A Family Doctor's Tale - ART OF COMMUNICATION IN FAMILY PRACTICE

THE ART OF COMMUNICATION IN A FAMILY PRACTICE

"Courtesy begets courtesy"

In order to treat and diagnose a patient it is important to communicate with the patient well.

Treat every patient with the respect you would want them to show to you.

When it is their turn to enter the consultation room, call them by their name rather than by a number.

This is a person that you are dealing with you, not a case. 
If you are free open the door for them to enter the consultation room.


When they are comfortably seated ask them 
" How can I help you?" or 
"What can I do for you?" rather than 
"What are your complaints?" or 
"What is wrong with you?". 

Always put them at ease. 
Talk to them as equals and never talk down to them. 
Always make the patient feel they are important to you.


You must be able to listen attentively to the patient's every complaint and make sure that every complaint is addressed in your treatment. 

In 90% of the patients, the history provides the diagnosis even before the physical examination is done.

If you can try to talk directly to the patient in his own Chinese dialect, Malay and English rather than through an interpreter, know a bit of his culture and diet, you will be able to get more information out of the patient to form a diagnosis and treat according to their complaints. 

Each complaint should be written down so that you do not forget to treat it.

Other information can be elicited by a series of questions so that most of the usual complaints are covered.

Always ask if there is any else that the patient may have forgotten to add to the history.

In children usually the mother or grandmother will be around to help in providing a history.

In the case of the deaf or hearing handicapped, try to write out the questions if he is able to understand written instructions and allowed him to answer back either verbally or in written form. 

I had a patient who is deaf together with his wife. However he is able to communicate through his son.

 In the case of the blind if he is able to talk, getting a history is of course no problem except maybe for description of color of his stools or things which they cannot see. Otherwise getting a history from a blind person is easier than from the deaf. 

The only problem is that you may need to guide him in and out of the clinic without knocking into chairs or other people.

For foreigners such as Thai and Japanese a few choice word like pain and gestures will help in communication. Of course if they have a friend who can communicate in English it will definitely be easier to get a history.

With a good history, the physical examination can be restricted to the main complaints. 

For example in a fall you will want to know whether the patient is able to walk after his fall, any disability, abrasions, cuts, swellings, or blackouts. Any symptoms of head injury such as loss of consciousness, nausea, vomiting, or blurring of vision or symptoms of brain injury.

Every effort should be spent on explaining why you are asking the questions and what physical signs you are looking out for.

Treatment is then based on the illness diagnosed as well as symptomatic treatment for all the complaints.

The culture and religion of the patient is important when treating the patient. In the Taoist the seventh lunar month is the hungry ghost month and many patients are worried that their illness may become worse during this time or the ghost relative may want to take their spirit away. You have to reassure them that the medicines will help them rather than make them more sick. Then there is the Chinese new year where all sort of goodies are eaten and there is a lot of visiting so the chance of getting infectious disease is higher.
For the Muslims the month of fasting means they can only eat before sunrise and after sunset. Some Muslims also do not allow injection during this period. The medicines sometimes have to be adjusted to two times a day (after sunset and before sunrise) instead of three or four times a day.
Some Indian women who may want to visit temples may request for stoppage of their menstruation during their visits to the temple
as the menses are considered contamination of their temple visits.

The rationale of the medicines given and the side effects to be expected must be also explained as well as preventive measures to be done by the patient himself (eg drinking more warm water, avoiding certain foods, doing certain exercises and living a healthy lifestyle.)