Communications Practical notes

• PH 3.8 - Communicate effectively with a patient on the proper use of

prescribed medication

• PH 5.1 - Communicate with the patient with empathy and ethics on all
aspects of drug used

• PH 5.2 - Communicate with the patient regarding optimal use of a) drug

therapy b) devices c) storage of medicines

• PH 5.3 – Motivate patients with chronic diseases to adhere to the

prescribed management by health care provider

• PH 5.4 – Explain to the patient the relationship between cost of treatment

and patient compliance

• PH 5.5 - Demonstrate an understanding of the caution in prescribing

drugs likely to produce dependence and recommend the line of
management.

• PH 5.6 - Demonstrate the ability to educate public & patients about the
various aspects of drug use including drug dependence and OTC drugs.

• PH 5.7 - Demonstrate an understanding of the legal and ethical aspects of

prescribing drugs.

‘Patient-centred care’ is recommended in any health care settings – To achieve

such care, effective communications is needed.

PRINCIPLES OF COMMMUNICATION:

1. Should result into motivation – patient to narrate his/her story and doctor
to listen

2. Provide patient an insight into his/her general condition if she is

considered an expert in his/her own right

3. Should be able to reveal the mental status of patient as well as physical

illness
4. Patient should get maximum benefit out of the doctor’s speciality by
getting a clear & relevant information

5. Should include emotional content

6. Should reciprocate each others performance

7. Should provide power & freedom to change to both parties

CHALLENGES IN COMMUNICATION:

• Breaking bad news

• Culture based

– Patient’s preference on how to address them

– Personal space & permission to do a physical examination

– Language, Body language, Eye contact, Appropriate touch

– Authority or responsibility regarding a patient’s health

• Communicating with children, parents & older patients, mentally

challenged patients

• Symptoms not yet explained in medicine

• Special patient conditions

– Low IQ/illiterate

– Sensory impairment

– Sexual or genito-urinary problem

– Substance abuse

– Life threatening illness / ICU admitted patients

– Explaining risky management, death & bereavement

– Electronic communications
 COMMON QUESTIONS RAISED BY PATIENT:

• Cause of illness/problem

• Investigation or test advised

• Diagnosis

• Treatment and medicines prescribed

• Life style modification

• Prognosis

• Prevention - for future of/for family members

COMMUNICATION ON DRUG USE:

• Whenever a drug is prescribed, patient should always be informed about

the following

– Diagnosis/disease the patient is suffering from

– Purpose of the prescribed drug (cure/control, symptomatic relief,

palliative, prophylaxis)

– Name of the drugs – main therapy and accompanying drugs

– Generic & brand name, expiry before they start any therapy

– How, when, how much, what interval & how long to take?

– Information about formulation & expiry

– What to do if missed dose and its consequence

– How to recognise ADR, interaction with food, alcohol and its

influence on operating heavy machinery AND what to do?

– Any special instruction

– Storage

– Encourage to ask question

 – If no queries, next follow-up date should be informed

METHODS OF USE OF A MEDICATION:

• It is easy to assume patient understand how to use medications.

Communicating effectively on the proper use of medications especially
the following is essential

– Metered dose inhaler

– Spacer

– Nebulizer

– Self-administered insulin

– Transdermal patch

STORAGE OF DRUGS:

Most medication has its storage condition label on it. Care must be taken to
communicate regarding storage about drugs especially those which need
specific temperature and storage conditions so as not to waste its effectiveness.

COMPLIANCE: Extent to which a patient follows instructions for medication –

adherence to take the drugs prescribed by the clinicians

• Factors affecting compliance

– Financial - poverty

– Lack of motivation

– Lack of information

– Unable to understand instructions

– Unpleasant side effects

– Forgetfulness
 – Complex regimen – polypharmacy and more frequency

– Multiple diseases

– Physician’s personality – poor patient doctor relationship,

communication, not satisfied with doctor

• Others

– Severity of disease

– Patient’s education

– Unstable family

– Elderly patient

– Psychiatric disease

– Rural areas

– Patient’s inappropriate health beliefs and life style – intelligent or

wilful non compliance

Methods to enhance compliance:

• Good – patient doctor relationship (communication)

• Give oral and written information

• Allow patient to ask questions and clarification

• Dispense in patient friendly package

• Associate the drug intake with routine activity wherever possible

• Use FDC

• Prescribe economical drugs

Give reminder using suitable technology

Evaluation of compliance:

• Physiological markers

– BP for anti-hypertensive therapy

 – Blood sugar for anti-diabetic therapy

• Therapeutic drug monitoring

• Asking patient to come with container of drug

Cost and price of treatment:

• Unlike other consumers, consumer of drugs are patients - who depend on

clinicians for their purchase.

• To provide the best care with minimum cost without compromising the
quality of treatment and maintaining quality of life

• Cost variation amongst different generic drugs

• Cost variation amongst various brands of a particular generic drug

• Ability to calculate and compare the cost of treatment of different

therapeutic modalities

VARIOUS ASPECTS OF DRUG USE

Drugs are used for the following purposes

1. Prevention/prophylaxis – vaccine, OCP

2. Therapeutic purposes
a. Curative - Antimicrobial in infection
b. Symptomatic relief – Arthritis
c. Control of disease – Insulin in Diabetes
d. Palliative – Cancer pain
3. Diagnostic
4. Miscellaneous – GA for surgery

Drug categories:

1. Prescription drugs
2. Non-prescription/Over the counter drugs
OTC (Over the counter drugs)

Drugs available without prescription are called over the counter drugs. They are
considered safe and thus can be used without prescription eg vitamins and
antacids.

Though it is conveniently available for self-medication, it also has the risk of

many adverse drug reactions and unwanted drug interactions.

Drug Dependence

Dependence is caused by changes in the body, as a result of constant exposure

to a drug.

The common prescription drugs that are likely to cause dependence:

1. Opioid drugs
2. CNS depressants – alprazolam
3. CNS stimulants – amphetamine
4. Steroids – Prednisolone
The physician plays an important role in prescribing such drugs in order to
avoid development of dependence.

In order to avoid dependence, the following cautions need to be communicated

at the time of prescription

1. Risk of dependence
2. Expected withdrawal symptoms
3. Management of dependence (If the needed)

General principles of management of drug dependence

1. Psychotherapy, rehabilitation and occupational therapy
2. Psychosocial intervention
3. Substitution of less addicting drugs eg. Buprenorphine for morphine
4. Gradual withdrawing of the substituted drug
5. Aversion therapy eg. Disulfiram for alcohol
6. Education of the patient
Legal and ethical aspects of prescribing drugs

Some important rights of the patients

1. To be adequately informed about the illness and best possible treatment
2. To be informed about the approximate expenses to be incurred.
3. Details of healthcare professionals directly involved – Dr, nurse etc
4. Maintain confidentiality
5. Involvement in decision making that affects patient’s healthcare

The Drugs and Cosmetics Act (1940) regulate the import, manufacture,
distribution and sale of drugs in India. The various categories of drugs have
been assigned a schedule (Schedule H, X etc). All prescribers must be aware of
the various drug schedule in India and make a prescription accordingly.