PH 5.

1: COMMUNICATE WITH THE PATIENT WITH EMPATHY AND ETHICS

ON ALL ASPECTS OF DRUG USE

Objectives:

At the end of the session, a phase-II student must be able to

 describe empathy, correctly.

 describe ethical communication correctly.
 demonstrate empathy reasonably.
 enumerate various aspects of drug use, correctly
 explain various aspects of drug use in a layman's language, correctly.
 communicate with a volunteer with empathy and ethics on all aspects of drug use in his
language, correctly.
 communicate with a volunteer with empathy and ethics about precautions a patient
should observe while taking medicines, in his language, correctly.

There are two components of this competency. One is communication with empathy and
ethics and second is all aspects of drug use.

Communication: Communication is a two-way means of communicating information in the

form of thoughts, opinions, and ideas between two or more individuals with the purpose of
building an understanding. It involves sending and receiving messages through the verbal and
non-verbal methods.

Doctor Patient communication: doctor should be an active listener

 Diagnostic communication is the process of gathering information from a patient to

identify a medical condition. This type of communication typically involves asking
questions about the patient's symptoms, medical history, and lifestyle habits. The goal
of diagnostic communication is to obtain a complete and accurate understanding of
the patient's health so that a diagnosis can be made and appropriate treatment can be
recommended.
  Interventional communication—For Example, after giving an injection, if the
patient dies, then the patient party will think that it is the fault of the doctor. In such
instances, how should the doctor communicate with the patient party.

Communicating bedside, handling anti situations, management of Collision,

conspiracy, confusion

 Therapeutic communication is the process of creating a supportive and empathetic

environment that encourages patients to share their thoughts, feelings, and concerns.
This type of communication is used to build trust and rapport with patients, and to
help them cope with stress, anxiety, and other emotional challenges. The goal of
therapeutic communication is to improve the patient's quality of life and overall health
outcomes.

Main therapy—It is the primary treatment for a disease or condition. It is the

treatment that is intended to cure or control the disease or condition. For example,
surgery is the main therapy for many types of cancer.

Adjuvant therapy—Antibiotics are the main treatment for pulmonary infections in

people with CF. However, antibiotics alone may not be enough to clear the infection,
especially in people with severe CF. Adjuvant therapy is additional treatment that is
given along with antibiotics to help clear the infection. In the case of pulmonary
infections in people with CF, adjuvant therapy can include—Inhaled corticosteroids,
NSAIDs, Mucolytics etc.

Sympathy is a statement of emotional concern while empathy reflects emotional

understanding. Empathy has widespread applications, particularly in the field of medicine
where the success depends on effective patient-physician interactions.

Empathy

"Empathy is an emotional experience between an observer and a subject in which the

observer, based on visual and auditory signs, identifies and transiently experiences the
subject's emotional state". To be perceived as empathic, the observer must convey this
understanding to the subject. In the beginning, the observer must not only identify but also
understand the basis of the subject's feelings.
For example, a physician may encounter a patient who appears depressed, expresses feelings
of sadness, and informs the physician that a close relative has recently passed away. There are
three possibilities-

1. The physician recalls subconsciously a similar situation in which one of his close relatives
died.

2. He did not experience death in his family but understands the emotional response to death
in the patient's culture.

3. The physician has a dissimilar cultural background in which death is not associated with
grief but with joy and celebration of the deceased's life.

In the first two situations the physician may be able to respond empathically because he
understands and can relate to the patient's current grief. In third situation the physician may
feel confused because he does not understand the basis of the patient's sorrow. Thus, it may
be difficult for the physician to generate an empathic response without understanding the
nature and circumstances of the patient's emotional state.

Three stages of empathy:

Cognitive Empathy

The first stage of empathy is called cognitive empathy, which is the ability to understand the
thoughts, feelings, and motivations of another person. This can be done by observing their
nonverbal cues, such as facial expressions, body language, and tone of voice. It can also be
done by asking questions and seeking to understand their perspective.

Emotional Empathy

The second stage of empathy is called emotional empathy, which is the ability to feel the
same emotions as another person. This means being able to put yourself in their shoes and
experience their feelings as if they were your own. Emotional empathy is often described as
"feeling with" another person. It is also the most important stage of empathy, as it is what
allows us to truly connect with others and feel their pain and joy.

Compassionate Empathy

The third and final stage of empathy is called compassionate empathy, which is the desire to
help and support another person who is experiencing difficult emotions. This means being
willing to take action to make the other person feel better, even if it is difficult or challenging
for us.

Golden rule of Empathy—treat others as you would like to be treated yourself

Some basic facts about empathetic behaviour

The physician who understands each patient on a personal level stands a far better chance of
experiencing and conveying empathy and treating the patient and illness effectively.

It is also important that the physician possess sufficient communication skills to convey the
feeling he/she is experiencing to the patient. It is possible for a physician to be perceived as
non-empathic although he feels empathy but is unable to express it. Conversely, a physician
who may not actually feel empathy may still be able to generate an appropriate response
because he understands how he should respond in the situation and possesses excellent
communication skills.

Utility of empathy in clinical practice

Empathy is directly therapeutic by reducing anxiety in patients. There is increasing evidence

that, when choosing a physician, patients value affective concern as much as, if not more
than, technical competence. When a patient feels that a physician understands his condition
and apprehensions, he may feel more comfortable confiding in the physician. This process of
telling one's story can be therapeutic and may also help facilitate the healing process.

Empathy is also beneficial to physicians; it has been demonstrated that doctors who are more
attuned to the psychosocial needs of their patients are less likely to experience exhausted.

Teaching and Learning Empathy

When considering ways to develop the ability to be empathic, it is important to consider that
empathic responses result from the interaction between behavioural and emotional factors.
Thus, it is possible that increasing one's sensitivity to either of these factors will improve
one's capacity for empathic response. For example, enhancing observation skills should make
it easier to detect a patient's emotional state, while improving communication skills should
help a physician to convey his feelings to the patient.
The actual emotional process of empathy may be aided by-

1. Exercises such as self-reflective writing. This would help an observer to become more
aware about his own emotions.

2. Cultural education would give physicians a greater frame with which to understand and
relate to a patient.

3. Fake it to make it. Physicians who act empathically may be perceived by patients as being
genuinely empathic. Over a time, one learns to be genuinely empathic.

Barriers to empathy: Anxiety, language barrier, Physician not seeing patient’s emotional
needs, Tension between patient and physician
ETHICS

Ethics is defined as "moral principles that govern a person's behaviour or the conducting of
an activity". Ethics is a system of moral principles. Ethics provides us with a moral map, a
framework that we can use to find our way through difficult issues.

Four pillars of ethics:

1. Autonomy (giving patient the freedom to choose freely)

2. Beneficence (doing good)

3. Non-maleficence (to do no harm)

4. Justice (ensuring fairness)

Autonomy (right of self-government)

The right of patient to make decisions about their medical care without their health care
provider trying to influence the decision.

 Autonomy empowers patients to feel more in control and confident in their ability to
make educated health decisions.

• The treating physician is required to inform the patient of Details of the treatment
provided.

• Risk and benefits of the treatment provided.

• Alternative treatments.

• Individuals/patients right to accept or refuse any given treatment.

THE PATIENT’S AUTONOMY ALWAYS, ALWAYS SHOULD BE RESPECTED, EVEN IF IT IS

ABSOLUTELY CONTRARY-THE DECISION IS CONTRARY TO BEST MEDICAL ADVICE
AND WHAT THE PHYSICIAN WANTS. (JACK KEVORKIAN)

Beneficence (doing good)

• This refers to the tradition of acting always in the patient’s best interest to maximise
benefits and minimise harm.

• Choosing best/right treatment.

 • Welfare of the patient must be the top priority, that should be considered by the
physician.

Nonmaleficence (do no harm)

• This principle ensures that treatment or research ought not to produce harm.

• In unavoidable circumstances, minimize it.

Eg,. the use of morphine in the dying patient eases pain and suffering while hastening the
demise through suppression of the respiratory drive.

Physicians are obligated not prescribe medications they know to be harmful.

Violation of non-maleficence is the subject of medical malpractice litigation.

Justice (right to fair and equal treatment)

• The distribution of scarce health resources, and the decision of who gets what
treatment “fairness and equality”.

• For example, is it fair that two patients, otherwise similarly situated, are treated
disparately by the health care system because one is affluent and the other is poor?

• Between two otherwise similarly situated patients in need of a liver transplant, who
should receive the one organ that is available—the recovering alcoholic who has been
sober for one year or the patient dying of biliary atresia.
Ethical Communication

Ethical communication is fundamental to thoughtful decision-making and responsible

thinking. It is about developing and nurturing relationships and building communities within
and across contexts, cultures, channels, and media. Ethical communication is also accepting
responsibility for the messages we convey to others and the short-term or long-term
consequences of our communication. Whether we are talking to a patient or addressing a
gathering of students, our message must be truthful and consistent with our value system.
Misleading our listeners and delivering a message that is secret or not truthful is not ethical
communication.

Ethical communication extends to the medium and the language we choose for delivering our
message. Using a medium that limits the audience or delivering a message in a language that
our audience does not fully understand, limits how our message is received and perceived.

For example, if we are speaking to an audience of primarily deaf or hearing-impaired

persons, ethical communication requires having a sign-language interpreter.

Principles of Ethical Communication

Ethical communication should be honest and straightforward, it should never offend or

provoke listeners.

Ethical communication allows access to the resources and facts that helped to formulate the
message. For example, if we are sharing information about adverse effects of medicines, we
are to provide our audience with some pictures or clips of patients who suffered with these
adverse effects. Similarly, when we are taking of success of some medication, we should
provide the results of some clinical trials where the efficacy of regimen was proved.

Communicating in an ethical manner also requires making the message accessible. To deliver
a message that can be understood by a diverse audience requires engaging linguists or
translators who can assist us in making the message accessible to all. In addition to making
the message accessible and respecting the diversity of thought and perspective, ethical
communication means being considerate of basic human needs. Avoiding words and language
that are demeaning or intolerant and refraining from messages that hurt others is paramount
to ethical communication.

VARIOUS ASPECTS OF DRUG USE

There are various aspects of use of medicines which should be communicated to the patient.

The communication about certain precautions that a patient should observe while taking
medicines may proceed like this

No matter what type of medicine the doctor prescribes, it is always important to be safe and
follow some basic rules:

1) If you feel worse after taking a medicine, tell your doctor immediately.
2) Double-check that you have the right medicine. If you get the same prescription
dispensed more than once, check that it is the same shape, size and colour as the last time.
If not, be sure to ask the pharmacist about it.
3) Read the label and follow directions. Ask if you have questions.
4) Take medicines exactly as prescribed. If the instructions say take one tablet four times a
day, do not take two tablets twice a day. It is not the same. Ask if the medicine is likely to
affect everyday tasks such as driving or concentrating in school. Do not take more
medicine than is recommended. It will not make you heal faster or feel better quickly. In
fact, an overdose of medicine can make you sick.
5) Always follow your doctor's or pharmacist's instructions. For instance, he may tell you to
take a medicine with food to help lessen the stomach upset it can cause or to take the
medicine on an empty stomach so as not to interfere with the medicine's absorption into
the body.
6) Never share prescription medicine with anyone else, even if that person has the same
problem as you do. Today's medicines are very complex, and the dosages tend to be
precisely prescribed for each person's needs. Either under-dosing or over- dosing can be
harmful. Additionally, someone else's body may react differently to the same medicine
(for example, if the person has an allergy to one of the components of the medicine).
7) Always tell your doctor if you are taking any other medicines or any herbal supplements
so that he can check for any interactions between the medicines.
8) Be sure to tell your doctor if you are pregnant or likely to be pregnant. Some medicines
can be harmful to the baby. Also, let your doctor know if you are breastfeeding, as some
medications can cause problems with nursing.
9) Remember that drinking alcohol can dramatically worsen the side effects of many
medicines.
10) Even if you get sick with what you think is the same problem you suffered with in the
past, do not decide on your own that you know what is wrong and take some leftover
medicine. Taking that medicine for a different disease might not work, and it can even be
harmful. Talk to your doctor first.
11) Take antibiotics for the full length of the time prescribed, even if you start feeling better,
so that all the germs are killed and the infection does not bounce back.
12) Keep medicines in their original labelled containers.
13) Do not use expired medicines.
14) Medicines should not be stored in kitchen or bathroom because heat and humidity can
affect the potency of the drug. Most medicines should be kept at room temperature and
away from sunlight. Some must be refrigerated. Check with your pharmacist or doctor if
you are not sure.
15) Make sure all medicines are stored safely and out of the reach of children and pet
16) If you have any allergies, tell your doctor and pharmacist before they start you on a new
medicine.
17) If you get a rash, itching, vomiting, or difficulty in breathing after starting a medicine, tell
your doctor immediately. Breathing difficulty, breaking out in hives, or suddenly
developing swelling of the tongue, lips, face, or other body parts may be signs of a severe
allergic reaction; get emergency medical care immediately.
18) Taking medicines may feel like a tedious task sometimes. But medicines are the most
effective treatments available for many illnesses. If you ever have any questions about
what a medicine does or how you should take it, talk to your doctor or a pharmacist.