HCAS143 Human Disease and Drug Pharmacology

Language of Caring

Building a sustainable career in the 21^st century workforce, regardless of position or field, requires adults to develop a broad set of knowledge, skills, and competencies. This includes academic, technical and professional knowledge as well as the ability to deal with challenges, cultivate relations and navigate social systems in the world of work. These essential abilities include: thinking abilities, relational learning, information literacy, communication, quantitative reasoning, and career management within a global society. These abilities are interwoven to the Bryant & Stratton College experience and are known as Institutional Outcomes.

The following activity features essential interpersonal and communication skills required in healthcare, and the impact shared information has on patient understanding and safety.

This activity relates to the following outcomes:

• Course Outcome
  • Summarize the importance of consumer safety and drug regulations on prescription medications.
• Institutional Outcome
  • Community & Career - Participate in social, academic and professional communities for individual growth and to function as a citizen of a multicultural world.

Introduction

Wendy Leebov, Ed. D., Partner & Founder of the Language of Caring, has spent decades helping healthcare organizations create exceptional experiences for patients and their families.

As an internationally-renowned authority, Leebov and her team created the Language of Caring for Staff® approach which addressed Wendy’s most compelling research finding: In the face of job complexity, stress, and pressure, most employees and physicians communicate primarily in a task-oriented way. Her observations revealed scant behavioral evidence that they care about their patients as individuals. Wendy concluded, while we consider it a given that healthcare employees by nature are very caring people, unless they communicate their caring, the people they serve don’t feel it.

The program is designed for all employees, not only direct caregivers. It helps people develop the skills for personalized, two-way communication—skills for responding effectively when the patient or family has questions, concerns, anxieties and fears that require effective, spontaneous, think-on-your-feet communication — communication that you cannot script.

(Source: https://www.languageofcaring.com/resource/language...)

View the following presentation which explains the Heart-Head-Heart communication model, central to the Language of Caring approach here:

https://www.languageofcaring.com/programs/language...

Caring and communicating caring are two different things. As mentioned in the preceding video, people in healthcare are caring people who intend to be caring in their work. Yet these days, job demands and pressures cause people to be so task-oriented that they don’t make their caring felt. When employees don’t express their caring, when they don’t make their caring visible, it’s as good as absent from the experience of patients and families.

(Source: https://www.languageofcaring.com/programs/language...)

As health care providers, we must make the conscious decision to act in specific ways that demonstrate our caring to patients and their families every day.

Activity Instructions

Following is a scenario depicting a very typical visit to a medical provider. Watch carefully and observe the interactions between patient and clinician. Be prepared to answer the questions below so you can complete the activity that follows.

How might the patient view the encounter…do you think she felt rushed or was the service efficient?

Identify the phrases or actions that suggested to the patient that the physician was indifferent about their interactions.

How well did the physician employ the Heart-Head-Heart model?

Identify the message or actions that suggest sincere empathy on the part of the physician toward the patient.

Was there anything that the physician did that would have annoyed you?

Communication Role Play –

“Yesterday I had a most unimpressive doctor visit that left me feeling somewhat unsatisfied. I have had bicep tendonitis for the last two months. This is an extremely uncomfortable condition that constantly reminds me how much movement and involvement the shoulder has in every-day activities!

I am spoiled by the compassion and focus my primary physician Dr. J. provides to me. The doctor spends more time to help patients with their health not just their diseases. During my recent annual exam, I discussed my shoulder condition and informed Dr. J. that I was seeing a massage therapist and physical therapist every week.The doctor agreed with the physical therapist’s course of treatment.Although I am gaining increased range of motion, the pain seems to be getting worse. So, I called for an appointment and was unable to see Dr. J, but I was able to see Dr. X at the practice.

Scenario starts with the introduction, physician standing over patient in a chair.

•Doctor: “Hi, I am Dr. X, what brings you in today?”

•Patient: “Hi, nice to meet you. I’m here because my shoulder tendonitis is becoming more painful.”

•Doctor: “Now, when you say ‘shoulder tendonitis’ did you use Google for a self-diagnosis or has a physician defined this condition? (Physician is leaning back against the wall, arms crossed, glancing down at the patient with a questionable look).

•Patient: “Dr. J. and I spoke about it when I was in for an appointment a couple of weeks back. I am also working with a physical therapist as well as having massages for the compensating muscle tightness.”

•Doctor: “Are you seeing our physical therapist here, or someone else?”

•Patient: “I am going to Momentum Physical Therapy and seeing Mike. He is amazing. He originally ran me through a series of diagnostic tests to rule out a rotator cuff tear and determined that it was likely a bursitis that turned into tendonitis. He has treated me with dry needling, ultra-sound, passive range of motion within an exercise program. I’ve seen him four times and had three massages.”

•Doctor: “Oh, well that is good. The exercises are important to maintain and will rebuild strength. However, most patients don’t really do them. (Dr. looks at patient with a look of serious doubt). What has worked for you to alleviate the pain thus far?”

•Patient: “Well, I do think the exercises really help, as it feels better when it’s warmed up and been moved around. I have been taking over-the-counter Ibuprofen and the prescribed Naproxen.The medications were working well for the pain, but I started getting headaches, upset stomach and bloody-noses so I stopped taking the ibuprofen and increased the Naproxen.

•Doctor: Looking at the patient with a puzzled look… “How many milligrams of each were you taking in a day? And did you take the medication with food?

Patient:Maybe 400 milligrams of each, after I eat, three times a day.

Doctor: How often were the bloody noses?

Patient: These occur at night, I can usually predict the nose-bleed when my face is flushed and I am light headed.

Doctor: “OK, it sounds like you are experiencing NSAID Toxicity. If you read the contraindications on the prescription pages you would know that this is serious.” (said by Dr.X in a condescending tone).

Patient:What should I do now?

Doctor: “I am writing scripts for Norflex, a muscle relaxant and Daypro an anti-inflammatory medication. Please read this information and follow the instructions (accordion fold out of many pages).This should give you relief with fewer side effects.” Come back and see me if your condition doesn’t improve. I will also bring brief Dr. J.(Physician hurriedly escorts patient out the door glancing at a watch.)

Patient’s thought bubble

The entire time we were talking, I was hoping Dr. X would relate to me as a person, acknowledge my pain and feelings, and recognize that I have done my best during months of intense pain.

Assessment Overview:

There is not one thing Dr. X. did that was “bad”. Instead, the experience was filled with missed opportunities to make the patient feel cared about as an individual, knowledgeable about her needs and body and fully informed about the treatment and medications planned to support her recovery.

Part one – Building Communication Skills

Consider the behaviors of Dr. X during the appointment, and the patient’s reactions. After viewing the scenario, answer the following questions.

How might the patient view the encounter…do you think she felt rushed or was the service efficient? Explain your rationale for your response.

Identify the phrases or actions that suggested to the patient that the physician was indifferent about their interactions.

How well did the physician employ the Heart-Head-Heart model?

Did the physician empathize with the patient? If yes, identify the message or actions that suggest sincere empathy. If no, which communications led to your conclusion?

Was there anything that the physician did that would have annoyed you?

Part two – Cultural Competence

The understanding of diverse attitudes, beliefs, behaviors, practices and communication patterns is crucial in providing culturally appropriate health care. Medical professionals must acquire knowledge of these for their patients if they hope to be culturally sensitive. In today’s multicultural world, health care workers in all roles are exposed to vast differences among their clientele from ethnicity and religion to gender and sexual orientation, to historical and social factors like addiction and homelessness.Providers must educate themselves and be sensitive to these factors as they impact their ability to communicate effectively and offer appropriate care. Providing high quality care involves both being culturally aware to develop an appreciation of other cultures and to avoid potential prejudice, bias, and misunderstandings as well as to demonstrate empathy towards patients and truly listen to their questions and concerns.

Watch the following videos and answer the questions that follow.

What is Cultural Competency in Healthcare.

Think Cultural Health Case Study: Cultural and Religious Beliefs

Questions:

Considering your career goals, provide your interpretation of what was being represented in these two videos and how it will relate to you as a professional in the healthcare field.

Discuss the ideas of cultural bias and how your beliefs/prejudices may influence your interactions with others.

Present ideas as to ways that you can become more cultural sensitive and aware of others to ensure your ability to interact in our multicultural world.

Part three – Consumer safety and medication

Creating an environment of safety for patients is of major concern for every clinical service provider. Communication challenges are often at the center of potential error and misunderstanding. In the previous scenario between Dr. X and her patient, the way the doctor handled the discussion about the patient’s current medications and the prescribing of new medications was poorly handled and could leave the patient at risk.

Revisit the scenario once again, and answer the questions below:

1.The patient has been taking prescription Naproxen, to which she added over-the-counter Ibuprofen, trying for more relief. This combination is dangerous, as the two medicines serve the same purpose and as a result, she has been experiencing side effects due to overuse. How might the physician’s response to the patient’s comments about the NSAID’s have been improved to assure that the patient did not repeat the same behavior in the future?

2.The patient was given two alternative prescriptions. For what reason were these medications offered? Was the role these both serve in her treatment made clear to the patient? How do you know?

3.What might be the safety risks to the patient of sending her out of the office with only a pamphlet for the newly-prescribed drugs? What might have been a more effective way to handle this?

As healthcare providers, we have an opportunity to make each moment with our patients and family members meaningful to them far beyond basic medical care and services.Challenge yourself to think about small behavioral changes and enhanced communication skills that might make a different to others, and help you affirm your reason for a career in healthcare.

Resources:

Prescription Drug information - WebMD

https://www.webmd.com/drugs/2/drug-6746/daypro-ora...DayproAnti- inflammatory

https://www.webmd.com/drugs/2/drug-6933/norflex-or...Norflex muscle relaxant