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CROSS CULTURAL MEDICAL COMMUNICATION

CROSS CULTURAL MEDICAL COMMUNICATION. Yati Soenarto Center for Bioethics & Humanities, Faculty of Medicine, UGM,Indonesia. CULTURE; DEFINITION.

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CROSS CULTURAL MEDICAL COMMUNICATION

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  1. CROSS CULTURAL MEDICAL COMMUNICATION Yati Soenarto Center for Bioethics & Humanities, Faculty of Medicine, UGM,Indonesia

  2. CULTURE; DEFINITION • Taylor (1871): That complex whole which includes knowledge, belief, art, morals, law, custom and any other capabilities & habits acquired by man as a member of society. • Keesing(1981): System of shared ideas system of concepts, rules & meanings that underline and are expressed in the ways that human beings live

  3. MEDICAL COMMUNICATION • Doctor-patient communication: cornerstone of good medical practice (Doherty,1990, Rotter, 1995) • Interactional skills difference to a wide range of desirable patient outcomes: accuracy of diagnosing psychiatric disturbance patient, compliance with prescribed medication, recovery from medical interventions, smoking cessation, weight loss and Aids-related risk behaviors (Doherty, 1990, Mrks, 1979. Cockburn,1987, Mumford,1982, Slama, 1990, Stunkard,1985, Coates, 1990).

  4. HOW ARE COMMUNICATION PROBLEMS IN CLINICAL PRACTICE? • Common (Simpson,1991) • Late 1980th, few doctors has sufficient information for patients to effectively comply with their doctor’s recommendations (Cockburn, 1987, Horne, 1987). • Several recent studies of communication skills training have drawn positive conclusions regarding it’s impact

  5. WHAT TO BE TAUGHT? • WHO (1993): Things to be taught need to be relevant to particular culture. • Ask: 1). A group of doctors & other relevant professionals to identify particular behaviors that constitute good practice-core communication skills for the particular culture,2).A group of people representing consumers of health services-identify aspects of a desirable consultation.

  6. Definition : The process of understanding and sharing meaning KEYWORDS • Understanding: Perceiving, interpreting,and comprehending the meaning of the verbal & non verbal behavior of others • Sharing: An interaction between people in order to exchange meaning • Meaning:The shared understanding of the message (constructed in the minds of the communications).

  7. Jason, Hillard Md. 2000. A practical guide to communication skills in clinical practice. Education for Health. • Pearson,Judy C & Nelson, Paul E. 2000. An Introduction to Human Communication. 8th Ed. Mc Graw-Hill Higher Education. Boston • WHO. 2000. Health Ethics in South-East Asia. Vol 3. New Delhi

  8. PATIENT-DOCTOR RELATIONSHIP BASIC COMMUNICATION

  9. Patient-Doctor (P-D)INTERACTION & COMMUNICATION Effective P-D interaction & comm. Is: central to P&D satisfaction, to the clinical competence of D, & to the health outcomes of their patients Indicators show many doctors don’t comm. effectively , & training in interactional & relationship skills is important & low cost -- investment considering the high rewards that can be gained for P, D, medical schools & health care.

  10. COMMUNICATION Definition (Pearson & Nelson, 2000): The process of understanding and sharing meaning. Notes: • Communicare (Latin word):to share • A process : dynamic, ongoing, always changing, continuous

  11. Definition : The process of understanding & sharing meaning KEYWORDS • Understanding: Perceiving, interpreting,and comprehending the meaning of the verbal & non verbal behavior of others • Sharing: An interaction between people in order to exchange meaning • Meaning:The shared understanding of the message (constructed in the minds of the communications).

  12. Full Communication Involves: (Jason, 2000) • Learning & sustaining trust, • Listening actively, • Mastering timing, • Formulating ideas clearly & succinctly, • Conveying a sense of sincere caring, • Transmitting sympathy or empathy as needed

  13. PATIENTS HEALTH PROVIDERS INTERACTION HEALTH PROFESSIONALS (Physician,PH,nurse,mid-wife, dentist, pharmacist) NON-HEALTH PROFESSIONALS (administrative, finance) HOSPITAL (others) How to serve the community (colleagues/team members) How to make money (competitors)

  14. PATIENT-DOCTOR COMMUNICATION’S CONCEPT • PATIENT’S AUTONOMY vs DOCTOR’S RESPONSIBILITY onPATIENT’S VALUE vs HEALTH PROFESSIONALISM  THE ROLE OF PATIENT - IN MEDICAL DECISIONS MAKING PROCESS  CONFLICT? • PATIENT’S & DOCTOR’S NEED ON ETHICAL & LAW STANDARD FOR DOCTOR, INFORMED CONCENT & MALPRACTICE

  15. 4 MODELS OF COMMUNICATION • INFORMATIVE • INTERPRETIVE • DELIBERATIVE • PATERNALISTIK

  16. MODELS OF P - P COMMUNICATION; BASED ON: • PATIENT’S VALUE - AUTONOMY CONCEPT • DOCTOR’S RESPONSIBILITY - PROFESSIONALISM Autonomy: Central concept in health ethics- Respect for person-beneficence (do good), non-malfeasance (do no harm) & justice.

  17. Patient Autonomy: • Autonomy requires: • Capable of deliberation-personal • goals - treated with respect for • capacity for self determination- Impaired autonomy: • Dependent/vulnerable be provided • security against harm or abuse

  18. INFORMATIVE MODELSCIENTIFIC,ENGINEERING,CONSUMER • PATIENT: AUTONOMY HIGHCONTROL THE CLINICAL DECISION. PATIENTS’S VALUE HIGH; FACTS LOW • PHYSICIAN: PROVIDE RELEVANT INFORMATION. PATIENT CHOSE THE THERAPY; DOCTOR IMPLEMENTS PATIENT’S CHOISE

  19. INTERPRETIVE MODEL PATIENT: VALUE : • UNCLEAR/CONFLICTING MANAGEMENT AUTONOMY • SELF UNDERSTANDING RELEVANT TO MEDICAL SERVICE

  20. PHYSICIAN: • ROLE: • TO CLARIFY & INTERPRETATE PATIENT’S VALUE, AND IMPLEMENT SELECTED INTERVENTION • RESPONSIBILITY • GUIDING & COUNSELING • MAINTAINING EXPERTIES & • REFERRING OR ASKING SECOND OPINION

  21. DELIBERATIVE MODEL PATIENT: • VALUE: • OPEN FOR DEVELOPMENT & CORRECTION OF MORAL DISCUSSION • AUTONOMY: • MORAL SELF DEVELOPMENT WHICH RELEVAN TO MEDICAL SERVICES.

  22. PHYSICIAN : • ROLE : AS A FRIEND/TEACHER • RESPONSIBILITY TO ADAPT AND TO PERSUATE PATIENT FOR HAVING BEST MARKS & SELECTED IMPLEMANTATION

  23. PATERNALISTIC / PARENTAL MODEL PATIENT: • VALUE : OBYECTIVE & DISCUSSED AMONG PHYSICIANS • AUTONOMY AGREEMENT OVER OBJECTIVE VALUE

  24. PATERNALISTIC MODEL PHYSICIAN:1. ROLE: TO PROTECT AND TO GUARD2. RESPONSIBILITY: TO PROMOTE THE BEST INTERVENTION

  25. Traditional • Tradition: The passing down of elements of a culture from generation to generation, especially by oral communication: - thought or behavior - a set of such custom and usage viewed. Latin: “traditio” – to hand over, deliver, entrust • Traditional Relating to or in accordance with tradition

  26. CONCLUSION • Communication: patient-doctor relationship is compulsory • Multidimensional communication is needed • Communication models: move from paternalistic (doctor authority to deliberative (patient center) • Culture should be thought

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