Doctor-Patient Relationship (20414)
Qualification/course: Bachelor's Degree in Medicine
Year: 2
Term: 3
Number of ECTS credits: 5
Number of study hours:
5 ECTS credits per year: 5 x 25 h= 125 h:
- Theory classes: 20 h
- Seminars: 20 h
- Individual work: 85 h
Face-to-face activity: 32% = 40 h
Virtual activity: 68% = 85 h
Course Language(s):
Lecturers: Josep-E. Baños (UPF), Antoni Bulbena (UAB), Marta Torrens (UAB) and Mireia Valero (UPF)
1. Presentation of the course
Goals
•1. To provide the basic skills to allow effective and natural communication with patients.
•2. To learn how to face situations where communication is difficult during the visit.
•3. To recognise the needs of the patients during the diagnostic and therapeutic process.
•4. To acquire the knowledge that allows one to apply the main bioethical principles to one's professional relationship with the patients.
•5. To acquire sufficient knowledge to communicate effectively in a professional environment.
2. Competences to be achieved
1. Knowledge of the legal foundations to medical practice.
2. Knowledge of the nature of informed consent.
3. Learn how to uphold the confidentiality principle
4. Apply the personal professional values of excellence, altruism, sense of duty, responsibility, integrity and honesty when practising medicine.
5. Recognise the need to maintain professional competence.
6. Know how to practice one's profession respecting the independence of the patient, their beliefs and their culture.
7. Knowledge of aspects of communication with patients, family members and their social environment.
8. Knowledge of the features of a clinical relationship (interview, verbal communication, non-verbal communication and interference).
9. Learn how to give bad news, prognoses and therapeutic advice.
10. Knowledge of aspects of communication in public, in writing and orally, as scientific documents and/or professional reports.
3. Content
The programme takes place over 10 weeks during the third term, with 20 theory classes and 10 seminars.
Theory classes
Topic 1. Introduction to the theory of communication (I) S. Serrano (UB)
The importance of communicative competence.
Topic 2. Introduction to the theory of communication (I) S. Serrano (UB)
The importance of communicative competence.
Topic 3. The doctor-patient relationship in a historical context Josep-E. Baños (UPF) The understanding of illness in the ancient world: magical and religious origins. The scientific concept in Greek medicine. The healthcare model in the middle ages and changes associated with the birth of scientific medicine in the 19th century. Ethical implications of the doctor-patient relationship. The paternalistic model of the doctor-patient relationship. Recognising the right to information and the independence of the patient. The influence of the healthcare model on the doctor-patient relationship. Adult patients and the right to choose.
Topic 4. The basic elements of communication in a healthcare setting: the doctor's perspective (I). A. Bulbena (UAB)
Concept of communication. Types of communication: verbal, non-verbal and therapeutic communication. The emotional factors: empathy and antipathy. Most common communication-based conflicts. Communication difficulties as destructive elements in medicine. Importance of the personality of the doctor and the placebo effect.
Topic 5. The basic elements of communication in a healthcare setting: the doctor's perspective (II) Josep-E. Baños (UPF)
Types of communication according to healthcare situation. Differences between doctor's surgery care and hospital care. The shield concept in the doctor-patient relationship. The doctor-patient relationship as a preventive element in the judicial process.
Topic 6. Patient verbal communication B. Molinuevo (UAB)
Concept and components. Relationship between verbal and non-verbal communication.
Topic 7. Patient verbal communication B. Molinuevo (UAB)
Concept and components. Relationship between verbal and non-verbal communication. Facial expression of emotional states. Interpretation of non-verbal communication.
Topic 8. The clinical interview Mireia Valero (UPF)
General concepts and stages of the interview. The beginning of the visit. Personal factors of patients and doctors. The basic elements of the visit: patient case history, physical examination and therapeutic plan. The end of the visit. Identification of the main problems and solutions. Concept of a difficult patient: diagnosis and possible responses.
Topic 9. Stages of the interview (I) M. Valero (UPF)
Welcoming the patient. Definition and parts of the patient's case history. Personal and family history. Balance between the need for information and respect for the patient's privacy. How to efficiently ask the patient about sensitive topics. Sexual behaviour and unhealthy habits. Awareness of cultural differences in the concept of illness.
Topic 10. Stages of the interview (II) M. Valero (UPF)
Definition and components of the physical examination. Advice before beginning the examination. Potential problems in some parts of the body. Examining children. Awareness of cultural differences. Prevention of some of the most frequent problems.
Topic 11. Stages of the interview (III) M. Valero (UPF)
Information on the diagnostic procedure and its uncertainties. Concept of prognosis. Tailoring the information to the needs of the patient. How to give good and bad news. Awareness of the expectations and needs of the patient and family in terms of information.
Topic 12. Stages of the interview (IV) M. Valero (UPF)
Concept of the therapeutic plan. Choosing treatment and communicating with the patient. Explaining the therapeutic goal. Means to ensure correct therapeutic procedure and monitoring. Follow-up visits and supervision of therapeutic response. Clinical research and the doctor-patient commitment.
Topic 13. Handling bad news (I) M. Valero (UPF)
Bad news and creating the environment in which to give it. Acceptance: stages and features. Awareness of the expectations and needs of the patient and family in terms of information. What to say and what not to say at each moment: adapting to the requests of the patient.
Topic 14. Handling bad news (II). M. Valero (UPF)
Decisions concerning death. Palliative care and medical futility. Explaining withdrawal of treatment. Care in the final days of life. Pain: concept and stages. The doctor and supporting the family after bereavement.
Topic 15. Exploration of beliefs and resistances J. M. Garcés (HdM)
Importance of awareness of cultural elements in medical care. Main beliefs of the largest minorities in Catalonia. Doctors and patients in Latin-American, Maghrib, Chinese and Hindu cultures. The importance of cultural mediators.
Topic 16. The doctor-patient relationship with difficult patients: managing conflict M. Torrens (UAB)
Topic 17. The doctor-patient relationship with pediatric patients A. Mur (UAB)
Pediatric neurocognitive development in the doctor-patient relationship. How to better relate to children. Tailoring information and respecting independence.
Topic 18. The doctor-patient relationship with geriatric patients R. Miralles (UAB)
Neurocognitive and sensory impairment in geriatric patients. How to ensure that information and the therapeutic plan is understood. Communication strategies with geriatric patients. The importance of the family and carers.
Topic 19. The doctor-patient relationship as seen by the patient A. Jovell (UAB)
The feelings of patients on falling ill. Patient needs in the relationship with healthcare professionals. Main points of neglect in the medical care process. Some suggestions for improving patient care in their relationship with healthcare professionals.
Topic 20. Confidentiality. A. Rodríguez-Pazos (UAB)
Concept. Ethical and legal framework. Confidentiality with respect to medical documents: clinical history, medical report and prescriptions. Systems to ensure the doctor's confidentiality and responsibility. What can be said to whom. The relationship with the press, police and legal system.
Seminars
Seminar 1. Clinical interview: general features. M. Valero (UPF)
Seminar 2. Oncology and terminal illnesses. M. Valero (UPF)
Seminar 3. Motivational interview techniques (I). M. Astals (HdM)
Seminar 4. Motivational interview techniques (I). M. Astals (HdM)
Seminar 5. Importance of psychological aspects in healthcare. Blanqué (HdM)
Seminar 6. Clinical interviewing in special places. L. M. Martín (UAB)
Seminar 7. Multiculturalness (cultural competence). J. M. Garcés (HdM)
Seminar 8. The doctor-patient relationship and research. M. Torrens (UAB)
Seminar 9. Health literacy. C. Iniesta (UAB)
Seminar 10. Giving presentations in public. E. Guardiola (UPF)
4. Assessment
This has various parts:
• During the course, the seminars are assessed and this counts for 20% of the final mark. It is done via the submission of two documents (one half-way through the course programme and one at the end), where the student will summarise the points which he or she considers to be most important in terms of his/her future professional life. The two documents will be a maximum of one sheet of A4 each. The first will discuss the first five seminars and the second the last five. Appropriateness of the content will be valued. Lack of punctuality will have a negative impact on this mark, as will lack of attendance and participation in the discussions during the seminars. Attendance at seminars is obligatory.
• At the end of the course the students must deliver of an individual piece of work (maximum 3 sides of A4), which will carry 20% of the final mark. In this document the student will summarise, using the content and activities of the course as a basis, the type of doctor that they plan to be and the characteristics of the doctor-patient relationship that they wish to attain. They may include thoughts on the strategies to use to make it possible. Points will be given for the personal involvement of the student in their project, and mastering the content of the course.
• At the end of the course there will be a final assessment, which will count for 60% of the final mark. This test will consist of multiple choice questions (PEM) (20% of final mark) and short answer questions (40% of final mark).
5. Bibliography and teaching resources
5.1. Basic bibliography
• Borrell F. Entrevista Clínica: Manual de estrategias prácticas. Ediciones Sociedad Española de Medicina de Familia y Comunitaria, 2004.
• Laín Entralgo P. El médico y el enfermo. Madrid: Tricastela, 2003.
• Groopman J. ¿Me está escuchando, doctor? Un viaje por la mente de los médicos. Barcelona: RBA Libros SA, 2008.
• Winkler M. La enfermedad de Sachs. Madrid: Akal, 1999.
• Morlans M. Fer costat al malalt. Barcelona: Columna, 1994.
• Serrano S. El regal de la comunicació.15a. ed. Barcelona: Ara Llibres, 2007.
• Vilardell. Ser médico. El arte y el oficio de curar. Barcelona: Plataforma Editorial, 2009.
5.2. Additional bibliography
• Cassell EJ. The nature of suffering and the goals of medicine. Nova York: Oxford Univ Press, 1991.
• Claries X. El pacient té la paraula: la comunicació amb els professionals de la salut. Edicions Viguera, 2009.
• Coulehan JL & Block MR. The medical interview mastering skills for clinical practice. 5a ed. Filadèlfia: FA Davis Company, 2006.
• Jovell A. La confianza. Barcelona: Plataforma Editorial, 2008.
• Kübler-Ross E. La rueda de la vida. Barcelona: Ediciones B, 2000.
• Lown B. The lost art of healing. Nova York: Houghton Mifflin, 2000.
• Molinuevo B, de Pablo J. Pràcticum de Psicologia Mèdica (I). UAB, Servei de Publicacions. Departament de Psiquiatria i de Medicina Legal, Bellaterra, 2007.
• Othmer E, Othmer S. La entrevista clínica. Tomo I. Fundamentos. DSM-IV-TR. Barcelona: Masson, 2003.
• Sommers-Flanagan J, Sommers-Flanagan R. Clinical Interviewing. 4a. ed. Hoboken: John Wiley & Sons, 2009.
• Srabanek P. La muerte de la medicina con rostro humano. Madrid: Díaz de Santos, 1999.
•Van de Meersch M. Cuerpos y almas. Barcelona: Plaza y Janés, 1998.
6. Methodology
The course programme includes:
a) Lectures, where the theoretical content of the programme will be given, and at the same time thought and participation of the student will be developed. Material from the presentations will be distributed as well as occasional extra reading.
b) Seminars, in groups of 30 students. Various active methodologies will be used as well as presentation and debating of cases, role playing, films and other techniques. Attendance at seminars is obligatory.
7. Programme of activities