Communication and Relationship in Medicine 3rd Year
A.Y. 2023/2024
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.
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.
Lesson period: First semester
Assessment methods: Esame alla fine del gruppo
Assessment result: Inserire codice AF
Single course
This course cannot be attended as a single course. Please check our list of single courses to find the ones available for enrolment.
Course syllabus and organization
Single session
Responsible
Prerequisites for admission
No prior knowledge is required.
Assessment methods and Criteria
Just one exam will be held in the 4th year.
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
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.
· 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
Each CFU consists of frontal and innovative teaching hours. Innovative teaching activities consists of detailed study of topics, included in the program and agreed with students.
Frontal didactic hours will be devoted to frontal teaching, supplementary activities (view and discussion of visits videos and role playing) and exercises in preparation for the final exam.
Frontal didactic hours will be devoted to frontal teaching, 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
- 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
- Practice on the agenda and the techniques;
- Attachment theory;
- The triadic relationship;
- The chronic patient: patient adherence, motivation and education (psychoeducational groups);
- Styles and values in medicine;
- Shared decision making;
- Practice on triadic communication and with the chronic patient;
- Individual practice on patient-centered communication.
- The patient's agenda,
- Communication techniques
- Practice on the agenda and the techniques;
- Attachment theory;
- The triadic relationship;
- The chronic patient: patient adherence, motivation and education (psychoeducational groups);
- Styles and values in medicine;
- Shared decision making;
- Practice on triadic communication and with the chronic patient;
- Individual practice on patient-centered communication.
Teaching methods
Each CFU consists of frontal and innovative teaching hours. Innovative teaching activities consists of detailed study of topics, included in the program and agreed with students.
Frontal didactic hours will be devoted to frontal teaching, supplementary activities (view and discussion of visits videos and role playing) and exercises in preparation for the final exam.
Frontal didactic hours will be devoted to frontal teaching, supplementary activities (view and discussion of visits videos and role playing) and exercises in preparation for the final exam.
Teaching Resources
Books:
· 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.
Reviews and chapters:
Patient-centered medicine model:
· Visser, L. N., Tollenaar, M. S., de Haes, H. C., & Smets, E. M. (2017). The value of physicians' affect-oriented communication for patients' recall of information. Patient education and counseling, 100(11), 2116-2120.
· Fuertes, J. N., Toporovsky, A., Reyes, M., & Osborne, J. B. (2017). The physician-patient working alliance: Theory, research, and future possibilities. Patient education and counseling, 100(4), 610-615.
· Kelley, J. M., Kraft-Todd, G., Schapira, L., Kossowsky, J., & Riess, H. (2014). The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PloS one, 9(4), e94207.
· Eton, D. T., Ridgeway, J. L., Linzer, M., Boehm, D. H., Rogers, E. A., Yost, K. J., ... & Sauver, J. L. (2017). healthcare provider relational quality is associated with better self-management and less treatment burden in people with multiple chronic conditions. Patient preference and adherence, 11, 1635.
· Rutten, L. J. F., Hesse, B. W., Sauver, J. L. S., Wilson, P., Chawla, N., Hartigan, D. B., ... & Arora, N. K. (2016). Health self-efficacy among populations with multiple chronic conditions: the value of patient-centered communication. Advances in therapy, 33(8), 1440-1451.
· Mattarozzi, K., Sfrisi, F., Caniglia, F., De Palma, A., & Martoni, M. (2017). What patients' complaints and praise tell the health practitioner: implications for health care quality. A qualitative research study. International Journal for Quality in Health Care, 29(1), 83-89.
· Schaad, B., Bourquin, C., Bornet, F., Currat, T., Saraga, M., Panese, F., & Stiefel, F. (2015). Dissatisfaction of hospital patients, their relatives, and friends: Analysis of accounts collected in a complaints center. Patient education and counseling, 98(6), 771-776.
·
Styles in medicine:
· Emanuel E.J., Emanuel L.L. Four models of the physician-patient relationship. JAMA 1992; 22/29 (267): 2221-2226.
· Del Negro, S. M. L., Borghi, L., Ferrari, D., & Vegni, E. (2017). Comunicare l'indicibile: proposte dalla medicina centrata sul paziente al paternalismo palliativo. Recenti Progressi in Medicina, 108(12), 508-510.
Values in medicine:
· 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
· Thompson, I. E. (1979). The nature of confidentiality. Journal of medical ethics, 5(2), 57-64.
· 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).
· Truog, R. D, et al. Microethics: the ethics of everyday clinical practice. Hastings Center Report. 2015; 45(1), 11-17.
· Lamiani G, Meyer EC, Rider EA, Browning DM, Vegni E, Mauri E, Moja EA, Truog RD. Assumptions and blind spots in patient-centredness: action research between American and Italian health care professionals. Med Educ. 2008 Jul;42(7):712-20. doi: 10.1111/j.1365-2923.2008.03038.x. PMID: 18588650.
The triadic relationship:
· Iapichino E., Vegni E. "Il terzo incomodo. Complicanze comunicativo-relazionali nella visita medica tiradica". La parola e la cura, Autunno 2007; 28-32.
· 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.
· 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).
The chronic patient's motivation:
· Emmons KM, Motivational Interviewing in health care settings. Am J Prev Med 2001; 20 (1): 67-74.
· Gruninger UJ, Patient education: an example of one to one communication. Journal of Human Hypertension 1995; 9: 15-25.
Patient education:
· Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-managment of chronic disease in primary care. JAMA 2002; 288 (19): 2469-2475.
· Lipkin M, Patient education and counseling in the context of modern patient physician-family communication. Patient Education and Counseling 1996; 27: S-11.
Patient adherence:
· Osterberg L, Blaschke T. Adherence to medication. New England Journal of Medicine 2005; 353(5): 487-97.
· McDonald HP, Garg AX, Haynes RB. Interventions to enahnce patient adherence to medication prescriptions. JAMA 2002; 288 (22): 2868-2879.
· 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
· 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.
Reviews and chapters:
Patient-centered medicine model:
· Visser, L. N., Tollenaar, M. S., de Haes, H. C., & Smets, E. M. (2017). The value of physicians' affect-oriented communication for patients' recall of information. Patient education and counseling, 100(11), 2116-2120.
· Fuertes, J. N., Toporovsky, A., Reyes, M., & Osborne, J. B. (2017). The physician-patient working alliance: Theory, research, and future possibilities. Patient education and counseling, 100(4), 610-615.
· Kelley, J. M., Kraft-Todd, G., Schapira, L., Kossowsky, J., & Riess, H. (2014). The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PloS one, 9(4), e94207.
· Eton, D. T., Ridgeway, J. L., Linzer, M., Boehm, D. H., Rogers, E. A., Yost, K. J., ... & Sauver, J. L. (2017). healthcare provider relational quality is associated with better self-management and less treatment burden in people with multiple chronic conditions. Patient preference and adherence, 11, 1635.
· Rutten, L. J. F., Hesse, B. W., Sauver, J. L. S., Wilson, P., Chawla, N., Hartigan, D. B., ... & Arora, N. K. (2016). Health self-efficacy among populations with multiple chronic conditions: the value of patient-centered communication. Advances in therapy, 33(8), 1440-1451.
· Mattarozzi, K., Sfrisi, F., Caniglia, F., De Palma, A., & Martoni, M. (2017). What patients' complaints and praise tell the health practitioner: implications for health care quality. A qualitative research study. International Journal for Quality in Health Care, 29(1), 83-89.
· Schaad, B., Bourquin, C., Bornet, F., Currat, T., Saraga, M., Panese, F., & Stiefel, F. (2015). Dissatisfaction of hospital patients, their relatives, and friends: Analysis of accounts collected in a complaints center. Patient education and counseling, 98(6), 771-776.
·
Styles in medicine:
· Emanuel E.J., Emanuel L.L. Four models of the physician-patient relationship. JAMA 1992; 22/29 (267): 2221-2226.
· Del Negro, S. M. L., Borghi, L., Ferrari, D., & Vegni, E. (2017). Comunicare l'indicibile: proposte dalla medicina centrata sul paziente al paternalismo palliativo. Recenti Progressi in Medicina, 108(12), 508-510.
Values in medicine:
· 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
· Thompson, I. E. (1979). The nature of confidentiality. Journal of medical ethics, 5(2), 57-64.
· 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).
· Truog, R. D, et al. Microethics: the ethics of everyday clinical practice. Hastings Center Report. 2015; 45(1), 11-17.
· Lamiani G, Meyer EC, Rider EA, Browning DM, Vegni E, Mauri E, Moja EA, Truog RD. Assumptions and blind spots in patient-centredness: action research between American and Italian health care professionals. Med Educ. 2008 Jul;42(7):712-20. doi: 10.1111/j.1365-2923.2008.03038.x. PMID: 18588650.
The triadic relationship:
· Iapichino E., Vegni E. "Il terzo incomodo. Complicanze comunicativo-relazionali nella visita medica tiradica". La parola e la cura, Autunno 2007; 28-32.
· 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.
· 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).
The chronic patient's motivation:
· Emmons KM, Motivational Interviewing in health care settings. Am J Prev Med 2001; 20 (1): 67-74.
· Gruninger UJ, Patient education: an example of one to one communication. Journal of Human Hypertension 1995; 9: 15-25.
Patient education:
· Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-managment of chronic disease in primary care. JAMA 2002; 288 (19): 2469-2475.
· Lipkin M, Patient education and counseling in the context of modern patient physician-family communication. Patient Education and Counseling 1996; 27: S-11.
Patient adherence:
· Osterberg L, Blaschke T. Adherence to medication. New England Journal of Medicine 2005; 353(5): 487-97.
· McDonald HP, Garg AX, Haynes RB. Interventions to enahnce patient adherence to medication prescriptions. JAMA 2002; 288 (22): 2868-2879.
· 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
Clinical psychology
M-PSI/08 - CLINICAL PSYCHOLOGY - University credits: 2
Informal teaching: 16 hours
Lessons: 8 hours
: 4 hours
Lessons: 8 hours
: 4 hours
Professor:
Vegni Elena Anna Maria
Internal medicine
MED/09 - INTERNAL MEDICINE - University credits: 2
Lessons: 16 hours
: 8 hours
: 8 hours
Professor:
Vegni Elena Anna Maria
Educational website(s)
Professor(s)