Psychology of doctor-patient interaction in the context of medical specialist's communicative tolerance

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Mukachevo State University

Psychology of doctor-patient interaction in the context of medical specialist's communicative tolerance

Tetiana Shcherban Doctor of Psychology, Professor,

Rector Mukachevo State University

Tyberiy Dolynay Postgraduate Student

Abstract

The relevance of the study is due to the need to find ways to ensure high-quality interaction between a doctor and a patient in the context of a medical professional's communicative tolerance.

The purpose of the study was to determine the psychological characteristics of the interpersonal relationship between a doctor and his/her patients.

The basis of the theoretical and methodological approach was a qualitative combination of methods of structural and functional analysis of the problem of psychological training of medical professionals and analytical research on the formation of constructive relationships between doctor and patient.

Several surveys were conducted on the tolerance of healthcare professionals and their emotional well-being in the context of individual psychological characteristics.

The results are presented, which reflect the methods of doctor's influence on the psychological state of the patient and his/her family.

The question of how trust in a doctor and his/her professional competences is formed is highlighted. The problem of ethical principles, professional motivation of medical professionals and the specifics of their communication in the team are revealed.

The subjective feelings of doctors about the work they do are revealed. The issues of modernization of medical education and digitalization of services are revealed. healthcare medical education ethical doctor

The conditions, components, and approaches to effective interaction between doctor and patient in the healthcare system are identified. The problems of developing diagnostic tools for assessing the psychological state of a medical professional in his/her professional activity are detailed.

An experiment was conducted to substantiate the need to implement programmes to improve the communication skills of healthcare professionals, including interns and nurses.

The practical value of the results of the research work is the possibility of using the outlined approach to improve the methods of improving the communication competencies of doctors in their professional activities

Keywords: emotional stability; communicative tolerance; professional motivation; morality; medical ethics

Introduction

Communication culture plays an important role in human interaction. At the same time, tolerance and communication skills of each individual become a problem in relationships. This problem is especially acute in the communication between healthcare professionals and patients, where the paternalistic model of interaction between a doctor and a patient is replaced by a partnership model that involves the patient's active position in treatment, raising their awareness of their own health and searching for constructive sources of help. This also leads to increased requirements for a modern doctor, in particular, for his or her professional competencies, professional development, moral and ethical principles, as well as the ability to conduct organizational activities and the ability to use information and digital technologies in professional activities. The totality of these provisions determines the relevance of research on the psychology of doctor-patient interaction in the treatment process.

The transformation of political and economic processes indicates the need to introduce new approaches to the education of the younger generation, where the modernization of the educational system will contribute to the training of highly qualified and competitive international specialists. Studying the problem of professional training of public health specialists in medical educational institutions, M. Diachenko & T. Zakusilova (2020) note that the modern educational system needs to be modernized to support psychological and pedagogical conditions for the development of students' integrative thinking. In particular, the authors emphasize the need for the purposeful formation of professional qualities of future specialists, where specialized knowledge will be reflected in the personal and social development of a person. Similar conclusions were reached by I. Melnychuk (2021), studying the issue of an interdisciplinary approach to the training of medical specialists, the author points out that it is necessary to form a qualitatively new level of thinking in students, where the process of mastering the profession will be accompanied by interest and activity in studying the material, activation of mental activity and effective integration of theoretical knowledge into practical experience. In addition, according to K. Ivanova et al. (2022), the professional development of a future doctor should be based on the formation of the principles of bioethics. Studying the problem of professional activity of a doctor in the context of its bioethical essence, the authors note that the formation of professional competences of a healthcare professional should take place through the formation of a system of stable personal characteristics based on bioethical thinking and behaviour of an individual, as well as reflecting his/her readiness for professional interaction with patients.

In the period of rapid technological progress, it is important to develop communication competences in future doctors. L. Samburska (2022) points out that the accumulation of experience of communicative interaction in the educational process precedes the conscious use of psychological skills, which in the further professional activity of a doctor facilitate his/her communication with patients and colleagues.

Studying the issue of developing the communication competences of future healthcare professionals, the author also notes that it is in the educational process that a person develops the ability to establish contact with others, where the development of internal resources precedes the construction of effective communication in interpersonal interaction. Similar conclusions can be traced in the study by O. Lazurenko & N. Smila (2022), who studied the problem of professional development of a doctor. The authors note that the accumulation of practical experience allows a doctor to pay more attention to psychological aspects in therapy, as well as to regulate the degree of their own emotional involvement in this process. Studying the deontological approach in the training of medical professionals,

O. Rykachevskyi (2022) notes that in the modern world, there is a tendency to reduce the quality of communication among medical professionals, which also has a significant impact on the effectiveness of interaction between the doctor and his/her patients. The author notes that well-established interaction between colleagues, consistency, and coherence of work of all healthcare professionals affect the quality and timeliness of medical care provided to patients.

The main purpose of the research was to reveal the specifics of doctor's communication in the medical environment, in particular, the psychological aspects of his/her interaction with patients in the course of treatment. In addition, consideration of the theoretical foundations of the research topic allowed putting forward a hypothesis: the higher the level of psychological well-being of doctors, the higher the level of their tolerance in interacting with patients and colleagues.

Materials and methods

The conceptual approach to the research problem was based on the identification of key aspects of the development of professional skills of a medical specialist and his/ her interaction with other people in practice. The implementation of this approach was facilitated by adherence to the principle of determinism in the development of future doctors' professional competence, which made it possible to identify the main principles of forming communication skills in medical professionals, the formation of their ethical values and morality in the learning process. At the same time, the methods of theoretical generalization and empirical comparison made it possible to determine the principles of building trust in a doctor and his/her professional opinion. In addition, the use of the pragmatic method and objective observation contributed to the disclosure of the peculiarities of psychological interaction between medical professionals, in particular, it allowed highlighting the peculiarities of interpersonal communication in the doctor-patient system. The use of the structuring method made it possible to systematize the world experience of studying the genesis of interpersonal interaction of people as a component of their successful social activity. This contributed to the analysis of the specifics of the development of communicative tolerance of the individual and formed the basis for revealing the importance of the principles of the bioethical approach to treatment.

The empirical study was carried out on the basis of the Kyiv City Children's Clinical Hospital No. 1, a municipal non-profit enterprise (MNE). Medical staff of the general paediatrics, surgical and cardio-rheumatology departments in the number of 62 people, including 18 doctors, 12 interns and 32 nurses aged 20 to 56 years, were invited to participate in the study. Prior to the study, an organizational work programme was developed and implemented in cooperation with the hospital administration and the staff of the selected departments.

The study participants were divided into three subgroups and made up the corresponding sample with groups of doctors (D-18), interns (I-12) and nurses (N-32), where the number represents the number of respondents in each group. The pilot study was conducted for seven months. In particular, a programme was implemented for healthcare workers to improve communication skills and reduce conflict in the team.

The programme was implemented in the form of training meetings with strict adherence to the chain of command among employees. In general, the corrective psychological programme was designed to include one introductory meeting with group interviewing on communication problems with paediatric patients and their parents, 12 formative meetings and one final meeting, where respondents were given recommendations to reduce psychophysiological exhaustion in their work. Meetings with the respondents were held twice a month, with mandatory subordination.

The survey of healthcare workers was conducted online, which helped to minimize the influence of external factors on the respondents' opinions. The questionnaires “Scale of subjective well-being” (n.d.) by G. Perue-Badou (adapted by M. Sokolova) and the Express questionnaire “Index of tolerance” (Soldatova et al., n.d.) were used to diagnose the components of successful communicative tolerance of medical professionals. At the same time, in the course of the study, individual meetings and ongoing questionnaires were provided for medical staff, which helped to determine their personal attitude to work and communication with colleagues, emotional comfort and motivation in their professional activities.

During the pilot study, an anonymous online survey was also conducted among hospital patients, which was created on the basis of Google Forms software and distributed through printed advertisements with a QR code placed in the hospital (Assessment of the quality..., 2023). To track the dynamics of improving the communication skills of healthcare professionals, the responses of 74 people who visited the hospital repeatedly during the pilot study and filled out the survey form twice were taken into account and analysed. Technical devices (computer, tablet) were used to implement the experiment, including completing the survey, processing the data, and evaluating the results of the study. For the current interviews, questionnaires and observations, appropriate forms were developed. The hypothesis was tested using the statistical software “SPSS v. 16.0” and was based on the identification of correlations between the data obtained, which were calculated using the Pearson's parametric criterion. During the survey, the interviewer followed the European Commission's guidance note (2021) on ethics and data protection and the principles of the Helsinki Declaration (2013). All procedures conducted in research involving people complied with ethical standards, did not violate the honour and dignity of respondents, and were conducted with the results anonymous.

Results

The modern approach to treatment involves a combination of three aspects of therapeutic influence, including psychological, biological, and social. In this case, the evaluation of the treatment process is subject to the criteria of recovery, improvement, deterioration, or unchanged condition. At the same time, the treatment process is accompanied by a number of psychological phenomena that are related to the personal characteristics of the patient, the doctor, and the treatment methods chosen by him/her. Modern research indicates that, for the most part, psychological interaction between a doctor and a patient occurs spontaneously, and their communication depends on a specific situation where there is a possibility of a lack of contact (trust) between them (Wang et al., 2022; Lu et al., 2023; Wang et al., 2023). This has a negative impact on the information content of the patient's medical history and the outcome of treatment. It should also be borne in mind that a prerequisite for a positive doctor-patient relationship is the qualifications and experience of a medical professional. However, this is only a tool for proper treatment, while building trust in the doctor is a key point in this process.

A patient's willingness to cooperate with a doctor is subject to his or her previous experience, compliance with expectations regarding the doctor's appearance, professionalism, interest, emotionality, and motivation in providing care. The combination of these factors produces patient compliance, when the patient follows the doctor's recommendations (behaviour and responsibility in treatment). In general, in the analysed scientific publications, trust in the social life of citizens is divided into two types: interpersonal, as a result of the social order, and institutional, which is the result of economic codependence and professionalization of the individual (Rasiah et al., 2020; Aremu et al., 2022). This implies, on the one hand, adherence to common norms and values in social interaction between people, and on the other hand, integration of social ties through information, material, or psychological resources.

For the healthcare sector, the concept of trust is characterized by an indicator of support for transformation processes in the digitalization of the medical system and personal changes in people, where their behaviour in real-life situations of choice is formed (Swash, 2022). In addition, the understanding of trust as a key feature of doctor-patient interaction is based on a sociological approach, in which treatment involves not only determining its direction, but also the patient's acceptance and use of healthcare services, including the ability to influence the patient's behaviour in the treatment process (Blendon & Benson, 2022). Despite the autonomy in making treatment decisions, the patient relies on the competence of the doctor and the correctness of the treatment methods determined by him/her, which also involves their joint actions to find and implement rational treatment methods (Keshavarzi et al., 2022). The combination of personal qualities of a doctor in the context of his/her moral and ethical beliefs, proper professional training, professional skills, independence, and responsibility in decision-making, as well as the ability to adequately assess the patient's condition (psychological, physical), be understandable, attentive, accessible, communicative, and tolerant allows him/her to build a trusting relationship with the patient (Rasiah et al., 2020).

In the course of treatment, the physician should pay special attention to the patient's family members, who should receive full information about the health status of their loved one. However, the key point in this matter is the dosage of information in situations of uncertainty (coma, severe injuries, etc.) or the inability to predict the outcome of treatment (oncology, surgery, etc.). At the same time, there are cases when the patient is unable to provide complete information about the disease (seizures, stroke) or its course, so the doctor needs to contact a third party (spouse, parents, children, neighbours, eyewitnesses) to clarify the information. The data obtained from third parties about the patient's health status will help to supplement the medical history (Eggleton et al., 2022). The main principle of interaction between the doctor and the patient's relatives is based on practical mutual trust, where an individual approach to patient treatment promotes honest answers and conscientious compliance with treatment recommendations.

Communication with the patient's relatives is not just an exchange of information, but involves their involvement in the therapeutic process. In this case, the interaction between the doctor and relatives is based on support, understanding, respect, compassion, and cooperation. This is especially important in the context of communication with paediatric patients and their parents, as interaction with a child in a healthcare facility is different from interaction with adults. Examination and hospitalization of paediatric patients requires establishing confidentiality and trust with them and their parents (guardians), and involves creating an atmosphere of calm and appropriate communication with due regard for the child's age-related development. This necessitates the development of the doctor's knowledge of the psychological development of the individual from birth to puberty (Nunez et al., 2022). Communication with a child is determined by the conditions of his or her psychological state at the time of the first contact, when the doctor needs to determine the health status of the paediatric patient, the nature, and type of the disease, and the intensity of clinical symptoms.

The analysed scientific approaches to the psychology of interaction with children in the therapeutic process show that children's fear is associated with the fact of staying in hospital, in particular, due to unknown scenarios or painful diagnostic or treatment processes (Keshavarzi et al., 2022; Eggleton et al., 2022; Paley & Hajal, 2022). Healthcare professionals need to eliminate this fear at the stage of getting to know the child, as this will serve as a key to establishing a trusting relationship. This can be done through a friendly and calm tone, non-verbal communication, and engaging the child's attention in the therapeutic interview process through playful activities. It is also important to avoid talking about the child's illness with outsiders in the child's presence. At the same time, the specifics of the holistic concept of interaction with paediatric patients are based on communication with family members, which requires consistency, humanity, professional behaviour and listening skills from the doctor. For young children, interaction with the doctor takes place playfully using non-verbal communication through facial expressions, gestures, and palpation. Paediatric patients with hearing impairments, psychomotor disorders, and autism spectrum disorders require special interaction. The doctor needs to communicate with parents or guardians to take a medical history. At the same time, the information provided by the doctor to parents should be clear and understandable, taking into account their psycho-emotional state.

The empirical study was based on identifying the peculiarities of psychological interaction between healthcare professionals and patients. The first stage involved drawing up a plan and organizational work with the hospital management and its employees. The next step was to determine the current situation regarding the relationships of healthcare workers in teams, their emotional and physical condition, social behaviour, and level of tolerance. Given the data obtained, a psychological programme was developed to develop the communicative tolerance of healthcare workers, including improving their communication skills and reducing problem situations and disagreements in teams. Indicators of the overall level of subjective welfare of healthcare workers according to the “Scale of subjective well-being” (n.d.) before and after the experimental work are presented in Figure 1. The results of the study indicate an increase in the level of psychological well-being of healthcare workers after completing the correctional programme, which indicates the need for ongoing psychological support for healthcare workers. The current interviews revealed that seven doctors sought psychological help due to a loss of motivation in their professional activities. In particular, individual interviews with respondents indicate that along with experience comes professional exhaustion, when certain factors (low salaries, lack of social and legal security, workload) contribute to professional burnout and emotional imbalance. Many respondents value the support of their close environment, but a decrease in psychological stability leads to conflict behaviour, which eventually transforms into aggression.

Figure 1. Analysis of the results of the level of psychological well-being of respondents before and after the implementation of the psychological programme Source: compiled by the authors

The respondents noted that the feeling of loneliness in everyday life also affects their professional activities, in particular, in communication with patients. This problem is particularly acute when interacting with adolescents undergoing treatment and parents of younger patients. In addition, the assessment of each individual cluster using this methodology revealed that at the beginning of the pilot study, tensions in professional activities among respondents in groups I-12 and N-32 (interns and nurses) created a need to avoid any interaction with others. Interviews with respondents in these groups show that in their social life (outside of working hours) they sought to be alone and avoided communication with friends and relatives. In the course of the psychological programme, these indicators changed. The highest resilience of psychological and physical health was recorded among doctors, while the indicators of interns and nurses were in some points opposite. A more visual analysis of the results by the criteria of the subjective well-being assessment scales is presented in Table 1.

Table 1. Analysis of the results of respondents' psychological well-being by clusters (scales) before and after the experiment

Source: compiled by the authors

The diagnostics carried out using the method of subjective assessment of psychological well-being shows that the emotional and physical state of healthcare workers affects their professional activity. However, it is still important to understand the level of tolerance of medical professionals. To diagnose the degree of tolerance of doctors, a survey was conducted using the Express questionnaire “Index of tolerance”, which allowed determining the overall tolerance index of respondents (Soldatova et al., n.d.). An analysis of the results of the tolerance index before and after the experiment is presented in Figure 2.

Figure 2. Analysis of the results of the respondents' tolerance index before and after the implementation of the psychological programme

Source: compiled by the authors

The determined indicators of tolerance indicate an increase in the level of tolerance of the respondents after completing the psychological program. The current interview showed that among the respondents of group I-12 (interns), the low rate at the beginning of the experiment reflected the inability to communicate tolerantly with patients due to a lack of understanding of their psychological state, in particular, due to a lack of experience in communicating with different types of patients. At the same time, the low level among the respondents of group N-32 before completing the psychological program is explained (according to interviews with respondents) by exhaustion in professional activities. That is why it is expedient to consider not only the index of tolerance of respondents, but also the level of formation of tolerance according to ethnicity and social affiliation, as well as a personal trait of a person. These data are clearly presented in Table 2.

Table 2. Analysis of the results of respondents' tolerance indicators before and after the experiment

Source: compiled by the authors

The survey results indicate that it is possible and necessary to influence the level of tolerance of healthcare workers, as it ensures the stability of their interaction with patients. In addition, the results of the current interviews show that targeted influence on the personal qualities of the respondents helped to improve relationships in the team. At the same time, respondents noted an improvement in responses to patients' destructive behaviour during the psychological programme (adolescents ignoring the rules of rest, parents self-medicating their children during hospital stays).

Medical specialists point out that instead of feeling aggressive in such situations, they have begun to understand the peculiarities of people's behaviour and have improved their communication with puberty-age children and parents who are in hospital with their children.

In general, the implemented programme indicates a decrease in conflict in the team, as well as an increase in tolerance, motivation, and interest in the professional activities of medical professionals.

This is especially true for the younger generation of respondents, among interns and nurses who have just begun to gain professional experience in practice. To test the hypothesis about the relationship between the psychological well-being of healthcare professionals and their tolerance in communicating with colleagues and patients, a correlation analysis was performed using the Pearson's method, which was calculated in the statistical data processing software SPSS v. 16.0. The results are presented in Table 3.

Table 3. Correlation between the components of psychological subjective well-being of respondents and tolerance