Healthcare provider-patient communication

A successful doctor-patient communication is a result of effective communication in which the patient describes his symptoms while the doctor listens. And then the doctor explains effectively a diagnosis, treatment or prevention plan, which the patient must understand and endorse (Lukoschek, Fazzari, & Marantz, 2003). Various studies confirm that patients without common language with healthcare providers are the most disadvantaged ones. Owing to that

9 limitation, among others, immigrant populations are the most vulnerable healthcare consumers, and suffer from higher rates of morbidity and mortality than other segments of the population. They often have to struggle with their poor levels of language and health literacy.

These problems are strengthened by cultural differences and economic problems (Matiasek &

Wynia, 2008).

Clear communication is needed between doctors and patients. Failure to communicate clearly can result in unnecessary return for treatment or/and it can lead to more ailment or adverse events (Simpson et al., 1991). A clear communication includes limiting the number of messages delivered at one time, using simplified, jargon-free language, and having patients explain what they have been told and repeating the information until it is clear the patient understands. Therefore, good communication and relationship between HIV positive immigrants and doctors can play a significant role in influencing the treatment decision, and is closely linked with improved patient satisfaction, adherence to medical recommendations, and health outcomes (Thomas, Aggleton, & Anderson, 2010).

Research on doctor-patient communication makes distinctions between disease-centered approach and the patient-centered approach. In the disease-centered approach, the doctor concentrates on his or her own agenda notes and where he or she seeks to reach a clear diagnosis of the problem through ‘text-book’ style enquiries about the patient’s symptoms and medical history (Williams, et al., 1998). The doctor suggests certain best health-related values that can be realized in the clinical situation. This approach is also known as ‘The paternalistic model’, in which the doctor presents the patient with selected information that will encourage the patient to choose the intervention the doctor considers best.

(Graugaard, 2003). This notion of the doctor “knows best” has dominated research on doctor-patient communication. Immigrants patients from Sub-Saharan African countries are heavily influenced by this approach, and the legitimacy of biomedical knowledge and doctors’ influence and dominance over their views (Thomas, et al., 2010).

Recent studies have shifted their focus towards egalitarian relationship between doctors and patients in which the patient’s resourcefulness and expertise is given wider legitimacy (Williams, et al., 1998). This approach assumes that the conventional biomedical model is incomplete and suggests doctors must be able to empower patients. It renounces the traditional power balance in which the doctor has the upper hand in the doctor-patient relationship (Graugaard, 2003). In this approach the patient-centered approach, the

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doctor works with the patient’s agenda listening and responding to what the patient says and the doctor-patient relationship is considered egalitarian. The doctor enables the patient to express his or her reasons for attending, including their symptoms, ideas, in feelings and expectations.

This approach is however seen as impractical with regard to HIV positive immigrants from Sub-Saharan Africa (Thomas, et al., 2010). There is deep-rooted professional power among doctors and the structural constraints which govern resource accessibility. According to Thomas, et al (2010) African Immigrants living with HIV have high level of respect for their doctors and they may not feel secure enough to change the power balance. African immigrants living with HIV consider the fact that doctors had been the major factor in their survival, and therefore place ultimate faith in doctors (Thomas, et al., 2010). As a result they give the entire responsibility to doctors, and have minimum involvement in decision making with regard to their treatment.

Information from healthcare providers and patient satisfaction

Giving information to patients is complex, yet doctors must be able to provide health information and ensure the information is understood by patients. Studies confirm that patients’ comprehension of health information was associated with patient satisfaction.

Satisfaction is by far the most used outcome measure within communication research (Lukoschek, et al., 2003). Studies show that a positive relation between the amount of information that the doctor provides for the patient and patient satisfaction. Information provision by doctors specifically during the examination, but also during the concluding section of the consultations has been found to be related to increased patient satisfaction (Williams, et al., 1998). Similarly, the personal manner of the doctor during consulting has raised patient satisfaction. Positive verbal behavior and partnership building during

consultations has also been reported to be directly related to the level of patient satisfaction.

Doctor-patient relationship and the expression of affection during consultations are found to be important factors in enhancing patient satisfaction. Doctor anger or disagreements or negative tone expressed by either the doctor or the patient is negatively related to patient satisfaction (Williams, et al., 1998). Thus a good communication between doctors and immigrants living with HIV is crucial to improve health outcomes. Good doctor-patient communication exerts a positive influence not only on the emotional health of the

11 patient, but also on symptom resolution, functional and physiologic status and pain control (Williams, et al., 1998).