Question

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?

Answer 1

Good doctor-patient communication has the potential to help regulate patients' emotions, facilitate comprehension of medical information, and allow for better identification of patients' needs, perceptions, and expectations.4,7,17 Patients reporting good communication with their doctor are more likely to be satisfied with their care, and especially to share pertinent information for accurate diagnosis of their problems, follow advice, and adhere to the prescribed treatment.1,6,7,9,14,16,18–23 Patients' agreement with the doctor about the nature of the treatment and need for follow-up is strongly associated with their recovery.10

Studies have shown correlations between a sense of control and the ability to tolerate pain, recovery from illness, decreased tumor growth, and daily functioning.16,20,24Enhanced psychological adjustments and better mental health have also been reported.6,10,16,25,26 Some studies have observed a decrease in length of hospital stay and therefore the cost of individual medical visits and fewer referrals.1,27

A more patient-centered encounter results in better patient as well as doctor satisfaction.1,5–7,9,13,15,18,19,22,25,26,28–30Satisfied patients are less likely to lodge formal complaints or initiate malpractice complaints.1,5,9,19,22,28 Satisfied patients are advantageous for doctors in terms of greater job satisfaction, less work-related stress, and reduced burnout.4,26

THE PROBLEMS

There are many barriers to good communication in the doctor-patient relationship, including patients' anxiety and fear, doctors' burden of work, fear of litigation, fear of physical or verbal abuse, and unrealistic patient expectations.31

Deterioration of Doctors' Communication Skills

It has been observed that communication skills tend to decline as medical students progress through their medical education, and over time doctors in training tend to lose their focus on holistic patient care.32 Furthermore, the emotional and physical brutality of medical training, particularly during internship and residency, suppresses empathy, substitutes techniques and procedures for talk, and may even result in derision of patients.32

Nondisclosure of Information

The doctor-patient interaction is a complex process, and serious miscommunication is a potential pitfall, especially in terms of patients' understanding of their prognosis, purpose of care, expectations, and involvement in treatment.12 These important factors may affect the choices patients make regarding their treatment and end-of-life care, which can have a significant influence on the disease.33 Good communication skills practiced by doctors allowed patients to perceive themselves as a full participant during discussions relating to their health.10 This subjective experience that influences patient biology is the “biology of self-confidence” described by Sobel, which emphasized the critical role of patients' perception in their healing process.