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Examining Doctor- Patient ,[object Object],Interactions and Communication,[object Object],Dorothy Gallop, Ian Parsells, Mary Chu,[object Object],1,[object Object]
2,[object Object],Some of the Most Cited Authors:,[object Object],DiMatteo, R.,[object Object],	Hall, J.A.,[object Object],	Kaplan, S.H., Greenfield, S.,[object Object],	Levinson, W.,[object Object],Ong, L.M.L.,[object Object],Roter, D.L.,[object Object],		The Roter Interaction Analysis System (RIAS),[object Object],	Stewart, M.,[object Object],	Stiles, W.B., Putnam, S.M., Wolf M.H., James, S.A.,[object Object],Waitzkin, H.,[object Object]
3,[object Object],The Roter Interaction Analysis System (RIAS) is a method of coding doctor-patient interaction during the medical visit. The system is broadly derived from the seminal work of Robert Bales for assessing patterns of small group interaction during problem-solving and decision-making (Interaction Process Analysis, Cambridge, Mass.: Addison-Wesley, 1950). The RIAS differs substantially from the original Bale's Process Analysis in four ways: ,[object Object],• The coding approach is tailored to dyadic exchange specific to the medical encounter. All patient and physician dialogue is coded into categories that may be applied to each speaker, although some categories may be more common to a particular speaker. ,[object Object],• Categories are tailored to directly reflect the content and context of the routine dialogue between patients and doctors during medical exchanges. ,[object Object],• Identification and classification of verbal events are coded directly from videotapes or audiotapes and not transcripts. ,[object Object],• Since coding is done directly from video or audiotapes, rather than transcripts, assessment of the tonal qualities of interaction is possible. These tonal qualities transmit the emotional context of the visit beyond the significance of the words spoken. Based on a general affective impression, coders rate both the patient and physician on global affective dimensions such as anger, anxiety, dominance, friendliness and interest. ,[object Object], ,[object Object],55 page paper explaining the Roter method,[object Object],http://www.rias.org/manual.pdf,[object Object]
4,[object Object],Some of the most cited journals,[object Object],	Annals of Family Medicine,[object Object],	British Medical Journal,[object Object],	Information Research,[object Object],	Journal of the American Board of Family Practice	,[object Object],	Journal of the American Medical Association,[object Object],	Journal of Health Communication,[object Object],	Journal of Health Economics,[object Object],	Journal of the Medical Library Association,[object Object],	Patient Education and Counseling,[object Object],	Social Science & Medicine,[object Object],	Sociology of Health & Illness,[object Object]
5,[object Object],So Many Choices, So Little Time…,[object Object]
6,[object Object],			  Lay Information Mediaries,[object Object],Parents		         Spouse		      Other Family Members,[object Object]
7,[object Object],Figure 1: View 1 of the lay information mediarybehaviour Model ,[object Object]
8,[object Object],Figure 2: View 2 of the lay information mediarybehaviour Model ,[object Object]
9,[object Object],The rise of the e-patient,[object Object],Susannah Fox from the Pew Internet and American Life Project discusses the latest research on e-patients, including now many people are engaging in social media for health. Fox also gives advice for how patients can avoid information overload when going online.,[object Object],http://www.icyou.com/topics/politics-policy/health-2-0-meets-ix-susannah-fox,[object Object]
10,[object Object],RCS-O,[object Object],Relational Communication ,[object Object],Scale for Observational Measurement,[object Object]
11,[object Object],Immediacy/affection,[object Object],The physician was intensely involved in the conversation with the patient,[object Object],The physician did not want a deeper relationship with the patient,[object Object],The physician was not attracted to the patient,[object Object],The physician found the conversation stimulating,[object Object],The physician communicated coldness rather than warmth,[object Object],The physician created a sense of distance between he/she and the patient,[object Object],The physician acted as if he/she was bored,[object Object],The physician was interested in talking to the patient,[object Object],The physician showed enthusiasm while talking with the patient,[object Object],Similarity/depth,[object Object],The physician made the patient feel that they were similar to he/she,[object Object],The physician tried to move the conversation to a deeper level,[object Object],The physician acted like he/she and the patient were good friends,[object Object],The physician seemed to desire further communication with the patient,[object Object],The physician seemed to care if the patient liked him/her or not,[object Object],Receptivity/trust,[object Object],The physician was sincere,[object Object],The physician was interested in talking with the patient,[object Object],The physician wanted the patient to trust him/her,[object Object],The physician was willing to listen to the patient,[object Object],The physician was open to the patient’s ideas,[object Object],The physician was honest in communicating with the patient,[object Object]
12,[object Object],Composure,[object Object],The physician felt very tense talking with the patient,[object Object],The physician was calm and posed with the patient,[object Object],The physician felt very relaxed talking with the patient,[object Object],The physician seemed nervous,[object Object],The physician was comfortable interacting with the patient,[object Object],Formality,[object Object],The physician made the interaction very formal,[object Object],The physician wanted the discussion to be casual,[object Object],The physician wanted the discussion to be informal,[object Object],Dominance,[object Object],The physician attempted to persuade the patient,[object Object],The physician did not attempt to influence the patient,[object Object],The physician tried to control the interaction,[object Object],The physician tried to gain the approval of the patient,[object Object],The physician did not try to win the patient’s favor,[object Object],The physician had the upper hand in the conversation,[object Object]
13,[object Object],Domains of communication in the provider-patient relationship,[object Object]
14,[object Object],House demonstrates ,[object Object],how to not engender trust…,[object Object],http://www.youtube.com/watch?v=pZsICYJ1tW4,[object Object],first minute and 8 seconds,[object Object]
15,[object Object]
16,[object Object],Why they thought the doctor had a negative feeling about the information,,[object Object],[object Object]
'Because I was going against his advice he was difficult, but finally agreed'.
'The doctor obviously felt that it was not the correct method of treating the problem'.
'The doctor thought I was trying to self diagnose'.
'He said he was the doctor... what did I know?',[object Object]
18,[object Object],What are some of the methods used ,[object Object],to study these communications?,[object Object]
19,[object Object],“Towards a theoretical framework”,[object Object],L.M.L. Ong, et al,[object Object],(1995),[object Object]
Nonverbal Behavior and Communication,[object Object],What do we say when we’re not talking? What’s hidden underneath when we are? Are words the only means of information transfer?,[object Object],20,[object Object]
Nonverbal Behavior and Communication,[object Object],When did we start discussing Nonverbal Behavior?,[object Object],What we recognize as Nonverbal Behavior began with Charles Darwin back in 1872. According to Darwin, earlier in our evolutionary history, Nonverbal Behaviors had specific functions that now have lost their initial meanings. ,[object Object],	Over time, these behaviors have gained a communicative value as they provide others with external evidence of someone’s internal state.,[object Object],	(Krauss et al., 1996),[object Object],21,[object Object]
Nonverbal Behavior and Communication,[object Object],	What constitutes as Nonverbal Behavior and why is it important?,[object Object], 	According to D.L. Roter, J.A. Hall, et al. (2005), nonverbal behavior includes communicative behaviors that do not carry content of a linguistic nature such as:,[object Object],[object Object]
  Smiling/Frowning
  Eye Contact
  Head Nodding
  Hand Gestures
  Posture and Body Leaning
  Position
  Appearance
  Speech Rate
  Loudness
  Pitch
  Pauses
  Interruptions
  Tone“An estimated 60-65% of the meaning in a social encounter is communicated nonverbally,” (Griffith et al., 2003). ,[object Object],22,[object Object]
Nonverbal Behavior and Communication,[object Object],Confused?,[object Object],Then let’s begin with some visual examples!,[object Object],http://www.youtube.com/watch?v=cEkT5uspE3c,[object Object],23,[object Object]
Nonverbal Behavior and Communication,[object Object],How does this apply to Physician-Patient interaction?,[object Object],[object Object]
Emotion-related communication skills, mostly nonverbal, are critical for high-quality care and influence patient satisfaction, adherence, and outcomes. (Roter et al., 2005)24,[object Object]
Nonverbal Behavior and Communication,[object Object],	How does this apply to Physician-Patient interaction? (cont.),[object Object],Nonverbal behaviors contribute to the development of trust and rapport, as well as the establishment and maintenance of relationships with patients. (Ambady et al., 2002),[object Object],Nonverbal behavior is the most essential way to convey empathy with patients. (Bensing et al., 1995),[object Object],25,[object Object]
Nonverbal Behavior and Communication,[object Object],	Specific Examples:,[object Object],Head nods, open arm positions, and forward leans are thought to convey encouragement and interest.,[object Object],Body position has been related to patients’ perception of warmth and empathy.,[object Object],Smiles convey approval or agreement, frowns disapproval. Blank expressions may convey boredom, aloofness, or dismissal.,[object Object],26,[object Object]

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Doctor Patient Communication

Hinweis der Redaktion

  1. first 3 minutes 25 seconds.
  2. -- Evidence that men and women are treated differently in everyday conversation
  3. Deborah Roter (John Hopkins University) & Judith Hall (Northeastern University)Individually, they have published extensively on different communicative roles of gender, and also collaborated on research together. Studies on gynecology and OBGYNs- 1 reported study higher but non significant levels of psychosocial behavior from male doctors to female patients.
  4. Scrubs– miscommunication between doctor and patient.Racist doctor? http://www.youtube.com/watch?v=K_ydNGDR-SM-- STAR TREK
  5. Previous research indicates that physicians expect themselves to not be affected by race or demographicsThe doctors in this study 84% were white, 11% Asian, 1% African American, and 3% HispanicPoint 1: Also perceived African-Americans and members of low/middle class groups more negatively than whites and higher SES. Point 2: Physicians attitudes towards patients is important because of their impact on the patient’s satisfaction and behavior. If a patient feels that the doctor cares about them and is interested in them as a person, they’re more likely to
  6. Information PovertyGordon– study on cancer patients, specifically looking at the racial issues and lung cancerDeclined elective surgery because they believed that when cancer was exposed to air, it would cause the cancer to spread.- Patients more cautious due to less favorable attitudes from doctors- less likely to engage, ask questions, SensemakingChilean study, patients claimed that being touched was a reason why the care they received was good. (Ong, L.M.L 1995)Not so in the U.S.
  7. School of Information and Library Science faculty @ UNC Chapel Hill ClaudiaGollop’s study looked at a very specific slice of a population in Pittsburgh– They considered their medical doctor to be the best and most reliable source
  8. But… they also held the library in high regard,
  9. #4: “Top down information transmission has ignored the realities of lay person’s lives […] it blames the victims and is received as irrelevant at best and prejudicial and oppressive at worse.#5 The information environment marked by decreasing trust in expert and institutional sources