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Communication in Family Medicine
Transcript of Communication in Family Medicine
Faculty of Medicine and Health Sciences
Universitas Muhammadiyah Yogyakarta Family Physician Provides continuing, comprehensive care in a personalized manner to patients of all ages and to their families, regardless of the presence of disease or the nature of the presenting complaint.
(Rakel, 2007) The Specialty's foundation remains clinical, with the primary focus on the medical care of people who are ill. (Rakel, 2007) Five-star Doctor to being a Doctor who humanize another human being How to achieve that? It's a must are Bio Psycho Social Spiritual Cultural HUMAN me, you, and them When there are a doctor and a patient, and both are a complex creature; human being, then the only way to start achieving that is through a great communication. Consultation & Referral
(Goh et al, 2004) a situation when a patient seeks medical information, advice & treatment from a doctor. In general practice, the family physician is able to deal with some of the problems presented to him. For the remainder, he needs to refer his patient to a consultant or specialist to seek an expert opinion. Referral The referral is a situation when a family physician refers his patient for his expert opinion, treatment or both. The consultant specialist takes over the management of this referred patient and subsequently refers the patient back to the family physician after the treatment has been completed. Consultation GOOD Knowledge
Skill (esp. communication)
Attitude Seven steps/ tasks of Effective Consultation
(Pendleton,1980) Find out why the patient has come (reason for encounter/ RFE) and from there go on to take a history covering:
a. the nature and history of the problem.
b. the patient's ideas, concerns & expectations.
c. the effects of the problem on the patient & significant others Consider the other problems that the patient may have:
a. continuing problems
b. risk factors Choose with the patient as appropriate action for each problem. Achieve a shared understanding of the problems with the patient. Involve the patient in the management and encourage him to accept appropriate responsibility Use time and resources to good advantage. Establish or maintain a relationship with the patient that helps to achieve other tasks Understanding Why Does the Patient Come RFE & ICE Reason for encounter Ideas, concerns, expectations Physical complaints
Continuity of care/ continuing care
Prevention of disease
Accident & emergency
Problems of living
Need to legitimize sick role a patient-oriented comprehensive
diagnosis OMSK berisiko lanjut pada balita dengan kurangnya kepedulian keluarga Asma bronchiale tidak dalam serangan & hipertensi terkontrol pada kepala keluarga dg faktor risiko tempat tinggal & masalah psikososial Hipertensi pada istri sebagai pencari nafkah utama
keluarga yang berkaitan dengan stressor psikis Education vs. Counseling the process of receiving or giving systematic instruction. the provision of assistance and guidance in resolving personal, social, or psychological problems and difficulties, esp. by a professional Three Steps:
Exploration & understanding
Rational Discussion Techniques: CEA method (Bio-psycho-social problems)
BATHE technique (Bio-psycho-social problems)
Rogerian/Client-centered counseling (Psycho-social problems)
Intentional Family Counseling/ Marital Counseling (Problems between married couples/ any couples)
Lifestyle Modification Counseling (Unhealthy lifestyle behaviors) 1. Dioniso AR et al, 2003. Counseling Skills for Caring Physicians I: Models for One-on-One Counseling, University of Philippines Manila Department of Family & Community, Philippines
2. Dioniso AR et al, 2003. 15th Post-Graduate Course: Counseling Skills for Caring Physicians 2: Family Interventions in Family Practice, University of Philippines Manil, Department of Family & Community, Philippine Refferences BATHE & CEA
Method Session II The busy physician can help many patients by applying Stuart & Lieberman’s “15-minute hour” method primary care counseling
Using SOAP to BATHE [SOAP = Support-Objectivity-Acceptance-Present focus] Catharsis
Pengeluaran emosi/ perasaan pasien atas keadaan sakit yang dialaminya, dapat mengidentifikasi adanya kesalahpahaman pasien tentang keadaan sakitnya yang menyebabkan kecemasan (emotionally critical misperception). Education
Koreksi atas kesalahpahaman pasien tentang keadaan sakitnya dan edukasi tentang penyakitnya.
Tindakan untuk pengelolaan penyakit pasien.