patient-clinician communication are:

1. Good Interpersonal Relationship: Patients describing good communication with their clinician are more satisfied with the treatment. Moreover, they do not hesitate in sharing full information about their concern. Such patients are more likely to follow the clinician’s advice and stick to the prescription.

2. Facilitating Information Exchange: Proper exchange of information helps regulate a patient's emotions. Hence, the clinician can provide a comprehensive treatment plan to the patient. It prompts proper identification of the patient’s expectations. Also, contented patients barely lodge formal complaints.

3. Including Patients in Decision Making: It is important as the patients feel a sense of control. It improves the ability to tolerate pain, enhances recovery, and improves disease outcomes. A patient-centered approach develops better clinician and patient satisfaction.

4. Improved Disease Outcomes: Effective clinician-patient relationship is associated with positive clinical and symptom-based outcomes. Hence, it directly affects the patient's health.

What Are the Strategies for the Improvement of a Clinician Patient Communication?

1. Communication Skills: Developing positive communication skills can be fruitful for the clinician. Clinicians must be attentive to patients and ask open-ended questions. Breaking bad news is a daunting task for the clinician. Hence, the most important characteristic of a good clinician in such cases is empathy.

2. Communication Training: Clinicians must practice good communication skills. If needed, they should modify their communication style. Self-awareness, self-monitoring, and training are important. Regular feedback can be helpful for the clinician. Medical education should include training for the same. Active listening skills are convenient tools.

3. Collaborative Communication: It involves a two-way conversation between the patient and clinician. Clinician-patient collaboration is ideal to provide the best care for patients. Clinicians sometimes take hasty decisions that lead to unconscious bias towards patients. A particular condition can also be identified with collaborative communication.

4. Conflict Management: Often the cause of conflicts is not conveyed. Conflicts induce helplessness, frustration, anger, and uncertainty. Clinicians must recognize these feelings and dilute the situation. It enables the relationship to turn into clinical success. Besides, avoidance behavior should be minimized.

5. Health Beliefs: Beliefs and values hold importance and affect the clinician-patient relationship. They are highly influenced by social and behavioral factors. Different health beliefs affect healthcare through competing treatments, anxiety, and fear, or distrust of the offered treatment.

What Are the Future Directions for Assessing a Clinician's Patient Communication?

Various approaches in evaluating clinician-patient communication are:

Recordings: Recordings can be done to assess the medical encounter.

• Recordings are done for the behavioral and observational components. Standardized observations can also be made through recordings.
• Audio or videotaping is useful.

Surveys: The patient’s perception is analyzed via surveys.

• Quantitative: The frequency, occurrence, and other behavioral elements are checked in quantitative surveys. The patient’s perception has a greater impact on their own outcomes. The comparison of studies is a satisfactory tool for patient perception measurement.
• Qualitative: These are difficult to gauge. However, these provide a deeper understanding of patient perception. Physiological measures are specific. They help in assessing patient satisfaction. Patients experiencing good care and outcomes are more satisfied. Hence, they are more likely to maintain the relationship. The main predictors of satisfaction are the patient’s perception and a positive clinician approach. It firmly predicts patient compliance.

Conclusion

The clinician-patient interaction is complicated. Any miscommunication is a pitfall. Effective communication between patients and clinicians is pertinent to improve healthcare quality. Also, it is a source of patient motivation and self-confidence which highly influences the disease outcome.