Communication Competences of Medical and Health Professionals

Anna Włoszczak-Szubzda Mirosław Jerzy Jarosz Communication competences of medical and health professionals Lublin 2015 University of Economics and Innovation in Lublin Series of Monograph and Treates: Monographs of the Faculty of Health Sciences WSEI Anna Włoszczak-Szubzda, Mirosław Jerzy Jarosz Communication competences of medical and health professionals Reviewers: prof. Bożydar Kaczmarek prof. Rosemary Sage © Copyright by Innovatio Press Wydawnictwo Naukowe Wyższej Szkoły Ekonomii i Innowacji w Lublinie All rights reserved. No part of this publication may be reproduced in any form or by any means without prior permission from the publisher. Production editors and cover designers: Marek Szczodrak, Anna Konieczna Printed in Poland Innovatio Press Wydawnictwo Naukowe Wyższej Szkoły Ekonomii i Innowacji 20-209 Lublin, ul. Projektowa 4 tel.: + 48 81 749 17 77, fax: + 48 81 749 32 13 www.wsei.lublin.pl ISBN 978-83-64527-30-2 Table of contents 1. Theoretical perspective .............................................5 1.1. Philosophical and psychological sources of communication with patient .......5 1.2. Paradigms of medicine and way of perceiving a patient .....................14 1.3 Theories in medical ethics and place of the patient in relation to medical professional ..........................................................24 1.4. Ethics of care as a foundation of relationships between medical professional and patient ...........................................................32 2. Motivation, knowledge and skills – communication competences .......37 3. Interpersonal communication and quality care .......................45 4. Current issues and discussions about communication between professionals and patients .................................................50 4.1. Overview .............................................................50 4.2. Physicians ............................................................56 4.3. Nurses ...............................................................58 4.4. Paramedics ...........................................................60 4.5. Physiotherapists .......................................................63 5. Theoretical background of research .................................67 6. Research .........................................................70 6.1. Study design ..........................................................70 6.2. Methods ..............................................................70 6.3. Data analysis ..........................................................74 6.4. Participants ...........................................................74 7. Results ..........................................................81 7.1. Analysis of documentation ..............................................81 7.1.1. Physicians .............................................................. 81 7.1.2. Nurses ................................................................. 82 7.1.3. Paramedics ............................................................. 82 7.1.4. Physiotherapists ......................................................... 83 7.2. Diagnostic survey ......................................................83 7.2.1. Physicians .............................................................. 83 7.2.2. Nurses ................................................................. 87 7.2.3. Paramedics ............................................................. 90 7.2.4. Physiotherapists ......................................................... 94 7.3. Professional self-evaluation .............................................98 7.3.1. Physicians .............................................................. 98 7.3.2. Nurses ................................................................. 99 7.3.3. Paramedics ............................................................100 7.3.4. Physiotherapists ........................................................101 8. Discussion ......................................................103 8.1. Introduction .........................................................103 8.2. Physicians ...........................................................105 8.3. Nurses ..............................................................108 4 Communication competences of medical and health professionals 8.4. Paramedics ..........................................................111 8.5. Physiotherapists ......................................................112 9. Conclusions and limitations ......................................115 10. Abstract .......................................................117 11. References .....................................................119 Name index .......................................................133 Subject index .....................................................135 1. Theoretical perspective 1.1. Philosophical and psychological sources of communication with patient Communication with patients considered on the plane of medical sciences or other exact sciences has its deepest source in human philosophy, and within this philosophy, in the philosophy of dialogue. Martin Buber is the classical author of philosophy of dialogue, therefore, the theoretical perspective should originate from the presentation of his conceptualization of dialogue (later communication), concepts and persons of a specific drama which takes place in subject-to-subject communication . The term Grundwort’,‘ i.e. a fundamental word coming ‘from the bottom of the soul’ is among the central categories of Martin Buber’s philosophy1, 2 . Buber claims that the word comes from God. This divinity is expressed mainly in the feeling of love contained in words. Despite common thought, not intellectu- als, or according to other approach, deeply religious but primitive peoples can use the word with dignity. In contemporary times, words, according to Buber, have lost their past sense, because they were deprived of love and became just empty sounds. It was long forgotten that in the past they were ‘images of emotions’. In primitive cultures, objects do not obscure the real presence of man. Buber rightly contends that this fundamental instrument of dialogue should return to its origi- nal state 3, 4 . The following categories are the relationships and , and < inter-human sphere >. The relationships and are additional- ly specified as < Person > and < Individuum >, and the whole is comprised within < the life of dialogue >. In all relations of the , the < Word > is a type of a research method applied by the subject with respect to any being. When wants to cognize the surrounding reality, directs the questions exclusively to objects and, in such a kind of cognition, even < Thou > is approached instrumentally. In this conceptualization, things and man are considered in their externality. According to Buber, such cognition provides knowledge of individual qualities of reality, and 1 Buber M. Ja i Ty. Wybór pism filozoficznych. Instytut Wydawnictwa PAX, Warszawa 1990, 43, 47, 59. 2 Buber M. Opowieści rabbiego Nachmana. Paryż 1983, 16–18. 3 Buczyńska-Garewicz H. Martin Buber i dylematy subiektywności. Znak, Kraków 1980, 7. 4 Buber M. Między osobą a osobą. Społeczne i międzyludzkie. [in:] Ja i Ty. Wybór pism filozoficznych, PAX, Warszawa 1992, 138–139. 6 Communication competences of medical and health professionals simultaneously does not provide the image of the being as a unity. Objects are cognizable only by the differences which we notice between them5 . Cognition, for which a man should strive, should be of an overall character. Only such cognition is considered important by Buber. Partial, aspect-oriented cognition may give a false result while composing individual qualities 6. In order to change the relationship into , one should maintain a passive attitude in scientific understanding, no concepts, experiments or schemes reach the whole. To the question ‘What, therefore, do we know about < Thou >?’ Buber answers: all or nothing, because nothing partial is known about < Thou> 7. There are three spheres through which we can recreate the world in ourselves: 1. Living in accord with nature – we have such a reflection of the world as ani- mals do without awareness, why is it so?’ 2. Living with others – we acquire the reflection of the world and education by communicating with other people, 3. Living with God – in this case we obtain the image of the world as a reflection of Heaven, not reaching consciously, neither our instrumentality nor other instrumentalities 8. Each of the above-mentioned relationships takes place in a different time. The fulfilment of the < I-Thou > relationship happens only in the present time, while the present time is neither a point nor a seeming clock-stopping. Buber calls this phenomenon a ‘complete presence in the moment’. If the subject faces many contents, and not only an individual < Thou >, the relationship takes place in the past, and is not of an instrumental character 9. Therelationships between subjects are explained by Buber in terms expressing emotions. Very different emotions may accompany man when a person encoun- ters another person 10. According to Buber, each subject possesses predispositions for love, however, the emotion itself develops only during the dialogue. Love plays a very important role in the relationship. If we take responsibility for another human being (which results from the definition of love) we make

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