00:00
In this lecture, we're going to talk about healthcare
team relationships and how they bear on ethical practice.
00:08
At the heart of clinical medicine
is the therapeutic relationship,
the relationship between the clinician and the
patient to try to achieve the patient's well-being;
to keep them healthy, if they're healthy; if
they're ill, to get them feeling healthy.
00:22
If it's pediatrics and we're dealing
with a child as the patient,
then it's also involving the parents, so
a tripartite therapeutic relationship.
00:32
At the core, at the heart of all
those relationships is trust.
00:36
So the mutual respect that each party shows to
each other is foundational to establishing trust
and making sure that the
relationship can work over time.
00:46
And as I said, the reason we go
into this therapeutic relationship
is to promote the patient's rights
as well as their best interest.
00:55
So we have both the legal duty to
do that as well as an ethical duty.
01:02
The standards and expectations
are sort of conferred by the law
and by our professional standards
that we're going to be confident,
that we get certification for
the work we do as clinicians
and that we adhere to appropriate
behavior and judgment,
which we talked about in the
professionalism lecture.
01:22
And always in this effort in
the therapeutic relationship,
we're trying to aim for patient
and family centered care,
putting them at the center
of the relationship.
01:33
It's also important to note that we as
clinicians are also in relationship.
01:38
So, we're getting something out
of this relationship as well.
01:42
It is more one side in terms of really being
focused on the patient, but the clinician,
you know, can feel very strong
bond with their patient.
01:51
And acknowledging that the relationship
is also important and maintaining it,
restoring it if it's, you know, get severed,
making sure that it works over time
is going to really aid in the therapy and
the therapeutic relationship for everybody.
02:12
Alright, so what are the qualities that you need to have as
a clinician to establish good relationship with patients?
First and foremost, you know,
is you have to be competent.
02:24
You have to have the knowledge, the technical
skills, the ability to problem solve.
02:28
You know, patient is coming
in with a particular problem,
you've got to be able to figure out what's causing
it and how you're going to take care of it.
02:38
As a clinician, you also need to bring
empathy and compassion to the relationship.
02:43
So, feeling what the patient is going through,
the suffering that they are experiencing
and being moved towards doing something
about that, trying to ease their suffering.
02:55
As I mentioned, you know, to establish
trust you need to be respectful.
03:00
So, it's demonstrating both in
your behavior, in your language,
in how you interact with not only the patient
but their family that you show respect.
03:14
It also requires, you know, to maintain this
relationship over time that you are diligent;
that you are committed to keeping
the relationship going good;
you're making sure that you're attending to the details so
you're not letting things, you know, slide by the wayside;
you're being responsive when the patient,
you know, has questions or concerns;
you're trying to figuring
them out for them.
03:39
There's a certain amount of resilience that's also
required to maintain a good relationship with patients.
03:45
So, we certainly seen that their clinician
well-being is important in this.
03:52
Not just achieving the
patient's well-being,
but making sure you're taking care of yourself
so that you can be there for your patient.
04:00
And lastly, you need to have
good interpersonal skills.
04:03
So, how do you establish
rapport with the patient?
How do you build up
rapport over time?
Can a patient feel comfortable,
you know, in coming to you,
talking to you about their concerns especially
about, you know, maybe difficult topics?
It requires good communication
skills, so being a good listener.
04:21
And also in how you speak,
that you are understandable,
that you are speaking at a language that the
patient can really figure out what's being said,
it's not just the medical jargon but really trying to make
it so the patient is getting a lot out of the relationship.
04:41
It also means that communication is
nonverbal and some would say that,
you know, 90% of
communication is non-verbal.
04:47
So, the body language that we demonstrate to a patient is a
means of communicating with them and building that rapport.
04:54
So, it's also important to just check yourself
and make sure that you're doing things
that are showing the patient
that you are interested,
that you are listening, you
are attentive to their needs.
05:06
So, one way to do that is establishing
eye contact with the patient.
05:09
Now, there are some cultural
norms about, you know,
how much eye contact you
should have with the patient
but trying to be at the same eye level, checking
in with them, you know, through eye contact.
05:20
Maybe you mix it up a little bit,
you know, and always stare at them
that might get a little
overwhelming for a patient.
05:27
Generally having a
relaxed posture.
05:28
So, some inviting posture that says, you
know, you want to hear from the patient.
05:36
You might learn, you know, communication skills
where you're trying to match body language.
05:41
So that's another way
of building rapport.
05:44
If you see the patient is in a particular posture, if
you assume the same posture, you know, or close to it
that matching is a way of showing that you're
trying to, you know, connect with the patient.
05:58
And even it's at a
subconscious level.
06:02
Your facial alertness
and animation.
06:04
So, varying your facial expressions in
relation to what the patient is saying
or how you are intonating, you
know, what you're saying.
06:12
All of that sort of shows that
you're invested in the relationship.
06:19
Any kind of encouraging
body posture.
06:21
So the head nods, the head
tilts, leaning forward,
all of these might facilitate this nonverbal
communication in connecting with the patient.
06:33
There have been studies
that showed that, you know,
physicians often interrupt patients
pretty early in a clinical encounter.
06:40
So, you know, trying to minimize that
and just use brief vocalizations
that encourage the patient
to do more talking.
06:48
So the uh hums or the ah has are ways to make sure that you're
getting them to do the talking that not just you talking.
06:57
As I mentioned, the intonation of your
voice or moderating your voice volume,
again trying to match, you know, the patient's
voice volume is a good way to build rapport.
07:12
And then as we're going to talk
about later in the lecture,
you know, there are also aspects of
physical contact that can be therapeutic.
07:20
So, a hand on the shoulder
for a patient that is,
you know, having an emotional reaction
to something they've learned,
you know, perhaps some bad news,
a new diagnosis or something.
07:33
That non-threatening physical contact
is a way of building rapport.
07:40
It's also important to point out that, you know,
you have to be aware of underinvolvement.
07:44
So, you know, we talked about a doctor's
bedside manner and how far that can go
to building trust and making patients feel
comfortable in the therapeutic relationship.
07:58
So, you know, if you're cold or
distant or more formal, you know,
don't seem easy going to get into a conversation
or build a relationship with the patient,
they might be a bit
dismayed about that.
08:13
Being dismissive of a patient.
08:15
So disregarding what they are saying
and just going with your own agenda.
08:20
Being distracted and that
becomes increasingly, you know,
harder as we have documentation
in electronic medical records,
you know, we see clinicians sort of focused
on the screen rather than on the patient.
08:34
So, that inattention to the patient and what they're
experiencing not being in the moment with them,
being distracted by other things or,
you know, looking at a mobile phone
or checking a page that you've gotten,
you know, about another patient.
08:50
All of those can you show sort of underinvolved and not
really invested in this patient that's in front of you.
08:57
So it's also important to make sure you're
paying attention to unwelcoming body language.
09:03
So the crossing the arms or crossing your legs
as a sign that you're sort of being defensive,
that you're not being receptive and open to what the patient
is saying, pointing an index finger at the patient.
09:15
It might be fine to point a finger at a
diagram that you're showing a patient,
but actually pointing a finger at
them may put them on the defensive.
09:23
And maybe avoiding eye
contact or staring.
09:26
You know, we talked about
that before where, you know,
if you're not really establishing good eye contact then
building rapport that way or staring them down or just,
you know, looking away and not even paying
attention then they may feel disconnected.
09:40
Showing signs of
nervousness on your part.
09:42
So, fidgeting, wringing your
hands, actually sweating,
you know the patient is going to start to think
well what's going on with this clinician,
why are they so nervous
about talking to me.
09:53
Any kind of frustrated
vocalization.
09:56
So the "th" sound when a patient
says something, they may feel like
"Why is the clinician doing that?" You know.
"Are they dismissive of what I'm saying?"