Better bedside manners for doctors on the cards with NTU-TTSH study

SINGAPORE — It is not uncommon for patients to walk out of a doctor’s consultation room feeling confused or unsatisfied with the session. To improve the experience for patients and to provide better medical services, researchers from Nanyang Technological University (NTU) and clinicians at Tan Tock Seng Hospital (TTSH) are taking up a joint study on the communication flow between doctors and patients.

The study, which compiled and analysed video recordings of 150 first-visit consultations at TTSH’s urology clinics, aims to give doctors more insight into what makes patients more receptive to medical procedures, and how to help them feel more satisfied with their consultations. It will also train doctors to better communicate the importance of medical tests, and address their patients’ fears.

For example, TTSH doctors can learn how to better pick up on a patient’s non-verbal cues expressing anxiety and fear, and analyse a patient’s questions, said Dr Png Keng Siang, an adjunct assistant professor and senior consultant at TTSH’s urology department.

Dr Png collaborated with two NTU researchers — Professor Luke Kang Kwong Kapathy and Assistant Professor Lim Ni Eng — for the study.

Asst Prof Lim told TODAY that he is hoping to share the study’s findings and recommendations with the 22 doctors from the urology department who were involved in the video recordings.

This could be done through a half-day workshop, which may also involve doctors from other departments. The two researchers are hoping, too, that the study’s findings will be used as case studies for communication modules at NTU's Lee Kong Chian School of Medicine, to teach medical students how to better interact with patients.

Prof Luke, who is the chair of NTU's School of Humanities and the associate dean (research) of the College of Humanities, Arts, & Social Sciences at the university, said: “Studying the languages, responses and social psychology in the clinical setting gives us insights on what makes patients more receptive to doctors’ recommendations.

“What we are hoping to offer is another layer in learning, (for students) to observe real consultations on video, which they can rewind and play again to analyse together with facilitators, (and learn) how to better improve the conversation.”

The issue of poor communication between doctors and patients is a long-standing one here, with 29 out of 159 complaints received by the Singapore Medical Council (SMC) last year attributed to this reason.

A recent opinion piece published by TODAY also described how a patient who consulted an eye specialist for redness went through several tests without being properly informed of the purpose of the tests and the costs.

WHAT DOCTORS CAN SAY

While doctors are experts at providing “factual information” such as risk percentages, causes and symptoms, there remains room for improvement in picking up “non-verbal cues” and “psychological fears”, said Dr Png.

“The senior doctors are able to pick up on them after years of experience, but through this study, watching these videos could prove useful for junior doctors,” he added.

Based on the recordings collected, Asst Prof Lim recounted several examples where patient-doctor interaction could be improved.

Case study 1:

When a doctor orders multiple tests for a patient who has blood in his or her urine

• Patient’s question: “What happens if the result from the urine test is negative?”

• Doctor’s response: “If it is negative, then that’s good. We don’t have to worry about it.”

• What the doctor could have said: “While a negative result from the urine test means there is no bacterial infection, your symptom of seeing blood in your urine could be due to a kidney infection, or other kidney diseases, and to accurately determine the cause, you will have to go through more tests.”

Case study 2:

When patients have a fear of pain, and of undergoing anaesthesia

• Patient’s question: “Would I be put to sleep?” or “Is it going to be painful?”

• Doctor’s response: “We’re going to provide you with anesthetic, and it will be administered locally.”

• What the doctor could have said: “There could be discomfort, but many other patients have been able to undergo the procedure with little complications. Rest assured that it will go well.”
   

The NTU-TTSH study, which began in July 2016, first involved 50 patients and three urology consultants. From the initial findings, a larger study involving 100 patients and clinicians from the urology department was conducted from mid-2017 to mid-2018.

Patients gave their written consent to take part in the research project, which was approved by the National Healthcare Group’s ethics review board.

While the findings have yet to be published, the research team has presented the findings at several international conferences such as the Singapore Public Health & Occupational Medicine Conference, and the Global Health Histories Seminar jointly organised by the World Health Organization and Sri Lanka’s government.

Going forward, the researchers hope to broaden the scope of study to other departments at TTSH. Prof Luke told TODAY that they are collecting video recordings of consultations at TTSH’s ophthalmology department for further study.