Physicians` discussion on trusting doctor-patient relationships

An interactive discussion workshop on important issues of industry development was held. Experts and specialists of our center actively participated in discussion devoted to cardiovascular disease problem and medical tourism development.

On the 15 of August, a burning issue of compliance, (actions of a patient according to physician`s recommendations), was discussed at a focus group “Doctor-patient effective relationships. Motivation. Adherence.”: persuasion the population to undergo a full medical examination of circulatory system, leading a healthy lifestyle and medication adherence.

Dzhinna Lebedeva, Chief Doctor of Regional treatment-and-rehabilitation center, the main non-staff specialist on neurology of Health Department of Tyumen region, mentioned that 51% of patients systematically ignore obligatory medical prescriptions and recommendations.

Adherence to medical prescriptions is often underestimated. Patients’ poor medication regime adherence, change multiplicity and dose of drugs lead to serious health consequences. Sometimes a physician trusts patient too much, has confidence in her/his discipline and does not properly control a treatment process.

Anton Fanakov, Head of Department, cardiologist of outpatient clinic, presented a report “Outpatient care stage problems in cardiac patients”    

Circulatory system disease mortality is almost the half of all deaths. So, Anton Fanakov considers start of a struggle from this field of medicine.

Physician offered to increase the effectiveness of cardiac care at outpatient stage using several methods: training staff and engaging new specialists; introduction of mentoring elements from more skilled colleagues, creation of joint communities for an employee competence development; forming a desire to learn and to help a patient effectively, increase a consultation time per one patient to improve an adherence to a treatment, to organize a training discussions, to persuade a patient of dangerous complications and necessity of taking prescribed medications.  

Physician explanations motivate the patient very much. If a consultation interval was longer, the quality of medical aid provision would be better. A patient-physician contact would be more confidential and patients would follow physician’s prescription. Dissatisfaction and complaints often appear, when a physician does not fully listen to patient, writes a lot and does not pay attention to a patient.

It was suggested to pay the main attention to diagnostics and follow-up care in patients with arterial hypertension, which are very widespread among young people. However, there are some problems here: physicians often formulate diagnoses incorrectly and the tactics therefore has a lack. Digital Patient Card doesn’t implement all functions for follow-up care, for instance, the programs of a patient automatic appointment invitation aren’t used. The issue of a prescription medication waiting list is not solved, and what is more, free medication list is very limited.

In addition, the issue of comorbidity, (the presence of additional chronic diseases, which have common pathogenetic mechanism), has become significant. Nowadays, patient may take 20 medications or more per day. However, taking each of them is obligatory and reasonable. Anton Fanakov suggested an establishment of commission on priority management issues of various drug implementation.

Patients` medical ignorance and mass media influence were the issues of discussion.

The speakers noted some social and advertising campaigns paied no attention to “working” blood pressure term, did not always determine complications at hypertension and might give doubtful recommendations, which were difficult to implement to all categories of patients.

Patients often argue with physicians’ prescription, because completely different information broadcasts on TV. All medical TV programs have to have consultation with physicians. Social campaigns and training courses for patients have a poor audience coverage and all the same patients attend these meetings. There is a proposal to develop a YouTube channel to eliminate medical ignorance and creating a healthy lifestyle.

Tatiana Sereda, MD, PhD, Chief Doctor of Tyumen Cardiology Research Center, the main non-staff specialist on cardiology of Health Department of the Tyumen region, supported the opinion of individual approach to a patient.

Processing a lot of paperwork takes the time away from a physician-patient discussion. An adherence to treatment is higher, when physician explains the diagnosis and the aim of taking each medications.   Tatiana Sereda agrees to the necessity of censorship in publications and mass media. She also told that medical histories of patients in our city and region are analyzed and usually, there are no remarks about physicians` recommendations, but, in future, patient may not attend a doctor appointment or use nonconventional methods of treatment.

Certainly, it is necessary to educate patients, inspire trust, be very endearing, persuade to take care of own heath. Problem of a patient visit duration may be solved by participation in consultation of middle-level staff or assistant practice clinician, who can process paperwork.   

Sergry YArtsev, MD, PhD, Chief Doctor of Regional Clinical Hospital #1 took part in discussion: "Unfortunately, there is no a unique solution for all challenges. Increasing of physician`s appointment length is impossible any time soon. It is necessary to seek other approaches, to raise physicians` responsibilities and widespread the knowledge of different specialties, change an inner logistics."   

Sergry YArtsev is sure medical awareness is increasing with help of mass media and internet. An information field will develop. It cannot be stopped. Patients may obtain more information through the internet, although physicians criticize the web data and offer to discuss and filter it. Physician have to keep up with data in the internet and correct it. Patients must know the data was verified and professional medical associations must put their "seal of approval", accept mass media information. It must be a wise security standard combination; and experience will be gained progressively.

Nina Shurkevich, MD, PhD, Cardiologist of highest category, Leading Scientific Researcher of the Department of Arterial Hypertension made a presentation titled: “An effective outpatient level dialogue on cardiac aid provision”. She told about an experience of a physician-patient compliance development in Tyumen Cardiology Research Center and particularly, an optimization of arterial hypertension treatment in shift workers with the help of chronotherapy. Nina Shurkevich notes shift work has specificities: relocation, stress, separation from family, incomplete adaptation syndrome. Arterial hypertension in shift workers reaches 47% and even more. In addition, patients from northern regions have many risk factors: smoking, low physical activity, high cholesterol. Despite the fact, government provides such workers with free medications, our scientific researches reveals less than 50% of patients take prescribed medications. There are different reasons: young age, oligosymptomatic course of a disease, bad tolerance of drugs, medical ignorance.

Examination and treatment were prescribed depending on chronostructure of blood pressure. A follow up period was lasting a year. Results showed: such an approach allowed to achieve a target blood pressure, a blood pressure reduction at nighttime, to determine which medications were more effective. What is more, the number of smokers decreased; physical activity and quality of life improved, in general.

Nina Shurkevich told that patients were involved in process, explained a diet, and necessity of taking medications and a risk of not taking. It is possible to cope with cardiovascular diseases or to decline them by improving a physician-patient interaction. Our scientist added the government should assist the physical and social environment projects to support an easy healthy choice.   

Tatiana Skvortsova, Chief Executive of regional social organization “Sport federation of individuals with musculoskeletal system diseases of the Tyumen region”, the winner of European ballroom dancing competition, shared her opinion within the meeting: “Physician`s professionalism is the main quality, that patients appreciate.”

Two more reports were delivered by Olga Sharashkina, coach-psychologist of “Medical information and analysis center of Tyumen region” and Tatiana Kalinkina,manager of the educational activity sector. The first presentation was devoted to aspects of therapeutic communication in medical practice from the perspective of personal psychological characteristics. The second report revealed patient questionnaire results on issues of improving health responsibility, comfort and politeness in hospitals.

Preliminary results showed patients' acceptance of reminders about check-up necessity via web accounts, sms mailings and phone calls. In addition, patients want to have a schedule of medical examinations and get information about a healthy life style through social networking websites. A key conclusion was: trust — an important part of treatment, all problems have to be solved gradually and collectively. The positive tendency has already been — dialogue with the patient has been developed.

Vladislav Smaznov, MD, PhD, Deputy Director for Economics, cardiologist, took part in another discussion workshop. He introduced issues of medical tourism and health care services to colleagues. He told how to make the patient pleasant, loyal, to live him/her up to his expectations. On the 20 of August, the team of our center will participate in plenary session related to the summing up of discussion platforms in the community center “Neftyanik”.