Uso de medicina complementaria y alternativa y su asociación con la relación médico-paciente en enfermos con artritis reumatoide / Association between physician-patient relationship and the use of complementary and alternative medicine in patients with rheumatoid arthritis

RESUMEN Introducción: El uso de medicina complementaria y alternativa (MCA) en pacientes con enfermedades reumáticas es prevalente pero la comunicación con el reumatólogo suele ser deficiente, lo cual afecta la relación médico-paciente (RMP). Objetivos: Evaluar la asociación entre el uso de MCA y la RMP en enfermos con artritis reumatoide. Como objetivos adicionales, describir la percepción del paciente sobre la comunicación con su reumatólogo respecto al uso de MCA y el patrón de uso de las diferentes modalidades terapéuticas. Materiales y métodos: Estudio descriptivo de corte transversal. El uso de MCA y la RMP se evaluaron mediante la autoaplicación de cuestionarios validados (I-CAM-Q y PDRQ-9 respectivamente). Resultados: Se incluyó a 246 pacientes ambulatorios de una institución de tercer nivel de atención. Se encontró asociación entre una mayor satisfacción con el tratamiento y el no usar MCA, y entre el hecho de informar al reumatólogo sobre el uso de MCA con un mayor grado de acuerdo con el médico sobre el origen de los síntomas y mayor satisfacción con el tratamiento. Las modalidades más frecuentemente utilizadas fueron: quiropraxia, acupuntura y productos herbales. El 78,5% afirmaron estar de acuerdo con comunicar el uso de este tipo de medicación al reumatólogo, sin embargo, solo el 31,3% lo notificó, por temor a represalias (54,4%). Conclusiones: Pese a la alta prevalencia de uso de MCA en nuestros pacientes, la mayoría no lo comunicó al reumatólogo. Se encontró asociación entre el uso de MCA y una menor satisfacción del paciente con el tratamiento y entre la comunicación médico-paciente sobre la práctica de MCA y una mejor satisfacción con el tratamiento.

ABSTRACT Introduction: Although complementary and alternative medicine (CAM) use among patients with rheumatic diseases is extensive, discussions regarding these treatments occur rarely in the rheumatology setting, directly affecting the physician-patient relationship (PPR). Objectives: The aim of this study was to evaluate the association between patient-physician relationship and complementary and alternative medicine use. As secondary objectives, to describe the patient's perspective towards CAM use and estimate the prevalence of CAM treatments used in patients with rheumatoid arthritis. Methods and materials: A descriptive cross-sectional survey was conducted, in which CAM use and physician-patient relationship were assessed by self-reported validated questionnaires (I-CAM-Q and PDRQ-9, respectively). Results: The study included a total of 246 outpatients of a tertiary care hospital. There were no significant differences between CAM users vs. non-users, or informers vs. non-informers in terms of physician-patient relationship measured by PDQR. The most frequent used CAM treatments were: chiropractice, acupuncture, and herbal products. A large majority (78.5%) of the patients expressed agreement to the discussion of CAM use with the rheumatologist, but only 31.3% of total CAM users did so because of fear of retaliation (54.4%). Conclusion: Despite the extensive practice of CAM among patients with rheumatoid arthritis, most patients did not discuss these treatments with their physicians. Associations were found between MCA use and a lower patient's treatment satisfaction and between physician-patient communication about CAM practice and a higher patient's treatment satisfaction.

Effectiveness of doctor-patient communication course on improvement of doctor-patient communication ability / 中华医学教育探索杂志

Objective To analyze the effectiveness of doctor-patient communication course on improvement of doctor-patient communication ability.Methods Totally 360 eight-year program medical students of clinical medicine from Shanghai Jiaotong University School of Medicine were chosen as the research object and were divided into educational group(n＝l80) and control group(n＝180).Students in educational group study doctor-patient communication course while those in control group do not.SEGUE Framework was used to conduct exploratory research between educational group and control group.Accuracy of questionnaire database was examined by Excel software and logical test.KoImogorov-Smimov(K-S test) was applied to analyze the scores and (x ± s) was used to express the data through SPSS 16.0 statistical software.Comparison between group differences are statistically significant(P＜0.05).Results Overall score was higher in educational group than in control group.Concerning of communication initiation,infomation collection and understanding of patients,scores of educational group were significantly higher than those of control group(P=0.001,P=0.002 and P=0.007,respec-tively).Furthermnore,KoInogorov-Smimov(K-S test) and (x ± s) statistical results showed that scores of detailed items were higher in educational group than in control group as well.Conclusions Doctor-patient communication course is of great importance to help medical students practice physician-patient communication based on related knowledge learning,but course content setting remains to be further improved.

A literature review of instruments measuring communication skills in medical education / 医学教育

Objectives: This study reviewed the literature on instruments measuring physician-patient communication skills in medical interviews. Our goal was to clarify the features of current instruments and problems in assessing physician-patient communication with them.<br>Methods: In 2012, we searched for published articles about instruments assessing physician-patient communication skills in the bibliographic databases PubMed, PsycINFO, and the Education Resources Information Center using the combination of search terms （“consultation skills” OR “doctor-patient communication” OR “physician-patient relations”） AND “medical education” AND （instruments OR measurement OR assessment）. Instruments designed for faculty observers and to be used in medical education were included in the study. To compare the instruments, we classified the items of each instrument on the basis of the framework of the Kalamazoo Consensus Statement （KCS）, an experts’ consensus statement on 7 essential elements of physician-patient communication.<br>Results: Ten instruments were included in the study. Eighty-three percent of all 277 items of the instruments were classified to any of the 7 elements identified in the KCS. Most of the instruments included more than 6 elements identified in the KCS, and some of the instruments had been constructed on the basis of the KCS. However, the instruments varied considerably in essential communication skills to understand the patient’s perspective, to share information, and to reach agreement on problems and plans.<br>Conclusions: Further study is needed to provide evidence for essential communication skills in physician-patient consultation. Because essential communication skills depend on the educational goals, culture, language, and other factors, ensuring the reliability and validity of tools administered to evaluate communication must be required.

Improving doctor-patient relationship, enhancing the oral cavity medical service effect / 中华医学教育探索杂志

While the medicine pattern of biomedicine turn to biological-psychology-society, the medical trouble communication becomes more and more important in the medical service. Good medical trouble communication ability is the essential condition of doctor. As oral cavity clinicians, only by gasping the principle of communication can we appropriately utilize some skills of communication exchange,establish the good medical trouble relations with the patient and achieve the good treatment result finally.

Barriers and facilitating communication skills for breaking bad news: from the specialists’ practice perspective / Barreras y facilitadores en la comunicación de malas noticias: Perspectiva desde la práctica de médicos especialistas

Introduction: Breaking bad news is one of a physician’s most difficult duties. There are several studies related to the patient’s needs, but few reflect on the doctors’ experience. Materials and method: A descriptive, cross-sectional research was carried out to study issues related to the process of delivering bad news which might act as barriers and facilitating skills from the doctor’s point of view. These issues were identified through a self-administered survey. Results: Participant doctors use different strategies to communicate bad news to their patients. Examples of these strategies are: to be familiar with the patients’ medical history, to ensure that there is enough time, to know the patient’s caregivers and/or relatives, to determine the patient’s level of knowledge about his/her condition, to use non-technical words, to give information in small pieces, to assess the patient’s understanding, to devise a joint action plan, among others. Conclusion: The communication barriers that were identified focused on the emotional issues of the communication process, particularly those related to the recognition of own emotions, and the limited training about communication strategies available to doctors. Consequently, there is a need to implement training programs that provide doctors with tools to facilitate the bad news communication process.

Introducción: La comunicación de malas noticias es una de las tareas más difíciles que deben enfrentar los profesionales de la salud. Existen múltiples estudios acerca de las necesidades del paciente, pero pocos que tengan en cuenta la experiencia de los médicos. Materiales y método: Se realizó una investigación descriptiva, transversal para estudiar aspectos del proceso de comunicación de malas noticias que pueden actuar como barreras y facilitadores desde la percepción del médico; identificados por medio de una encuesta auto-aplicable. Resultados: Los médicos participantes utilizan distintas estrategias durante la comunicación de malas noticias a sus pacientes como: conocer los detalles de la historia clínica, asegurarse de tener tiempo suficiente, conocer a los acompañantes e identificar cuánto sabe el paciente acerca de su situación, utilizar vocabulario sencillo, dar la información por partes, comprobar que el paciente esté comprendiendo, formular en conjunto un plan que se ha de seguir, entre otros. Conclusiones: Las barreras comunicativas identificadas se centraron en los aspectos emocionales del proceso comunicativo, específicamente en lo relacionado con la identificación de emociones propias, y en la limitada formación que reciben los médicos en estrategias comunicativas, lo que genera la necesidad de implementar programas de capacitación que les brinden herramientas para facilitar el proceso de comunicación de malas noticias.

The approach of a way to enhance interns’skills of physician-patient communication / 中华医学教育探索杂志

From the current state of the medical environment and health issues,we dis-cuss the necessity of physician-patient communication skills and find the way to enhance the skills of interns.

The Effects of Physicians' Nonverbal Behavior on Patients: Development and Evaluation of Video Recordings of Simulated Patient-Physician Communication / 医学教育

Video recordings of two styles of consultation were created to assess how a physician's nonverbal communication behavior affects patients. A physician spoke the same lines for both recordings but demonstrated different nonverbal behavior: “immediacy” in one recording and “psychological distance” in the other. The frequency and length of the physician's nonverbal communication behavior were measured. Then two groups of subjects were asked to watch one of the recordings ( “immediacy” recording, n=32, and “psychological distance” recording, n=34) and rate the nonverbal behavior on a scale of 1 to 5. Subjects recognized that the physician was warmer, smiled and nodded more often, and made more eye contact with the patient in the “immediacy” recording than in the “psychological distance” recording. These video recordings could be used in patient-satisfaction surveys and medical education.

The Practice and Methods of Physician-patient Shared Decision / 中华医学教育探索杂志

Probing into the methods and techniques of physician-patient communication is important to clinic medicine and medical education. Physician- patient shared decision is one of important aspects of physician-patient communication, 80 patients with hematologic malignancies were reviewed for classification of models of medical decision making, and the methods and techniques of physician-patient shared decision were also discussed .

Informed Consent and Physician-Patient Communication / 中国医学伦理学

The aim of informed consent is to regard patients as the centre of medical service.Physician-patient communication is an effective way to improve the construction of a harmonious physician-patient in medical practice,so more attention should be paid to the communication.

Emphasize the Ethical Issues in Emergency Medicine / 中国医学伦理学

Objective:To explore the significance of ethical issues in emergency medicine.Method:Literature review combined with specific features of emergency department in author's hospital is employed to explore the ethical issues in current emergency medicine,and the necessity to emphasize ethical issues.Related countermeasures are also come up with according to a small sample investigation among emergency residents in author's hospital.Result:Due to the unique characteristics of emergency medicine,there are specific ethical issues arising in emergency department.Conclusion:Enough emphasis should be attached to the reasons for ethical issues in emergency medicine.Relevant regulations and patients triage should be improved in emergency medical treatment.It is also called for to value patients' legal rights,strengthen physician-patient communication,and protect patients' life safety after emergency treatment.Meanwhile,it is also significant to relieve emergency doctors' stress at work,and strengthen sustainable on-job training and team-work of emergency doctors.

Humane Medical Spirit and Doctors' Professional Responsibilities / 中国医学伦理学

The humane spirit,being a crucial part of medical science,builds up the spiritual cornerstone of medicine and professional doctors,thus it is the spirit and soul of medical science.This paper clarifies its emphasis on humane spirit from the perspectives of medical modes,medical purpose,medical legislation,medical education,medical practice,medical market,medical high-tech,physician-patient relationship,and medical risks,and emphasizes that physician-patient relationship can not be handled simply by economic or legal means,but also be modified and improved by humane spirit of medical science.

Carry forward Traditional Chinese Virtues and Optimize Teaching of Physician-Patient Communication / 中国医学伦理学

Staring from the significance of traditional Chinese virtues,this paper proposes to carry forward education of traditional Chinese virtues in the teaching of physician-patient communication,cultivate harmonious personalities of medical students and promote their abilities of communication with patients by absorbing the essence from traditional Chinese virtues.

Restressing the Language Cultivation of Medical Staff / 中国医学伦理学

The humanity-oriented spirit is being reestablished and developed in medical activities,but there are still deviations clearly demonstrated in language expression and communications between doctors and patients.This paper discusses the relationship between medicine and language expression,empirically analyzes the language problems in physician-patient communication including inadequacy of information,rigidness of speech,frankness in speech,the lack of language skills,shortage of non-linguistic information,and the causes of such problems.Finally,the paper proposes that language cultivation should be improved and restressed from the perspectives of both medicine and linguistics.

On Physician-Patient Communication Behavior and Its Standardized Management / 中国医学伦理学

This study explores the association between physician-patient communication and healthcare service quality,and relevant factors.The physician-patient communication belongs to medical behaviors,and plays a key role in the improvement of physician-patient relationship and the overall healthcare service quality.The consults of physician-patient communication were affected by many factors including physicians' attitude,and usage of words and behaviors,in which the positive attitude and behaviors are key solution to the improvement physician-patient relationship.Therefore the urgent matters are to strengthen standardized management of physician-patient communication,and set up related regulations and effective measure.

The Significance of System Building in Solving Physician-Patient Information Dissymmetry / 中国医学伦理学

Dissemination in physician-patient relationship seriously destroys the credit system in medical field,in which information dissymmetry contributed a lot.However,information dissymmetry only serves as the necessary condition for the current physician-patient conflict,not the sufficient condition.The fundamental causation lies in the pursuit for economic benefit in medical service.Therefore,it is necessary to establish a value concept oriented by patient's benefit.Physician-patient communication is useful to improve current information dissymmetry,but can't guarantee the trusting medical behaviors of medical staff.Characteristics of systems satisfy the need of transformation from specialized trust which may lead to cheating behaviors in the state of information dissymmetry to universal trust which brings trust into a regulatory system.In order to improve the effect of system in improving the current state of information dissymmetry,the compliance rate and feasibility of the system should be improved,and the system of reward and penalty be perfected.

Ethical Reflection on Physician-Patient Communication / 中国医学伦理学

Establishment of a harmonious physician-patient relationship plays an important role in constructing a harmonious society.Poor communication is the main reason for the present tense contradiction between doctors and patients,therefore medical workers should improve their professional morality,self-cultivation,and communicating skills with patients.Besides,they should cultivate respect,understanding,and humanistic care for patients,mitigating the contradiction of disequilibrium and dissymmetry between doctors and patients.In this way,mutual respect and understanding can be built up and a harmonious physician-patient relationship established.

Physician-Patient Communication:The Essential Quality of Medical Students / 中国医学伦理学

Satisfactory communication skill is the essential requirement for medical students to become future qualified medical doctors.Clinical clerkship is the key process to absorb medical knowledge and professional skill,cultivate the ability to solve practical problems in medical practice,and develop medical students into qualified doctors by guiding them to reasonably handle physician-patient relationship,better solve medical disputes,and gradually improve their legal awareness.Therefore,medical students should strengthen to cultivate their communication ability,and set up reasonable sense of physician-patient communication.

Factor and Measure of Affecting Physician-Patient communication / 中国医学伦理学

The paper analyses the influencing factors of Physician-Patient communication from three respects,some feasible measures on the mutual communication between doctors and patients are also raised in order to improve Physician-Patient relationship.

The Application of Standardized Patients in the Education of Ethics and Physician-Patient Communication Skills for American Resident Doctors.An Observational Study / 中国医学伦理学

Standardized patients are now serving as an important vehicle in the education of ethics and physician-patient communication skills for American resident doctors.This observational study introduces the background,design and implement of the education of ethics and physician-patient communication skills,and describes the author's personal experiences as an a trained standardized patient in the ethics and communication training workshop for American residents.Some experiences are concluded on related issues including expected roles of teachers,teaching philosophy,SPs design,supportive environment building,and some primary assumptions on applying SPs to Chinese medical education.