Communicating compassion in the global treatment of rheumatological   pain.

Communicating compassion in the global treatment of rheumatological pain.

Posté le décembre 22, 2014 par Ressources Soins Aînés Québec en Bénévolat, Blog - English, Centre de Vie Assistée, Éducation, Éducation aux Aidants, Gestion des soins gériatriques, Ressources communautaires, Site pour Soins Palliatifs

Special Thank’s  for sharing  this article to ,
Monique Camerlain MD, FRCPC, Geneviève Myhal PhD.
Clinique Médicale Belvédere, Sherbrooke Québec.

Cultural diversity and the age of the social media have confirmed what physicians already perceived: there is no single right way to communicate with a patient. As within management and the silver economy, the concept of value delivered to consumers is coming to the forefront within healthcare and it modifies the requirements of practice especially in the treatment of the aging population.  Value in health care is based on service, and value is now an experience co-created with one patient at a time. Consumer advocacy has also created an evolution from the top-down, paternalistic doctor-centered approach to a horizontal, patient-centric approach based on two-way communication and shared decision-making.

It has been stated that the experience of pain is an overwhelming whole-person experience.  Through the use of compassionate, evidence based-medicine and motivational communication, all dimensions of the patient’s experience can be reached: physical, rational, social and spiritual. However, according to the New England Journal of Medicine,The scope of the problems of management in chronic pain is daunting, and the limitations in knowledge and education of health care professionals are glaring.As synergy is created between doctor and patient’s perspectives appropriate solutions can be created  to improve  outcomes and compliance  in a win-win approach to care. The purpose of this article is to raise consciousness on this approach.

Motivational communication is a way of reaching people and of guiding them as they construct and strengthen their motivation for positive change. As we seek to improve communication in the management of chronic diseases to engage patient in treatment goals, the importance of associating it with compassion must be stressed as compassion decreases both the perception of pain and anxiety.

Motivation energizes, maintains and controls human behavior. Communication role enactment must respect the patterns of internal and external locus of control as defined by the Mentalistic and Environmentalist assumptions and the stages of change as defined by the Transtheoretical model of Prochaska and Di Clemente.(7)  The need for such respect  is confirmed by a publication in rheumatology featuring 103 patients with rheumatoid arthritis and 74 with osteoarthritis reporting that: 44% were in pre-contemplation, 11% in contemplation, 22% in preparation, 6% in action and 17% in maintenance .

Adaptation to a chronic disease requites mourning of the past- self and a rebirth in a limited self.  However, the literature shows that patients’ expectations of the medical interview are not always fulfilled. Only 12% of subjects say that doctors have given them hope, while 50% say that doctors have taken away their hope. (4) Patients now require more information and increased participation in their treatment. Giving the patient a comfort zone to mention all complaints may take about 2 minutes, but it can increase quality of information gathering as well as satisfaction for both patients and doctors. Since satisfaction influences outcomes it may be a worthwhile investment in order to create a new framework of care in rheumatology.

The social life of the Middle Ages revolved around the spires and buttresses of cathedrals. The social life of our time reaches for the limits of the contemporary information superhighway. Alas, we often fail to realize that the “Miserables” described by Victor Hugo in 1862 are still among us: they have simply moved from the portals of Notre Dame to the cyber- limits of the current healthcare eco-system. We must serve our patients through the pertinent tenets of modern management  and using the global resources of technology. Yet in this age of information, we must also learn to communicate in a way that gives them hope and heals the total patient through both science and compassion,

References:

1) Camerlain M, Richard N, Trasler T. L’art de la Science: communiquer aux patients. Perspectives du College Royal 2:3:12-14. Autumn 2005

2)Ferrel B. Ethical perspective in pain and suffering. Pain Manag, Nurs, 2005,3.83-90

3) Pizzo PA, Clarc N, Alleviating Suffering 101- Pain Rlief in the United States. N. Engl J Med 2012: 197-8.

4) ) Camerlain M, Myhal G. Give them the Microphone. UNITE Training Meeting. Sheraton Gateway. Toronto. November 28,1974.

5) Dohe: 1nt K, Rx for better health care’ kindness and Compassion Health Day

6) Long Larry W, Communication and Motivation. Copyright 2000 Illinoi State University

7) Prochaska, JO; Norcross, JC; DiClemente, CC. Changing for good: the revolutionary program that explains the six stages of change and teaches you how to free yourself from bad habits. New York: W. Morrow; 1994.

7) )  Dohe: 1nt K, Rx for better health care’ kindness and Compassion Health Day.Nov 24,

8) Farley M, Compassionate Respect.A feminist approach tomedical ethics and other questions. Madeleva Lecture on Spirituality. Mahwah : Paulist Press. 2