Some characteristics of neurogical dieases and the communication skills课件

1、Some characteristics of neurogical dieases and the communication skillsPorf. Zhang Ru-Xu Department of Neurology, the Third Xiangya Hospital2013-05ContentsDoctor-Patient Communication Characteristics of neurological diseases Physical and mental characteristics of neurological patients, social factor

2、s Some doctor-patient dispute in neurological department and relative preventions Case analysis Underlying assumptionsCommunication is a basic clinical skillCommunication in medicine is a series of learned skills not a personality trait anyone can learn who wants toExperience can be a poor teacherKn

3、owledge of skills does not translate directly into performanceCommunication skills teaching or learning is differentUnderlying assumptions - continuedEssentials needed to learn skills, change behaviour:u systematic delineation and definition of skillsu observation of learners with patients (live or

4、on videotape)u well-intentioned, detailed, descriptive feedback (prferably with videotape)u practice and rehearsal of skillsu planned reiteration and deepening of skills (a helical, reiterative model)Underlying assumptions - continuedCategories of skillsContent skills what doctors do (substance, inf

5、ormation, differential diagnosis, knowledge)Process skills how they do it (ask, listen, set up explanation, build relationship)Perceptual skills what they are thinking and feeling (awareness of decision making, attitudes and emotions, distractions)Goals of medical communicationPromoting collaboratio

6、n and partnership (relationship-centred)Ensuring increased Accuracy Efficiency SupportivenessEnhancing patient and physician satisfactionImproving health outcomesApproaches to communicationShot-put approach: the well-conceived, well-delivered messageFrisbee approach: interaction, feedback, relations

7、hip, confirmation, common groundPrinciples that characterise effective communicationEnsures an interaction rather than a direct transmission processReduces unnecessary uncertaintyRequires planning and thinking in terms of outcomesDemonstrates dynamismFollows the helical model rather than a linear mo

8、delContentsDoctor-Patient Communication Characteristics of neurological diseases Physical and mental characteristics of neurological patients, social factors Some doctor-patient dispute in neurological department and relative preventions Case analysis Neurology Neurology is the medical specialty rel

9、ated to the human nervous system. The nervous system encompasses the brain, spinal cord, and peripheral nerves.Neurologist A specialist physician who treats patients suffering from neurological disease is called a neurologist. percussion hammertuning forkHigh morbidity, high mortalitylWith the popul

10、ation aging, the incidence of senile disease is gradually increased.lThe incidence of acute cerebral vascular disease (CVD) increased year by year. CVD became one of the three major life threatening diseases, ranking the second.lAcute CVD has not only high morbidity, but also high mortality.lThis al

11、ready cause social concern and personal attention.Acute onset, condition changes quickly, high rate of disability CVD is most common in neurological diseases.With abrupt onset, the changes of symptoms and signs ofen occurr in a short period of time.Despite active treatment, CVD still leaves patients

12、 with limb movement disablity. Some patients cant take care of themselves.The patients suffering from spinal cord disease, or severe peripheral neuropathy may also have residual neurologic deficiency, even disability.These diseases bring heavy burden to patients family and the whole society.Long dis

13、ease course, wiht repeated relapses or attackuSome diseases, such as multiple sclerosis and epilepsy, have long course, repeated relapses or attacks. Patients condition worsen gradually.uPatients bear not only the long-term illness, but also heavy psychological pressure and economic pressure. Slowly

14、 progressive disease, long-term medicationSome disease have chronic course and slow progress, such as Parkinsons disease, myasthenia gravis, et al.These patients need long-term medication, even lifelong medicationHaving internal medicine complicationsMost CVD patients are elderly people, suffering a

15、lso from high blood pressure, diabetes, heart disease, etc.Because of the existence of a variety of diseases, clinical diagnosis and treatment become more complicated and difficult.Take for exmaples:acute cerebral hemorrhage patients with serious heart disease, cardiac insufficiency; 1.CVD patients

16、having conscious disturbance, with diabetic hyperosmolar complicationsContentsDoctor-Patient Communication Characteristics of neurological diseases Physical and mental characteristics of neurological patients, social factors Some doctor-patient dispute in neurological department and relative prevent

17、ions Case analysis Because of the special nature, uncertianty of the treatment and prognosis of neurological diseases, patients and their family have doubts, anxiety and worry. They have some emotional and psychological changes. Fearp Some elderly, especially those suffering from hypertension, diabe

18、tes, heart disease, and high blood fat, high blood viscosity, often worry that they will suffer from CVDpSome CVD patients worry about disease recurrencepWhen they feel dizzy or limb numb, they will go to the hospital in a hurry, ask cranial CT scan to determine whether they already be caught by CVD

19、pIn the long course of time, they have psychological fear and pressure.pSome patient suffering form acute inflammatory demyelinating polyradiculoneuropathy, when the illness involving respiratory muscle paralysis, the patients have the fear that they will be suffocate to death and dare not sleep.Wha

20、t should we do?Proper mental comfort should be given to such patients to alleviate their fears.Health education.Anxiety and depression Some patients have limited limb movement, aphasia or dysarthria which leading to communication difficultiesThey worry they will be burden to their familiesThey are a

21、nxious, irritable or depressed, even unwilling to cooperate with their doctor to get active medical treatment.What should we do?The doctor should Have great patienceSpend more time to communicate with patients, Encourage patients to establish the confidence to overcome the diseaseLet patients believ

22、e illness can be curedConvince them that they can achieve good results when cooperate with doctors in medical treatment.Having social and psychological problemsRelapses and attacks These patients worry that they cannot go back to study or work if their disease progress. They feel frustrated, even co

23、ntemplate suicide when relapses or attacks happen.Difficulties in getting effective treatment.Chronic anxiety, depression, decreased immunity to patientsWhat should we do? In addition to treatment, doctors should communicate with patients, give psychological treatment timely. These patients should b

24、e regularly followed up after discharged. Doctors understand their condition changes timely, remove the inducments in time, and reduce the times of onset or relapse.Loneliness and personality changeBecause of the inconvenience in daily activity or unwilling to communicate with others, patients easil

25、y have mood changes, happy, sad, satisfied, disappointed.In the long-term result, they become emotional fragile, passive and dependent, self-centered, sensitive and suspicious.Some patients feel the good old days passed, friends is getting less. They feel lonely and sad.What should we do?Doctors and

26、 family members should have more contact with them, gain their trust, and encourage them to build confidence in themselves. Besides active treatment, doctors should give physical help and mental encouragement to obtain a good therapeutic effect.Family and community supprotSocial factorsPopulation ag

27、ingSenile disease CVD, Alzheimers disease, Pakinson disease et al. The changes in eating habits high fat, high cholesterol foodpremature atherosclerosis, and hyperlipidemia.-health educaton!ContentsDoctor-Patient Communication Characteristics of neurological diseases Physical and mental characterist

28、ics of neurological patients, social factors Some doctor-patient dispute in neurological department and relative preventions Case analysis Excessive medical expenseslCertain projects of the medical treatment charge too much, lCharge on projects which are not implenented yet.lCharge on drugs not used

29、lThese situations happen because of negligence during medical staffs busy worklThese will dissatisify patients and their family, and lead to dispute.PreventionsStrengthen medical personnel responsibility Establish the well-documented hospitalization expenses listRefund unreasonable fee that indeed e

30、xistExplain clearly to the patients and their families timely.Condition worsening in short period of timenThe condition may change quickly, especially in CVD patients.nIf the doctor didnot fully inform the risk to patients and their familiesnIf the doctor estimate wrongly, that illness is not seriou

31、s, not life-threateningnWhen the patient gets worse or even in critical ill, the family can not understand and accept the fact. These often result in disputesDoctor should fully estimate the possible risk in such patients and pay close attention to the condition changesDoctor should inform all the p

32、ossible risks to patients family timelyWhen the illness getting worse, doctor should take positive rescue treatment immediately.PreventionsUnreasonable inspection items or the wrong check list uSuch disputes occur in neurological outpatient department.uInspection item is not reasonable enough becaus

33、e doctors perform the physical examinations not so detailed when facing large amount of outpatients, or the patients condition is complex. uWritten mistakes also lead to wrong check list.Consulting roomThe doctor should treat every patient, every inspection items carefully, seriously. The doctor sho

34、uld strengthen their professional knowledge.PreventionsContentsDoctor-Patient Communication Characteristics of neurological diseases Physical and mental characteristics of neurological patients, social factors Some doctor-patient dispute in neurological department and relative preventions Case analy

35、sis SummaryYang X, female, 68 years old, history of diabetes for many years, from a common family.Complaint and ExamChief complaint of admission: weakness in right extremities with slurred speech for 1 day. physical examination: vital signs stable, sane, slurred speech, normal round pupils, pupillar

36、y reflexes +, right nasolabial fold shallow, deviating to right when protruding the tougue , muscle strength of right limbs grade IV, Babinski R+.Crainial CT scan: no clear lesion. Diagnosis: cerebral infarction, diabetesMedical treatment according to therapeutic schedule of cerebral infarction, blo

37、od glucose monitoring, and insulin treatment to regulate blood glucose levels. Process (1)The second day after admission, the patient became agitated, and paralysis of right limbs aggravated.Head MRI examination showed the left middle cerebral artery occlusion. Immediate antiedema medication impleme

38、nted, but the condition continue to get worse. Process (2)The patient became unconscious, with gastrointestinal hemorrhage. Doctor informed that the patient was in critically ill and implemented immediate rescue treatment . The patient died of respiratory and circulatory failure in the end.DisputeSince the patient walked into the ward when admitted to hospital, but became unconscious