Communication and relationship in medicine 3rd year

A.Y. 2020/2021
4
Max ECTS
52
Overall hours
SSD
M-PSI/08 MED/09
Language
Italian
Learning objectives
The purpose of the course is: i) to provide essential knowledge about behavioral skills in the human relations and in particular as far as the doctor-patient-family relations, also in the context of health education; ii) to provide knowledge of protocols and basic skills and attitudes as far as difficult conversation in medicine (e.g., giving bad news).
Expected learning outcomes
Students are able:
a) to recognize and use communicative and relational skills in the doctor patient family communication and
b) to describe complexity factors related to the physician's inner life.
Course syllabus and organization

Single session

The lessons of the first semester from 21 September to 4 November 2020 were held in mixed mode:
in the classroom with a limited number of students, who have booked using their unified e-mail credentials through the "lessonsUnimi" app (https://www.unimi.it/it/studiare/frequentare-un-corso -degree / follow ...) and at the same time synchronously through the "Teams platform" for students not present; the lessons were also video-recorded to allow students unable for documented needs to follow them in sync.
From 5 November 2020 to 15 January 2021, face-to-face lessons have been suspended as per the Rector's Decree. Teaching continued remotely: the lessons were delivered through the Microsoft Teams platform, mostly in synchrony, almost always respecting the calendars approved for the current semester.
The lessons of the second semester will start in early March 2021 and will probably take place in mixed mode, with booking through the dedicated app, following the rules adopted in the first semester: in safety, in compliance with hygiene rules, with the use of PPE and observing the spacing.

NB for any further information, consult the unimi.it website: (Home Studying Attending a degree course Following the course of study Lesson times)
Prerequisites for admission
No prior knowledge is required
Assessment methods and Criteria
A written exam composed of 4 parts: 1) multiple-choice questions; 2) open-ended question on a theoretical topic; 3) exercise on the transcript of doctor-patient dialogue; 4) writing of a doctor-patient dialogue according to the patient-centered model. Results will be communicated through the online platform.
Internal medicine
Course syllabus
· The patient and his symptoms: a rational approach to symptom characterization, interpretation and meaning
· Rational and relational strategies guiding collection of patients' symptoms
· Developing a rational strategy to collect information about a specific symptom during the patient encounter
· The discriminating value of symptoms and clinical findings
· Exploring patient beliefs
· Exploring personal, family and social context to correctly interpret information collected from the patient:
- the role of prior probability of disease
- positivity thresholds for diagnostic tests: a choice and its consequences
· Some quantitative indicators useful to guide the choice of information to be collected: sensitivity, specificity, positive and negative predictive values; likelihood ratios, introduction to Bayes theorem
Excluding or confirming diagnostic hypotheses. Diagnostic logic.
Teaching methods
Lectures; supplementary activities (view and discussion of visits videos and role playing) and exercises in preparation for the final exam
Teaching Resources
Wulff HR. Rational diagnosis and treatment. Oxford: Blackwell scientific publications. 1981
- Wulff HR, Pedersen SA, Rosenberg R. Philosophy of medicine. Oxford: Blackwell scientific publications. 1991
- Martin AR. Exploring patient beliefs. Steps to enhancing Physician-patient interaction. Arch Intern Med 1983;143:1773-5
- Edwards DAW. Defining vs. discriminating features. Proc Roy Soc Med. 1971;64:676-7
Clinical psychology
Course syllabus
the patient-centered medicine model and the disease-centered medicine model,
- the patient's agenda,
- communication techniques
- exercise on the agenda and the techniques
- the triadic relationship
- the chronic patient: patient adherence, motivation and education
- patient education and psychoeducational groups
- styles and values in medicine
-exercise on triadic communication with the chronic patient.
Teaching methods
Lectures; supplementary activities (view and discussion of visits videos and role playing) and exercises in preparation for the final exam
Teaching Resources
Testi:
· Moja E.A., Vegni E. La visita medica centrata sul paziente, Raffaello Cortina Editore, 2000
· Buckman R. La comunicazione della diagnosi in caso di malattia grave, Raffaello Cortina Editore, 2002.
· Kubler-Ross E. La morte e il morire, Edizioni La Cittadella, 1976.
· Truog RD, Browning DM, Johnson JA, Gallagher TH. Errori medici. La comunicazione con il paziente e i familiari. Raffaello Cortina Editore, 2013.

Articoli e capitoli di libro:
- Sugli stili:
o Emanuel E.J., Emanuel L.L. Four models of the physician-patient relationship. JAMA 1992; 22/29 (267): 2221-2226.
- Sui valori:
o Jansen LA. Between beneficence and justice: the ethics of stewardship in medicine. J Med Philos. 2013 Feb;38(1):50-63. doi: 10.1093/jmp/jhs058. Epub 2013 Jan
o Thompson, I. E. (1979). The nature of confidentiality. Journal of medical ethics, 5(2), 57-64.
o Roeland, E., Cain, J., Onderdonk, C., Kerr, K., Mitchell, W., & Thornberry, K. (2014). When open-ended questions don't work: the role of palliative paternalism in difficult medical decisions. Journal of palliative medicine, 17(4), 415-420. (consigliato).
- Sul consenso informato:
o Codice deontologico dei medici
o Capitolo 1: Il consenso informato questioni di principio e regole specifiche di Amedeo Santosuosso
o Vollmann, J., & Winau, R. (1996). Informed consent in human experimentation before the Nuremberg code. BMJ: British Medical Journal, 313(7070), 1445.
o Charles C., Gafni A., Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two tango). Soc Sci Med 1997; 44 (5): 681-692. (consigliato).
o Surbone A., Ritossa C., Spagnolo AG. Evolution of tuth-telling attitudes and practices in Italy. Critical Reviews in Oncology/Hematology 2004; 52: 165-172. (consigliato).
- Sulla relazione triadica:
o Iapichino E., Vegni E. "Il terzo incomodo. Complicanze comunicativo-relazionali nella visita medica tiradica". La parola e la cura, Autunno 2007; 28-32.
o Laidsaar-Powell RC, Butow PN, Bu S, Charles C, Gafni A, Lam WW, Jansen J, McCaffery KJ, Shepherd HL, Tattersall MH, Juraskova I. Physician-patient-companion communication and decision-making: a systematic review of triadic medical consultations. Patient Educ Couns. 2013 Apr;91(1):3-13. doi: 10.1016/j.pec.2012.11.007. Epub 2013 Jan 17.
o Iapichino E., Vegni E., Cavacciuti F., Moja EA. "La visita in medicina generale: l'incontro medico-paziente e l'incontro medico-paziente-accompagnatore. Uno studio descrittivo". Recenti Progressi in Medicina 2007; 98(3): 160-165. (consigliato).
- Sul malato cronico e sull'intervista motivazionale:
o Emmons KM, Motivational Interviewing in health care settings. Am J Prev Med 2001; 20 (1): 67-74.
o Gruninger UJ, Patient education: an example of one to one communication. Journal of Human Hypertension 1995; 9: 15-25.
- Sulla patient education:
o Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-managment of chronic disease in primary care. JAMA 2002; 288 (19): 2469-2475.
o Lipkin M, Patient education and counseling in the context of modern patient physician-family communication. Patient Education and Counseling 1996; 27: S-11.
- Sull'aderenza:
o Osterberg L, Blaschke T. Adherence to medication. New England Journal of Medicine 2005; 353(5): 487-97.
o McDonald HP, Garg AX, Haynes RB. Interventions to enahnce patient adherence to medication prescriptions. JAMA 2002; 288 (22): 2868-2879.
o Vrijens B, De Geest S, Hughes DA, Przemyslaw K, Demonceau J, Ruppar T, Dobbels F, Fargher E, Morrison V, Lewek P, Matyjaszczyk M, Mshelia C, Clyne W, Aronson JK, Urquhart J; ABC Project Team. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012 May;73(5):691-705.
- L'errore in medicina:
o Reason J. Human error: models and management. BMJ, 2000 Mar 18;320(7237):768-70.
o Vescovo A., Vegni E., "La comunicazione dell'errore in medicina: una rassegna". La Cura 2007; 3: 12-20. (consigliato).
o Plews-Ogan M, May N, Owens J, Ardelt M, Shapiro J, Bell SK. Wisdom in Medicine: What Helps Physicians After a Medical Error? Acad Med. 2016;91(2):233-41. (consigliato)
o Allan A, McKillop D, Dooley J, Allan MM, Preece DA. Apologies following an adverse medical event: The importance of focusing on the consumer's needs. Patient Educ Couns. 2015 Sep;98(9):1058-62. (consigliato)
- La comunicazione delle cattive notizie:
o Lamiani G, Leone D, Meyer EC, Vegni E. Communicating bad news: Theory and practice for healthcare professionals' training. In: MF Freda & R De Luca Picione, editors. Cultural construction of social roles in medicine. Charlotte, NC: Information Age Publishing, in press.
- La morte e il morire:
o Roeland, E., Cain, J., Onderdonk, C., Kerr, K., Mitchell, W., & Thornberry, K. (2014). When open-ended questions don't work: the role of palliative paternalism in difficult medical decisions. Journal of palliative medicine, 17(4), 415-420.
o Kissane, D. W. (2012). The relief of existential suffering. Archives of internal medicine, 172(19), 1501-1505. (consigliato)
o Rothman DJ. (2014). Where we die. N Engl J Med. 2014 Jun 26;370(26):2457-60. (consigliato)
o Cook, D., & Rocker, G. (2014). Dying with dignity in the intensive care unit. New England Journal of Medicine, 370(26), 2506-2514. (consigliato)
o Van der Heide, A., Deliens, L., Faisst, K., Nilstun, T., Norup, M., Paci, E., ... & van der Maas, P. J. (2003). End-of-life decision-making in six European countries: descriptive study. The Lancet, 362(9381), 345-350. (consigliato)
- Il mondo interno del medico:
o Meier, D. E., Back, A. L., & Morrison, R. S. (2001). The inner life of physicians and care of the seriously ill. JAMA, 286(23), 3007-3014.
o Lorenzetti, R. C., Jacques, C. H., Donovan, C., Cottrell, S., & Buck, J. (2013). Managing difficult encounters: understanding physician, patient, and situational factors. Am Fam Physician, 87(6), 419-25.
o Laidsaar-Powell, R. C., Butow, P. N., Bu, S., Charles, C., Gafni, A., Lam, W. W. T., ... & Juraskova, I. (2013). Physician-patient-companion communication and decision-making: a systematic review of triadic medical consultations. Patient Education and Counseling, 91(1), 3-13.
Clinical psychology
M-PSI/08 - CLINICAL PSYCHOLOGY - University credits: 2
Informal teaching: 16 hours
Lessons: 12 hours
Internal medicine
MED/09 - INTERNAL MEDICINE - University credits: 2
Lessons: 24 hours