The seeming lip of empathy and more cases, or why communication doctor-patients is important
« I told them, » Good afternoon. « Then I told them that their loved one had died and then I wished them » a nice day. « Neither the day was good nor it would be nice »S These are the memories of a doctor who had to report the death of his patient for the first time. He spoke about his experience of Kremena Kuneva, one of the founders of the Danaya Foundation, which at the end of last year published and adapted a Bulgarian language to communicate with patients with patients and their parents. The use of speech templates on the other side can be accepted as a form of lack of empathy.
In Bulgaria, there is a misunderstanding that communication between a specialist and the patient is directly related to the quality of medical care, according to medical law lawyer Maria Sharkova. There is no system training on how doctors communicate with patients to start at universities and continue outside. Sharkova has analyzed the case -law in recent years and points out that one of the main reasons for bringing cases against hospitals and doctors is precisely a poor/inadequate communication. Claims on this line are growing.
What is the preparation at universities
A problem that has been hanging for years, which for a unknown reason is not solved – so experts answer the question of why in Bulgaria there is no systemic training how doctors to communicate with patients. According to Kremena Kuneva, in all European countries, the improvement of these skills is embedded in curricula at medical universities, in some of them even repeatedly, and throughout the training period.
Lack of communication leads to a lack of confidence, a misunderstanding on the part of the patient, which prompts him not to adhere to the prescribed treatment, Kuneva said. It also leads to fear as well as to the familiar aggression. According to her, it is necessary to introduce communication standards with different patients – people with incurable diseases, children or adults with multiple diseases. For medical professionals themselves, it is also crucial to possess these communication skills and to apply them in practice, to train how bad news is reported. Multiple scientific data and analyzes indicate that to a large extent the level of anxiety and bout (from English ez Burnout, the so -called. Professional burnout syndrome) declines when they are prepared how to communicate with patients, says Kremena Kuneva.
The Diary asked the education ministry whether it is necessary to introduce structured communication training programs with patients at universities. From there, they commented that higher education institutions enjoy academic freedom and autonomy and determine the curricula and programs themselves. They also note that the universities have compulsory and elective disciplines such as « medical communication », « medical ethics », « medical psychology », « communicative training », which are studied both for the acquisition of a bachelor’s degree for a nurse and for a Master’s degree in medical.
According to Kremena Kuneva, however, subjects such as « medical ethics » and « medical psychology » are completely different disciplines and do not prepare doctors how to communicate with patients.
| From The Ordinance on Unified State Requirements for Acquisition Higher education in the specialty « Medicine » and « Dental Medicine » shows that Among the mandatory disciplines There is no communication course anywhere. Eleuable communication courses are available at medical universities in Plovdiv and Varna, is understood by Reference to the University’s websiteS At the largest medical university in the country, namely the one in Sofia, similar a course is missingS Dnevnik Send questions to the MU Sofia whether it provides for the course of patients in the curricula with patients in order to prepare future medics. Until the publication of this text, the answers were not received. |
Kuneva also says that even the one -time introduction of such courses into the program is something, but it remains not enough. Another important aspect to which it pays attention to is that there is no mandatory continuing training after graduation.
Attorney Maria Sharkova states that it is necessary to have a serious commitment from the state so that universities are encouraged to systematically bet on their programs similar trainings.
A good specialist is not equal to a good communicator
According to Kremena Kuneva, many of the doctors in Bulgaria are on the principle « If I am a good person, it means that I can also communicate well ». But this perception is extremely wrong because communication is a skill that should be developed, including how a medical error is reported, she said. « You can be a very good person, but not to know how to serve extremely difficult news, especially after a 24-hour duty with very serious cases, » Kuneva commented.
Attorney Maria Sharkova states that there is an interest in such trainings on the part of the doctors, since they themselves feel vulnerable when they do not know how to react. However, at a centralized level, there is no work on this issue, there is no realization that communication specialist patient is at the heart of the quality of medical attention.
Many doctors are extremely good professionals in their field, but since they are not taught how to communicate with patients, they are left with the impression that there is something hidden, wrong, that something is confused, hence the confidence in the doctor and
Maria Sharkova. Medical law lawyer
According to her, patients are much more likely to forgive a pass when the doctor was discovered with them and explained the situation.
Condemned for an unethical attitude
Several hospitals in Bulgaria have already been convicted not because they have made a mistake, but for the extremely rough way the patient’s diagnosis was reported, said lawyer Maria Sharkova. She has been collecting data for years and has been researching the case law in the field of healthcare. And its analysis from 2017 shows that 35% of cases in medicine are conducted due to poor/inadequate communication between doctors, medical staff and patient.
| According to her, the number of cases is increasing to date due to poor communication that end in favor of patients. There is also a major increase in cases brought against hospitals and doctors. If by 2020 the average number of such cases was 60-70 a year, the latest data from the electronic justice system shows an increase of 20-25%and in some cases more. |
It gives an example of a similar case from its practice. The Private Hospital « Madzhurov » in Burgas was convicted by the parents of a 2-year-old child who died at the hospital. The relatives were not admitted to the body of the child, they were not given adequate information where they were stored, they were only able to see it after the police intervention. The court sentenced the hospital for the damages that the parents had suffered as a result of poor and rough treatment, Sharkova commented.
Lawyer Maria Sharkova: Nearly 35% of medical errors are due to poor communication
In such a situation, patients may seek judicial protection, receive compensation for non -pecuniary damage as a result of an unethical and inhumane attitude. Because the case -law accepts that doctors, along with medical standards, methods approved by science and practice, must also comply with ethical standards of behavior that are enshrined in the Code of Ethics, Sharkova said.
| At the centralized level, no summary information is collected on how many cases filed against hospitals are, as well as what money the state medical establishments are paid for benefits, judicial and out -of -court agreements, convictions in civil cases, commented the lawyer. Sharkova. |
« These are huge sums of taxpayers’ money, which can largely be saved, even if we look at the health system only in its quality – as a money order, without talking about quality enhancement, » Kremena Kuneva commented.
Hospital mediators
The management in the medical establishments themselves do not have the necessary skills, abilities, knowledge and resources to resolve conflicts that have arisen on the territory of the hospital and for this reason it is very common to court, said lawyer Sharkova.
According to her, no alternative methods are used to resolve conflicts such as the introduction of hospital ombudsmans or mediators to successfully help resolve the situation in the bud and periodically train the staff of communication skills. She states that in some hospitals in Europe and the United States, there are specialists who take care of patients’ satisfaction, conduct studies, seek patients actively to get feedback after treatment and to identify problems if there were some that were resolved in a timely manner. In other medical establishments, there are programs in which medical staff is learning in mediation to use these skills in communication with patients or in conflicts in the team itself.
First steps
Kremena Kuneva of the Danaya Foundation says they have concluded an agreement with two hospitals SBAL « Prof. Ivan Mitev » and « St. Anna », where they will try to implement some of the standards set out in the communication manual with patients and their patients. The textbook adapted in Bulgarian has been developed for decades by the Texas Children’s Hospital, which is a leader in the United States.
Currently, the foundation is studying how, after discharge, patients evaluate communication in medical establishments – good, medium, bad. As well as how specialists evaluate their own skills.
« We will explore their attitudes before and after the training so that, among other things, we can prove efficiency, albeit only in two hospitals, » Kremena Kuneva said. By specifying that the volume of the necessary knowledge cannot be given to the full scale with courses within 1/2 days. In this way, however, the foundations will be laid and the health specialist themselves will be generated, as well as the bosses of hospitals to understand the need to invest time and resources in training their employees.
