AETCOM attitude ethics and communication.pptx

Aetcom question

1. AETCOM A T T I T U D E , E T H I C S & C O M M U N I C A T I O N Rajesh Bardale MD

2. Module 3.3: The foundations of communication Communication is a fundamental prerequisite of the medical profession and beside skills is crucial in ensuring professional success for doctors Competencies The student should be able to: 1. Demonstrate ability to communicate to patients in a patient, respectful, nonthreatening, non-judgmental and empathetic manner The student should be able to : 2. Identify, discuss and defend, medico-legal, socio-cultural and ethical issues as they pertain to consent for surgical procedures The student should be able to : 3. Administer informed consent and appropriately address patient queries to a patient undergoing a surgical procedure in a simulated environment

3. Case example You are working as a cardiologist. On one night at around 01.00 AM a 53 year married lady was brought to emergency department of your hospital with complaint of breathlessness. The junior doctor admitted the patient. Past history revealed that she had operated and have prosthetic aortic valve and was on aspirin. Since last few days she had not taken the medication. The junior doctor treated the patient and grave prognosis was explained. The relatives were repeatedly asking you to come and see the patient. But you said to your junior that you will examine her in morning . Subsequently patient died. Relatives ransacked the hospital and manhandle you.

4. The foundations of communication Question: State few essential elements of communication in medical encounters in accordance to the Kalamazoo consensus statement Communications in medical encounters involves building a relationship with the patient. A strong, therapeutic, and effective relationship is absolutely necessary for effective physician – patient communication.

5. Essential elements according to the Kalamazoo consensus statement involves: I. Opening the Discussion- Allow the patient to complete his or her opening statement. Establish a personal connection. II. Gathering information- Use open-ended and closed-ended questions appropriately Actively listen using nonverbal (e.g. eye contact) and verbal (e.g., words of encouragement) techniques III. Understanding the patient's perspective- Explore contextual factors (e.g., family, culture, gender, age, socioeconomic status, spirituality) Explore beliefs, concerns, and expectations about health and illness

6. IV. Sharing information- Use language the patient can understand Check for understanding Encourage questions V. Reaching an agreement on problems and plans- Encourage the patient to participate in decisions to the extent he or she desires Check the patient's willingness and ability to follow the plan VI. Providing closure- Summarize and affirm agreement with the plan of action Discuss follow-up (e.g., next visit, plan for unexpected outcomes)

7. Question: What is communication? What are the types of communication? Discuss the importance of efficient communication in healthcare settings. Communication: A process by which information and understanding is exchanged between individuals, by any effective means. Types: I. Verbal- • It involves the use of spoken words or sign language to share information. • It can either happen face to face or through other channels, such as mobile phone and video conferencing.

8. II. Non-verbal- Nonverbal communication involves passive communication through the use of gestures, tone of voice, body language and facial expressions to share your thoughts and feelings. It also involves communicating through the way you dress. III. Written- Written communication includes communicating through writing, typing or printing. It is done through channels such as letters, text messages, emails, social media and books.

9. Importance of efficient communication in healthcare setting: An efficient communication enables healthcare providers to establish rapport with their patients and work effectively with all members of the care team. Providers can help patients feel heard, ease their fears, and encourage them to disclose relevant information. Clear, honest and empathetic communication between patient and provider minimizes misunderstandings and paves the way for accurate diagnoses and treatment decisions. Moreover, it also helps the healthcare provider to reveal sensitive information regarding the treatment outcomes to the patient and relatives. In terms of patient counselling for various psychiatric disorders, effective communication plays a vital role. Furthermore, a sense of trust is established between the patient and physician which is essential for patient wellbeing.

10. Module 3.4: Case studies in bioethics - Confidentiality This introduces the student to confidentiality and its limits Competency The student should be able to: Identify, discuss and defend medico-legal, socio-cultural and ethical issues as it pertains to confidentiality in patient care

11. Case example Ramratan was in tears. “How is it possible doctor? We are expecting our son soon. He will not have a father”. Ramratan had seen you with vague aches, fever, weight loss and cough with expectoration not responsive to antibiotics for the past three months. He had a right mid zone lung shadow on X-ray and the sputum was positive for AFB. On being questioned, he had revealed that he had unprotected sexual intercourse with multiple partners 3 years ago. “But I stopped after I married Danno , doctor - I am faithful to her”.

12. An informed consent was obtained and HIV screening test was ordered and it was positive. A confirmatory test was subsequently obtained and it was also positive. The CDC count was < 100. Ramratan had come to discuss the results of his HIV test. After consoling him and writing out prescriptions for TB and HIV, you mention to him that he must bring his wife for testing. “This is important, Ramratan ”, you add - “especially since she is pregnant.” “Absolutely not, sir!” he explosively retorts. “That is not possible. I will be humiliated. Danno will leave me and go. I will never be able to see my son. I will become an outcast in our community. I can’t live without my wife, doctor. I urge you, doctor - don't do this. I forbid you…”

13. Points for discussion 1. The primacy of confidentiality in patient care. 2. What does confidentiality entail? 3. When can confidence be breached with whom and how? 4. Confidentiality and diseases that may engender patients and society.

14. Q. What is full and reasonable disclosure? What are the exceptions to full disclosure? A physician must disclose information that a reasonable person would want to have for decision making even though that information may cause the patient to refuse the treatment that the physician believes is in the patient’s best interest. No piece of information should be kept hidden. Important concerns of the patient should be addressed. In other words, the doctor is legally bound to pass on every detail regarding the disease condition, nature of the proposed treatment, alternative treatments if any, and prognosis with possible risks and benefits of the procedure to the patient.

15. Exceptions to full disclosure: 1. Therapeutic privilege of doctor : Patient’s physical and mental state, personality, and age should be considered. Full disclosure can result in frightening a patient who is already fearful or emotionally disturbed, who may refuse treatment when there is really little risk. The doctor should explain the risks to the family, note the same in patient’s records explaining his intension and the reasons. For example, malignancy and unavoidable fatal lesions may not be disclosed to the patient. In such case scenario, if the family member requests that certain information should not be revealed to the patient, the doctor should ask the patient if they would prefer to be told everything or would prefer their family to filter information. 2. Materiality : Materiality states that only that information should be stated that impacts the decision of the patients and unnecessary information should not be disclosed

16. Competency Acquisition: Suggested Log Book pattern Student’s descriptive narrative of skill acquired Faculty only: If the student has not completed the competency, write down the reasons and remedial measures suggested