Doctor – patient communication

1. Patients with special needs (socially disadvantaged patients, patients with permanent damage/disability, patients with impaired speech, sensorially handicapped patients)

2. Doctor – patient communication Socially disadvantaged patient: • Homeless people; • Drunks; • Addicts; • Prostitutes; • Abused by another person;

3. Doctor – patient communication • Special categories of social workers should take care of them. • Specific problem is a long-term unemployment. • Loss of the possibility of self-realization. • Absence of any ID.

4. Doctor – patient communication Entrance interview: • Find out the current situation; • In the case of the woman in productive age we ask about her family; • But there can be a problem that the patient is unable to speak. • Orient on the basis of ID. • Act as in case ofcrisisandassumeresponsibilityforthepatient.

5. Doctor – patient communication Patient with permanent damage/disease: • Mental (anxiety, aggression, depression); • Sensory (blind, deaf, deafblind); • Physical (wheelchair); • With reduced intelligence (mentally handicapped); • Combination of these defects.

6. Doctor – patient communication Professional approach: • Without bias; • Without prejudice; • Without aversion. • UN – 20. 12. 1971 – Resolution of right of the physically and mentally handicapped.

7. Doctor – patient communication Our society has decided to integrate disabled and handicapped people: • barrier-free access to schools, public institutions, to shops, to public sanitation; • installation of audio signal devices at crossings, guide strips on sidewalks.

8. Doctor – patient communication Guidelines for communication with handicapped patients: • Choose a communication which is adequate to form and patient´s individual disability; • Always keep eye contact; • Speak to the patient (even if she/he is accompanied, even if we are sure he/she can´t perceive us);

9. Doctor – patient communication • Speak clearly, always use literary language without foreign or slangy medical terminology; • Do not feel sorry about patient´s handicap, it decreases his/her psychological comfort; • Talk with a patient appropriately to his/her age, not according to her/his mentality; • Move tolerantly their moodiness, indiscretion, grain. • Talk with gentle, calm voice.

10. Doctor – patient communication Patients with impaired speech: • Do not repeat badly articulated words; • Speak slowly but not like with wrong understanding man; • Do not laugh at them; • Do not tell words for forward; • Wait until they say what they want;

11. Doctor – patient communication Patient with impaired speech caused by receptive aphasia (after an injury or stroke) or patient who is not able to speak for mental health reasons: • Do not ask questions „What does hurt you? Where does it hurt you?“ But Questions „Does your head hurt you? Does it hurt you behind the sternum? Do you want to eat, drink or urinate? Are you cold? Should I call someone from your family?“

12. Doctor – patient communication Deaf patient: The handicap can be: • Prelingual (he/she lost hearing ability before he/she learned to speak); • Postlingual (when he/she could speak); • Hearing loss (combined sense defect); • Deaf-blindness.

13. Doctor – patient communication • Deaf people think in a different way. • They don´t understand doctor terminology. • They don´t know synonyms and homonyms – they have for each word each sign. • People who lost their hearing ability as a child they don´t have developed the auditory centre in the brain. But they perfectly perceive and filter movements.

14. Doctor – patient communication Sign language: • is set of manual movements in a defined area. • Signs are made up of hand shapes, their position and movement in space. • Deaf people orient themselves in it as well as hearing people in a tangle of sounds. • For deaf people is really difficult to learn read and write. • Their understanding of words is very limited because they know only some meanings of words. • They usually don´t know abstract words.

15. Doctor – patient communication Deaf people use finger alphabet:

16. Doctor – patient communication Deaf people have different culture speech: • they think differently – they don´t know irony in speaking; • They name all things and situations directly; • They never leave a room or office unnoticed (they shake hands with everybody or kiss – saying goodbye takes long time); • In a room, they always sit facing the door; • They call by waving in the field of others view.

17. Doctor – patient communication Some rules of behaviour in deaf society: • Eye contact - break of eye contact is an instruction that the conversation ends. • Call for interview – touch or shake, wave by hands. The touch is permissible: the upper arm, forearm or arm and only slide. We don´t touch from behind. At a table is allowed to call somebody by bang on the table or trample down. • Coming into the room - quickly switch on and switch off the lights (it substitutes a knock on the door). Longer blinking means banging on the door (it´s not appropriate).

18. Doctor – patient communication General ules: • Notify deaf person by light touch or a quick hand shake in his/her field of view that you want to speak with him/her. • Do not talk to him/her behind his/her back. • Stand up to give the deaf person a good view on your lips. • Do not place the face to the light source. • Do not shout, the patient can not hear you. Conversely speak without voice, it allows you to articulate better.

19. Doctor – patient communication • Use common words in simple sentences. • Do not use foreign slang terms and medical terminology. • Do not make ironic remarks, deaf people don´t understand it. • Make sure about the feedback. • You can use natural gestures or finger alphabet. • If you do not understand, use a pen and paper.

20. Doctor – patient communication Blind patient: Jurášek is blind since he was born. He has only small remnant of sight, compensated by glasses with twenty-five dioptres. His handicap (disability) is combined – it is result of infantile paralysis (malformation of organs and bones), he suffers from dermatitis, doctors must watch epilepsy as well. Social adaptability is very difficult, he is unable to care for himself, but he was lucky because he was born into a cultivated and devoted family. With mother's careful and consistent leadership he has learned how to use the remnants of sight so he is able to communicate with the whole world using magnifying glass, special optics and the Internet connection. He uses a special mobile phone with display 5x10 cm and keyboard in a size of typewriter. Jurášek can also play the piano – he plays e.g. Prelude C-dur by J. S. Bach or world jazz cancan which he plays without any mistakes although his hands are partly paralysed after postpartum paralysis. Jurášek has been learning mainly by touch and hearing. Spoken word means a lot to him although he has difficulty with speech.

21. Doctor – patient communication National Disability Council established TenCommandments for dealing withpatients withvisual impairments: • Treat the patient so they don´t feel humiliated. • Treat directly with blind patient, not through his/her accompany. • A person communicating with blind person gives a hand first. • Giving a hand replaces a greeting. • During an examination it is necessary to explain what is going to happen. • Door to the doctor´s office should be fully open or fully closed. • Blind person things should stay on the same place. • During the communication with the blind patient you can use words „see, look, blink, watch“ with no worries. • On the guide dog is not appropriate „be smacking, whistle, stroke, feed“ • Blind should be ordered for a certain hour.

22. Doctor – patient communication It is appropriate if the doctor knows the patients handicap in advance: • practically blind; • totally blind; • partial impotence; • overwhelming helplessness; • entirely dependent on foreign help.

23. Doctor – patient communication • Some patients with degenerative eye disease variously rotate with head. They look for a point which they can see. They „are“ as a mentally handicapped. • Missing sight is replaced by smell, touch and hearing. • They can hear whence the voice comes, recognize head bowed over papers and face turned away.

24. Doctor – patient communication • If the patient is accompanied by a guide dog, pay attention only to the patient. • If we want the patient to sit, grab his/her arm gently, bring him/her to a chair, put his/her hand on the back of the chair (patient can feel the back of the chair) and encourage him/her to sit. • Let the patient (in a case he/she is being examined instrumentally) touch every tool or machine (if it´s possible).

25. Doctor – patient communication • Give me your hand. I´m going to take blood for the laboratory right from this place. I´m tieing a tourniquet – it is elastic gum which tightens your hand to get swollen your vein.