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ABCD, arq. bras. cir. dig. vol.24 no.4 São Paulo Oct./Dec. 2011
25 years of ABCD surgeon-patient relationship in the past and present
Nelson Adami Andreollo; Ivan Cecconello; Cleber Dario Pinto Kruel; Osvaldo Malafaia
Editor's Note: The text in the figure below was reproduced from the original first article of ABCD - Dig Arq Bras Cir. 1986, 1 (1):1-2
PATIENT - SURGEON RELATIONSHIP: WHAT HAS CHANGED?
A lthough the previous text was written 25 years ago representing the first article of ABCD Brazilian Archives of Digestive Surgery, the concepts on it are still very current.
In recent years occurred important advances in medicine and gastrointestinal surgery, both in diagnostic techniques (CT, MRI, PET-scan, endoscopy and interventional imaging) and surgical procedures (laparoscopic surgery, robotic surgery and transplants of organs) that are differed from the past. There was also great progress in medical therapy with the discovery of new drugs. Currently the training of the surgeon is longer, requiring complete two years of residency in general surgery and then another two or three on the specialty. Considering all these aspects, medicine has become more burdensome to the patient. The number of medical schools has tripled in the country and increased the number of doctors looking for job in the same market.
Nowadays, patients have easier access to various aspects of their diseases and treatment methods, obtaining valuable information on the Internet. This new time allows patients to ask questions and discuss with the surgeon the best way to treat them.
Despite these advances, the surgeon-patient relationship remains indispensable to reach the ultimate goal of the human being, i.e., to have good care, best treatment and better opportunity to recover both physically and emotionally. Therein lies the binomial complex: heart and surgical art, that permits to provide high quality in most cases of health care.
Patient dissatisfaction - and many of their complaints - is due to the poor doctor-patient relationship. Although we are in a new century and these facts have been known for decades, doctors tend to underestimate their ability to communicate.
The surgeon-patient interaction is a complex process; lack of proper communication is potential pitfall, especially in understanding the goals of patients, care, outcomes and prognosis of neoplastic diseases, very common in digestive disorders. Surgeons good communications allow patients to participate in all discussions, and important questions for them are answered before surgery is done. Empathy is one of the most important ways of providing care and support, reducing feelings of insecurity, isolation and distress.
A good surgeon-patient relationship facilitates the understanding of medical information, and allows better identification of their needs, expectations and emotions regulation. They feel, through a good communication with the surgeon, satisfied with their care. Better information related to the diagnosis and its consequences, permit joining and agreeing to the suggested treatments and, at the same time, stimulates the need for follow-up. Collaborative good communication will provide dynamic and reciprocal relationship.
The ideal way is surgeon collaboration in diminishing anxiety of their patients, giving them the best care, avoid making decisions based on quick assessments without detailed understanding of the situation that the case requires, missing opportunities to offer and discuss treatment options, sharing responsibilities and exchanging balanced and safe information. Following this approach, the doctor must discuss treatment options - especially if surgical treatment is required -, and the care needs to have better outcome. The risk level, family involvement, the understanding of cost and benefit, maximizes adherence of the patient and ensures the best results.
Doctors are not born with communication skills, as they have different interests and backgrounds. It is necessary to practice a lot during medical school, residency and expertise acquired over years, understanding the patient feelings. Some experts argue that medical education must go beyond training skills only in medical practice. They found that communication skills tend to diminish with the advance of the students in medical field; over time doctors in training tend to lose their focus on the patient. In addition, difficulties, barriers and the need for longer time to their medical training - especially during the internship and residency -, suppress empathy, diverting their attention to the purely technical, diagnostic, therapeutic and surgical involvement. There are many barriers to good patient-surgeon communication, and the surgeon's responsibility is to jump over them, especially in regard to anxiety, fear of litigation and uncertainty.
Most complaints about surgeons are related to communication issues, not competence. Patients want surgeons who can expertly diagnose and treat their illnesses, as well as communicate with them effectively. Physicians with better communication and interpersonal skills are able to detect problems earlier and provide better support to their patients, leading to greater satisfaction, reducing costs and getting better treatment adherence. The joint decision between surgeons and patients to attain the agreed objectives and favorable results, can lead to better quality of life.
A good surgeon-patient communication can be an effective source of motivation, encouragement, confidence and important component of the health care. Also, a good relationship can increase job satisfaction by increasing self-confidence, with direct influence in the final evolution of the treatment.
In summary, only few things changed in 25 years of medical care, when man is focused; the needs of human race are the same as they were in the past and, certainly, will continue as they are in the far future.