The legal responsibility of the physician for the communicative incompetence

Initially,  Spitzberg (1988) defined communication competence as “the ability to interact well with others”. He explains, “the term ‘well’ refers to accuracy, clarity, comprehensibility, coherence, expertise, effectiveness and appropriateness”. A much more complete operationalization is provided by Friedrich (1994) when he suggests that communication competence is best understood as “a situational ability to set realistic and appropriate goals and to maximize their achievement by using knowledge of self, other, context, and communication theory to generate adaptive communication performances.”

Communicative competence is measured by determining if, and to what degree, the goals of interaction are achieved.  As stated earlier,  the function of communication is to maximize the achievement of “shared meaning.” Parks (1985) emphasizes three interdependent themes:  control, responsibility, and foresight; and argues that to be competent, we must “not only ‘know’ and ‘know how,’ we must also ‘do’ and ‘know that we did'”.   He defines communicative competence as “the degree to which individuals perceive they have satisfied their goals in a given social situation without jeopardizing their ability or opportunity to pursue their other subjectively more important goals”.

  1. Main part

Communicative competence of the physician

Disease treatments have been significantly influenced by the communications between patients, their families, and doctors, the lack of which may lead to malpractice allegations and complaints. In particular, inadequate communication may delay diagnosis and treatment. Therefore, for doctors, communication and interpersonal skills are as important as clinical skills and medical knowledge.

In the emergency cases, a qualified neurosurgeon should handle communication more competently than in other medical encounters. Ineffective communication and consultation before life-saving operations may postpone diagnosis and treatment, thus resulting in complaints and even litigation; in contrast, good communication may retrieve more detailed patient information and proper informed consent. Regardless, many neurosurgery residents remain unskilled in communication and interpersonal skills.

Doctor–patient communication competencies are being assessed by psychometrically sound communication assessment tools,  mobile information and communication systems, database and multimedia authoring tools, and the Medical House Call tool. However, these techniques and tools can only be applied to patients capable of communicating. If the patients are not capable of communicating as they are admitted to the emergency room, coupled with the limited time, the strategies are prone to failure. Consequently, we created and trained a “standardized” family to simulate the communication counterparts and to evaluate, and rate the trainers. The standardized family consisted of actors without a medical background; they simulated patients’ families, or other representatives such as a friend, teacher, roommate, and/or colleague. When directly talking to the families of patients in a critical condition, above and beyond a kind attitude, well-developed and completely detailed medical practice and procedure information are important components of communication. In this study, we tried to develop a rating instrument that focused on the detailed content and knowledge used to inform patients’ families by referring to the Kalamazoo II Consensus Report.

We intended to develop two detailed communication content checklists and a modified interpersonal skills inventory, aiming to evaluate the neurosurgeons integrity in the midst of communication skills assessments, to provide feedback for some participants, and to observe their communication competence in both aspects.

Patient rights

Patient rights are those basic rule of conduct between patients and medical caregivers as well as the institutions and people that support them. A patient is anyone who has requested to be evaluated by or who is being evaluated by any healthcare professional. Medical caregivers include hospitals, healthcare personnel, as well as insurance agencies or any payors of medical-related costs. This is a broad definition, but there are other slightly more specific definitions. For example, a legal definition is as follows; patient rights is general statement adopted by most healthcare professionals, covering such matters as access to care, patient dignity, confidentiality, and consent to treatment.

No matter what definition is used, most patients and doctors are finding that many of the details of patient rights have changed and are continuing to change over time. This article is designed to give the reader a basic introduction to patient rights.

Often, people do not realize their specific rights at the time of their care because those rights are either not clearly defined or included in a bundle of papers that patients need to sign during registration. Some basic rights are that all patients that seek care at an emergency department have the right to a screening exam and patients that cannot afford to pay are not turned away. The details of these rights are detailed in the Emergency Medical Treatment and Active Labor Act (EMTALA) laws in the U.S. In addition, many people think that patient rights are only applicable between themselves and their doctor. This is not the situation; as stated in the first definition, patient rights can be extensive and exist between many people and institutions. Most notably, they can exist between patients, any medical caregiver, hospitals, laboratories, insurers and even secretarial help and housekeepers that may have access to patients or their medical records.

It is not possible in this article to list all of patient’s rights. However, most written rights that doctors and hospital personnel have patients read (and sign) are abbreviated statements that are summaries of all or parts of the American Medical Association (AMA) Code of Medical Ethics. Many of these patient rights have been written into state or federal laws and if violated, may result in fines or even prison time.

This article will focus on the doctor patient relationship and present areas of greatest concerns. Readers should understand that in most instances, when the word “doctor” is used, the reader may substitute many other names such as nurse, caregiver, hospital, insurer, doctor’s office personnel and many others. A patient’s rights in relation to their doctors occur at many different levels, and in all specialties. As stated above, the American Medical Association (AMA) outlines fundamental elements of the doctor-patient relationship in their Code of Medical Ethics.

III. Conclusion

For most people communication is simply talk.  It is a natural event. Students enrolling in an introductory undergraduate communication course will quickly reference a convenient and aging dictionary when asked to define communication and provide the following:

“Communication is a process by which information is exchanged between individuals through a common system of symbols, signs, or behavior” (Webster, 1983, p. 266).

The fundamental problem with defining communication as nothing more than information exchange is that information exchange is only a necessary but not a sufficient condition for understanding the complex process of communication.  The naive perspective which allows one to define communication as simple information exchange suggests that one can simply define engineering as “the art of managing engines” – a definition unlikely to resonate with most professionals who study mechanical, electrical, chemical, civil, or  biological engineering.

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The legal responsibility of the physician for the communicative incompetence

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