The communicative process in the medical-patient relationship
Summary
The objective of the article is to present the primary discoveries of hypothetical and experimental research on the correspondence in the specialized understanding relationship and its effect on the fulfillment of the patient and the adhesion to medicinal treatment, in the light of the logical writing of society. The monitoring of the bibliographic material in databases and libraries was completed. A total of 30 articles were advised. The incorporation criteria have been based on the topics that arise from previous research and as indicated by the established goal. Those with a non -exhaustive treatment on the subject and without a social methodology were rejected. The combination of all data related to the subject, which in different distributions were presented independently, is the main commitment of this research, whose fundamental purposes were: 1) In the relationship of tolerant specialist, the connection between nature is presented of the informative procedure. , client compliance and consistency with medications; 2) In the specialist: silent collaboration, persistent compliance and accession to treatment are multidimensional wonders, in which various issues influence; 3) There was a more serious danger of giving up treatment in welfare frameworks with incorporated consideration, extreme interest, little personal, postponements and less personalized consideration; and 4) The abnormal amounts of adhesion were related to correspondence models that think about the provisions, convictions, inclinations of patients and allow an exchange procedure with a more prominent understanding and empathy.
Keywords
Communicative process, medical-patient relationship, medical education, empathy
Summary
The Aim of the article is to present the Main Discoveries of Hypothetical and Experimental Research on Correspondence in the Specialized Underestanding Relationship and its Effect on Patient Complence and Adherence to Medical Treatment, In Light of The Logical Writing of Society. Follow-up of bibliographic material in databases and libraries was completed. A Total of 30 ARTICLES WAS RECOMMENDED. The incorporation criteria have been based on the problems that arise from the prior researc and as indicated by the establishment objective. Those with A Non-Exhaustive Treatment on The Subject and Without A Social Methodology Were Rejected. The Combination of All Data Related to the Subject, which in Different Distributions Were Presented Independently, Is The Main Commitment of This Research, fundamental Whoe. , Customer Compliance and Consistency with Medications; 2) In the Specialist: Silent Collaboration, Persistent Compliance and Adherence To Treatment Are multidimensional wonders, in which varyus issues influence; 3) There Was A More Serious Risk of Abandoning Treatment in Social Assistance Settings With Incorpoated Consideration, Extreme Interest, Little Staff, Postponements and Less Customized Consideration; and 4) The ABNORMAL AMOUTS OF ADHERENCE WER RELATED TO PATTERNS OF CORRESPOND.
Keywords
Communicative Process, Doctor-Patient Relationship, Medical Education, Empathy.
Introduction
The communicative act is the essential piece in the quiet relationship of the specialist and has been subject to different exams in the current decades. A large part of those works have concentrated on the impact (positive) of the correspondence in the restorative consistency and compliance with the client, in a paternalistic social status in which the specialist (the teacher) is decided by the options that concern the patient.
In recent times, social changes have gradually put the meaning of correspondence in the table, but this time it is essential for the patient’s self-government (one of the fundamental pillars of bioethics) and its right to data, in particular. A model of a progressively deliberative and participatory relationship, including well -being experts, not so much heroes but more educated and polite patients, while more and more fulfilled.
Despite the fact that this pattern and the discussion that some problems have created (informed consent, patient rights) are increasingly evident in the field of particular consideration, due to the most notable importance of options in general , we must not overlook. that most advisors are given in an essential consideration when, in addition, the correspondence of specialists is the best of innovations accessible in the symptomatic and corrective procedure.
In this specific situation, we trust that it is fascinating to complete this exam, whose main objectives are to examine the data provided by the family specialist in the interview, the data mentioned by the patient and his support in the basic leadership.
Methodology
The technique used was, according to the importance of the objective, the discussion of the bibliographic material created since the 90s in Latin America, the United States and Europe, taking as slogan in Spanish: ‘Correspondence between specialist and patient’, ‘Therapeutic relationship’. ‘- Understanding’, ‘Clinical Anamnesis’, ‘Silent Compliance’, ‘Sympathy’. The search was carried out through the advice of 30 articles. The criteria for consideration of the articles have been based on the development issues of the Journal of Communication and Health. Vol. . 4, pp. 19-34, 2014 22 COFRECES, OFMAN AND STEFANI of the Examination of the past substance and as indicated by the proposed goal. Articles with a non -exhaustive treatment were avoided in relation to the matter and that, meanwhile, did not have a social methodology on the subject. The incorporation of all data on the subject, which in different productions were presented independently, is the main commitment of this audit. They were used: Redalyc (Network of Scientific Journals of Latin America and the Caribbean, Spain), Medline (National Library of Medicine), Oxford Journals (Oxford University Press), CLACSO (America American Council of Social Sciences) and Pubmed (National Library of the National Library of US Medicine. UU.). This systematic review was completed from the reference arrangements of the works chosen with manual monitoring in libraries of instructive and open establishments, for example, the Faculty of Public Health and the Central Library of the Higher Polytechnic School of Chimborazo.
Results
To have the option to investigate and break down each of the points that intercede in the proposed objective, the bibliographic material chosen and subjectively evaluated was systematized in four topics: models of specialist – tolerant relationship; Relational skills of the specialist at the clinical meeting; compliance understanding; and adherence to therapeutic treatment.
In relation to the models of the medical-patient relationship, the definition of Pérez Cicili et al. They characterize it like this: ‘It is an expert relational relationship that is filled as a reason for the welfare of the Council. It is where there is an administration of great importance, since well -being is an outstanding among the most precious yearnings of the individual, and not as the restrictive relational connections, the most regular expert circumstance is the complete abandonment, without trying to establish correspondence with some Of the demonstrated perspectives (…) medical practice, from its starting points, has been firmly connected to relational correspondence and the improvement of clinical skills. Given its temperament as a social relationship, the silent relationship of the specialist supports the engraving of the social environment where ‘(2003) is created
Actually, the specialist-thole relationship has been considered as an outstanding among the most powerful factors in coherence with restorative proposals (Di Matteo et al., 1993, Froján and Rubio, 2005). Similarly, the importance of the correspondence procedure in this collaboration has been considered by a few creators, who indicate the current relationship between the nature of the open procedure, the fulfillment of the client and the consistency with the medications (Law, 1983; lassen, 1991 Barca et al., 2004).
According to the tolerant relationship models with the specialist and the level of adaptation, Rodríguez Silva (2006) states that there are several specialized understanding relationship models, but the most used by its reasonable importance is what builds three unique structures: the first one by The dynamic relationship on the margin (paternalistic model): is built, as a rule, with patients in a state of trance, or who are in a circumstance that does not allow them to establish a progressive participation relationship. At that point, the guided collaboration relationship (autonomous model where the patient chooses and the specialist has the position of advisor): it is established with patients who can participate in their discovery and treatment, as occurs in some intense and incessant diseases. And also for the common investment relationship (shared basic leadership model): not only think about the consistency with treatment. Also, control in exchange for circumstances, and moods identified with the reason and development of the disease.
On the other hand, Hernández Torres and his colleagues (2006) describe four correspondence models in the specialist: a quiet relationship that infers correspondence styles between both social actors: the first is the model of the three elements of the specialist: it includes the collection of data, react to patient’s feelings and instruct and impact patient behavior for better administration. At that point, the patient -centered clinical model: accepts that the patient’s experience moves more and more to digest levels, that the importance of infection should be understood by the patient and, in addition, proposes a mutual understanding of the specialist and the patient about regular basic concepts. Issues and its administration. The family systemic approach model for patient care: created from the point of view of family treatment and the hypothesis of the general frameworks. The family is seen as the most relevant environment that can affect well -being, disease and is vital to obtain great results. In addition, the specialist’s self-information model: part of the suspicion that from the learning that the specialist obtains from his own emotions, he can make his clinical experiences more and more competent.
Ruiz Moral (2003), referred to by Loriente (2009), adds to the transferred models the type of quiet relationship ‘specialist’ consumerist, portrayed by younger patients, with a higher educational level and who are more demanding and selfish. He assured, those who exercise more authority about the specialist.
With respect to the fact that there is a type of relationship superior to the other, Ruiz Moral (2003) argues that it cannot be expressed completely, but gives a position of importance to the relational skills of the specialist to receive a type of relationship according to the patient’s needs , which can have subtleties in its various stages, and consider its mental and social angles. In logical writing, some investigations give exact evidence in that way (D’Allo, 2006, Prados Castillejo et al., 2000). It emphasizes the undivided care of the specialist to achieve a progressively viable correspondence with its patients, as well as the dynamic cooperation of the patient that adds to the understanding of the data and to build their fulfillment and confidence in the specialist, resulting in positive for the consistency. and the adequacy of medicines (Balint, 1961; Mira and Rodríguez Marín, 2001).
The possibility of the expert patient, says Mira (2005), is related to the idea of self-sufficiency, grew from the beginning in 1977 as an option in contrast to medicinal paternalism. This issue had a minimum treatment and in recent decades its advantage increases. Also, workshops are being prepared for patients in perpetual disease administration. The well -being instruction has been demonstrating the viability of several organizations and the type of training in antihypertensive treatment and adhesion (Galarza et al., 2013, Danet et al., 2012).
In relation to the relational capabilities of the specialist at the clinical meeting. Canovaca Vega (2010) characterizes them as those specialized practices and instruments used by the specialist at the meeting, for the execution of proceedings. Mainly incorporates stories reinforcement systems (facial connection to eye, help, signal); Data procedures (representation, compound data, justification of treatment, supplement of visual material); and arrangement strategies (evaluation reaction, parentheses, double contract, deliberate task).
Moore and Gómez del Río (2007) confirm that the realization of any clinical meeting depends on the nature of the specialist: the understandable correspondence. The use of powerful relational skills tries to increase analytical accuracy, productivity regarding the fulfillment of the treatment and manufacture support for the patient, as indicated by Razavi (2000) and Stewart (1996), to which Vidal and Benito refer (2010 ).
Similarly, Moore et al. (2010) express that powerful correspondence is described by guaranteeing cooperation, instead of an immediate transmission or a direct data transmission. It decreases useless vulnerability, requires organization, shows dynamism and pursues a helical model (imparting is assembling meaning in cooperation) instead of directing (transmitting is deciphering data from a specific code).
The meaning of relational skills, as indicated and even the conjecture of the disease or the general state of solidity of the patient.
Be referred to the meeting time in the specialist tolerant correspondence. The duration of the conferences in essential consideration is identified with parts of the correspondence of tolerant specialists and, indirectly, with the style of the Restoration Meeting. The welfare framework forces times of increasingly short consideration. It is illustrated, according to Bellón (2001), that the shortest duration of the meetings is identified with a more prominent solution of the symptomatic drug; most prominent number of references; less possibilities that the patient ask questions or communicate her evaluations; Less data regarding the specialist of determinations and medicines; less preventive exhortation; More terrible realization of patients and specialists. and an expansion in the weakened counting visits. According to this creator, in general, the psychosocial approach waiting for 3 to 6 additional interview with.
On the other hand, Moore (2010) and Loriente (2009) point out that once the relational skills are properly taken care of, the main thing is the nature of the relationship established during the time that the remaining parts are at the meeting.
According to the particular skills that have the effect on the specialist – persistent correspondence. De la Rosa Legón (2010) and Van Der Hofstadt (2004) argue that to prevail with respect to convincing patients, the well -being group must have a strong logical learning and the expert must know their ability to open, which incorporates an inspiration Full of feelings. Circle (thought processes, purposes, desires and encounters of both social actors), where the subjectivity of experts and patients is a fundamental component. Remembering this, Alonso and Fuentes (2008) recommend that to achieve a decent communication environment, it is important to offer a satisfactory classification system, give reality, a delicate and moderate voice, a genuine look, undivided attention, restorative silences and reaffirmation. Space movements. This decreases pressure and nervousness, and a more prominent presentation of the substance.
In relation to tolerant compliance. As indicated by Carr and Hill (1992), the understanding of compliance depends on the distinction between their wishes and the vision of the administrations they have obtained. In this sense, emotional recognitions, united by the past desires of customers, organize the departure of the nature of the administration. In the field of well -being, compliance with the patient is distinguished with the quantity and nature of the data they obtain, in view of the correspondence of the well -being personnel with the patient as a compliance model.
Then, again, in view of the worldview of the contradiction (Linder-Pelz, 1982), compliance is characterized by being a multidimensional idea whose parts fluctuate as indicated by the type of arrangement referred to (intense medical consultation, Meeting of incessant patients, crisis, and so on.), more directly identified with the segment full of mood feelings towards the framework of well -being or any of its units (advice or experts) and that can be clarified by the non -affirmation of desires, where the distinction between desires and observations is The key component.
Some investigations showed that the focus parties of a primary care administration and that produce greater satisfaction in patients are those that allude to the relationship established with the specialist. They also found that it is advantageous to improve offices and hardware of well -being approaches, together with the opening to the administration; and that the correspondence style set in the patient has been decidedly related to compliance and the different consequences of the meeting (Varela Mallou, 2003, Ruiz Moral et al., 2011).
Finally, they attract attention that compliance with the patient with well -being administrations is an amazing idea, which is identified with an incredible variable of variables: way of life; past meetings; the time dedicated to discussion; The logical and specialized nature of the expert. the compassion seen by the patient; The wishes of the future and the qualities of the individual and society (Martín Alfonso, 2009, of Los Ríos and Ávila Rojas, 2004, Mira, 1998).
For adhesion to restorative treatment, the task ‘adherence to long -distance treatment: evidence of activity’, of the World Health Organization (Sabaté, 2004), considers corrective adhesion as the behavior of an individual, identified with the prescription , after a routine of eating or completing changes in the way of life, compared to the proposals agreed with a social security provider. Some creators agree to characterize this idea as a procedure in which patients participate effectively and a community association with experts is delivered to obtain a satisfactory result. Consequently, adhesion exceeds the dedicated and not involved insignificant consistency, which would little support the person’s duty to control his illness (Alfonso, Bayarre and Grau, 2008, Ingaramo et al., 2005). According to Varela (2010), its importance is given by repercussions from the clinical, monetary and psychosocial perspective; Despite its impact on the nature of consideration and the tolerant relationship with the specialist (Di Matteo, 2002).
According to Ortego Maté (2011), resistance or bad adhesion to well -being medications are related to a progression of negative results, which can be grouped into four main areas: the first is the expansion of hazards, sadness and mortality , and then the expansion of the probability of making mistakes in the finding and treatment, the development of the welfare cost and the improvement of the feelings of disappointment and the problems in the relationship established between the expert and the patient.
This makes it fundamental for well -being experts and establishments to receive procedures to prevent or reduce the lack of adhesion.
With respect to the reasons for the absence of adhesion to treatment, several creators agree that there are different elements that decide. They can be met in two meetings: the first about the factors obtained from the specialist, the patient, the type of persistent relationship established with the specialist; the second according to the factors that are derived from well -being (type of infection and gravity), of the complexity of treatment, of family, social, authoritarian and financial perspectives.
In this last perspective, having some kind of inclusion or social work decides a higher adhesion, which can be deciphered as another indicator, of the financial challenges facing a population meeting (Ingaramo, Vita and Bendersky, 2005).
As for the authorized factors, the recurrence of the agreements, the separation in terms of medical services assets, the absence of a specialist at the time the patient requires, or the changes of the specialist, transportation, can be Additional challenges for adherence to treatment. There was also a greater danger of surrender in the frames with concentrated consideration, where the problems identified with the Association of Medical Clinics of a more prominent and multifaceted nature were confirmed: intense interest, little personal, long pauses and less personalized consideration, between different points In view (Alfonso, Sairo and Bayarre, 2003, Ortiz and Ortiz, 2007, Ginarte Arias, 2001, Ingaramo, Vita and Bendersky, 2005, Alfonso, 2006, Arrossi et al., 2007).
Finally, it was observed that persistent compliance and correspondence with the group of human services are factors that can join adherence to treatment in patients with endless diseases (d’anello et al., Goldring et al., 2002; Di Matteo et al. , 1993; Di Matteo et al., 2000)
Conclusions
We must remember that at any point we are talking about the tolerant relationship with the specialist, we alluded to correspondence. The way individuals look at each other, how they are spoken and listened. Conclusion and the way it is landed. Concordance in the treatment to follow. The appearance, the word and the tranquility, as well as manual and instrumental research, are constitutive vertebrals of the specialist’s understanding relationship. The specialist and the patient are connected from a meeting and an organized discussion and with exact destinations. This discussion is the restorative meeting, which is described as basically specialized, since it seeks a particular objective: to obtain in a reasonable time the limit of the relevant data so that it is clear about the finding. At the moment when the specialist affirms the terminal idea of the infection, the new meeting is identified with perspectives related to the living conditions of the patient that lead him to confront his determination and predict better, as well as the feelings of concern identified with the treatment. Remember that the meeting between the specialist and the patient has an individual point of view. The specialist must be comprehensive and respond to what the patient communicates both verbally and not verbally. To appear in what is happening to them, in what they feel, it is a key piece of good correspondence that will decide the final destination of the relationship, and will join to make the human vital environment a useful and timely substrate to face what is To come.
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