Doctor-patient communication and information giving in an acute general hospital in Malta.

Abstract

Background: Communication is an important component of patient care. Providing patients with appropriate doctor-patient interactions while offering them complete information about their condition is important for patients' health, well-being and satisfaction. Improvements in doctor-patient communication can have beneficial effects on health outcomes. Objectives: This study aimed at exploring the quality of interactions between doctors and patients at an acute general hospital in Malta namely Mater Dei Hospital. The main focus being the doctor-patient communication and information given by doctors and how the patients perceived these interactions. Methods: Three cross-sectional sub-studies were performed using quantitative and qualitative research methods. Data for the first sub-study was collected through direct observations of 80 doctor-patient interactions for 36 consultants during ward round visits. This considered medical talk much like any other source for discourse analysis, with attention to the structure and functions of the medical interaction. Data for the second sub-study was collected through patient satisfaction questionnaire which included 251 participants representing 96.2% response rate. The patient satisfaction questionnaire considered important doctor characteristics elements towards patients' health outcomes, satisfaction, adherence to medication, lifestyle regimens, and communication skills between patient and doctor. Data for the third sub-study was collected through structured interviews with 10 ward managers. The author once again focused on doctor-patient communication issues with regard to interpersonal skills and confidentiality, facilitation and listening skills, medical and healthy living information, treatment and medicinal information, technical and empathy skills, written information, and consultation time. Qualitative content analysis was applied within the structure of the thematic guide and for the data that was emerged from the materials. Main findings: The collected data was analysed by means of SPSS Student Version 17.0. Results obtained from the direct observations on doctors indicated that some important aspects of positive interactions need to be improved during ward rounds. These included: inquiry on diet compliance, inquiry on risky habits, advice on healthy lifestyle, inquiry on

medicine compliance, inquiry on allergic reactions to medicines, and an explanation of medicine prescribed and its use by the patients. In the qualitative data (Structured interviews) it was argued that although doctors have very good interpersonal, technical, and empathy skills, they still need to focus on consultation privacy, encouraging the patients to ask questions, emphasising on patients' understanding of the provided information, inquiring about adverse events of medicines, and about risky habits like smoking and alcohol consumption. It was also revealed by ward managers that there exist low referrals to health educators or dietitians. Findings from the patient satisfaction questionnaire indicated that most of the patients were satisfied with the type of communication being offered to them by the doctors. However when analysing deeper the author recognised that the same communication needs match closely with those found with the previous two methods. These included: advice on healthy lifestyle, inquiry about diet, written information on patient's illness, importance on consent from patients, specifying possible side effects of prescribed treatment, information of what patient should do in case of adverse events, and inquiring from patient if help was needed at home following their discharge from hospital. Overall findings from all three methods used indicated satisfaction with doctor-patient communication and information giving. This was indicated by mean scores of > 3.5. However there were also indications that quality of communication between doctors and patients needs refining in certain areas like patient consent and involvement in decision making, medical and treatment information, written information and consultation times. Conclusion: Patient education needs to be improved and more tailored to patients' individual information, support needs and abilities. By exploring the required amount and content of information, treatment goals and expectations, doctors would be automatically directing patients to high patient involvement in self-care activities. This movement towards a more patient centred approach should ameliorate and strengthen our health care system. Recommendations are given to enhance recall of information in all patients; information giving needs to be more structured by summarising and repeating the most important, personally relevant information. Knowledge leaflets and written instructions can also be beneficial, as long as doctors use suitable language and the patient is competent to read them. To adapt to these specific information needs, communication training for doctors at all levels needs to be accentuated. Better doctor-patient communication may also be achieved through the involvement of multidisciplinary team approaches with emphasis on patient centred care.