Italian doctor-patient interactions:

Transcription

1 Italian doctor-patient interactions: A study of verbal and non-verbal behavior leading to miscommunication M. Grazia Busà - Sara Brugnerotto DIsaster Management and Principled Large-scale information Extraction (DIMPLE) Workshop, Reykjavik, Iceland May 31, 2014

2 Focus of this presentation Analysis of videos of doctor-patient interactions in Italy. Aims: Study how miscommunication may affect relations of trust in care providers Future directions: Use information on dynamics of communication for security critical issues

3 About patients trust in health care professionals In the past: Patients blind reliance in doctors due to: longstanding patient/doctor relationship patients recognition of the physician s knowledge and medical expertise

4 Changes in the culture of health care Today: decreasing deference to authority and trust in doctors and care providers.due to: wider level of education growing level of available information (i.e. through traditional and new media) patients increasing confidence in the their own personal judgment of risk

5 Other factors technological progress increases efficiency and rapidity of treatments higher technological and scientific standards expectations have risen that solutions and care should be provided rapidly mistakes are not justified

6 Characteristics of doctor-patient communication Increased attention to the technical, biomedical detail Less attention to communication creation of barriers increasing the distance between doctors and patients patients frustration, suspicion and lack of trust

7 This slide has been removed because it contained a copyright-protected video The video shows patients getting angry at the doctor and telling him that he is incompetent

8 Miscommunication and lack of trust Hypothesis: Care providers use of communication strategies may: be the cause of misunderstandings affect patients trust in the physician condition the perception of the physician s reliability.

9 Materials and methods Collection of video clips on doctor-patient interactions (from the film Mi prendo cura di te*). Clips were analyzed qualitatively by both authors separately to detect where communication goes wrong and what contributes to it * An initiative part of a project of the Italian Ministry of Health called medicinema

10 Preliminary results 3 categories of communicative barriers were identified: - external interruptions - verbal barriers - non-verbal barriers

11 External interruptions Occurring during the physician s interaction with the patient Phone calls Medical staff entering the room Effects: source of distraction break in the conversation and information exchange generate frustration in the patient interpreted as a sign of lack of interest

12 This slide has been removed because it contained a copyright-protected video The video shows doctors being interrupted by phone calls or medical stuff while talking to their patients. Patients faces reveal that they are annoyed by these interruptions.

13 Verbal communication The language used by the doctors is: 1. Too technical (use of medical terms) 2. Patients fears are minimized or involuntarily underestimated. Come on! Take it easy, it s not that bad! Try not to think too much about it! You worry too much! etc.

14 Verbal language = Verbal barrier Technical language uncomprehensible to patients impacts on patients dissatisfaction and level of trust in the doctor Minimizations and underestimations patients feel judged and isolated in their fears feelings of lack of empathy impact on level of trust in the doctor

15 Body language affecting communication Contrast between expected doctors behavior in interaction and doctors non verbal communication Revealed by: body posture hand gestures gaze and facial expressions presence of physical objects acting as a communication barrier

16 Body posture* Body leaning back in the chair signals lack of interest * In this and the following slides people s faces have been blocked due to copyright

17 Hand gestures Hands joined together in front of the body are used to signal conflict or closure towards the listener

18 Hand gestures Chin-stroking gestures signals perplexity: the listener is being critical of what the speaker is saying.

19 Hand gestures Hands between speaker and interlocutor function as a distancing device. Signal that the interlocutor is given little consideration

20 Gaze Top-down gaze is interpreted as a signal of dominance Side gaze signals diffidence, criticism à No signals of empathy and partnership

21 Objects creating distance Desks between doctors and patients, charts held in front of patients for extended periods of time also create a communication barrier

22 Ways to reduce the physical distance with the patient

23 Summing up The doctors in our sample seem to be unaware of the meanings of some of the verbal and non-verbal strategies they use in their communication with their patients This impacts their relations and development of trust with their patients

24 Final considerations In emergency situations effective communication can help ensure public trust and credibility, contributing to saving lives and property Future work will look at communication strategies used in emergency situations