Summary

Patience and communication are the keys that allow the doctor to open minds and hearts in search of the right dialogue, which leads us to achieve the diagnosis and cure of patients. Patience is a virtue that has been less encouraged than communication at home and school, but it has been shown that it is susceptible to education, being convenient to answer a few questions before specific training. Communication requires patience with difficult patients and in special cases. Various methods of teaching listening and patience have been introduced in medical schools and need to be disseminated. An attempt has been made to develop a profile of the doctor who communicates with patience, an essential condition in the doctor-patient relationship. It is advisable to educate patience together with communication as an indissoluble binomial in medical practice.

What is the conceptual definition of this binomial?

Patience: it is the tendency or disposition to proceed calmly in the face of frustration or adversity. Patience has long been considered a strength of character and a trait that promotes human flourishing and well-being. There are three types of patience: interpersonal, in the face of life difficulties, and in the face of daily annoyances (1).

Patience is one of the virtues most desired by few and forgotten by many. Among the components of patience we find tolerance, self-control and calm. Tolerance consists of respect, acceptance and appreciation of the rich diversity of our world's cultures, of our forms of expression and means of being human. Tolerance is the harmony of difference, it is fostered by knowledge, an open attitude, communication and freedom of thought, conscience and religion. Self-control is the instrument with which we build or destroy roads, bridges, and paths in our lives. We need to cultivate mastery over all those things and factors that alter our way of thinking and feeling (2).

Communication: it is a dynamic process that involves different senders and receivers. A source or sender sends a message through a channel or medium to a potential receiver who, in turn, can also become a sender. The issuer uses a system of symbols that must be clear and shared by the recipient. For the message to be objective and fulfill its purpose, it must be delivered with a minimum of errors. (3). The receiver who hears the message must be attentive, an indispensable condition for successful communication, remember that communication can be two-way. The social role, the culture, and the way in which one constructs their message must be taken into account. The good communicator "must know how to listen" (4).

Is patience a virtue?

Patience is a highly relevant virtue in daily life. It has been widely discussed in various disciplines such as philosophy, psychology, religion, spirituality, and ethics. In the Aristotelian system virtue was considered as a subdivision of the fortress. The strong have in themselves the strength to stand firm and do not bear misfortune out of fear of infamy or out of the hope of pleasure but out of pride and out of a "love of good." Also the Stoic doctrine on virtue subordinates patience to fortitude. The wise man must exercise his will by enduring the ills of this life and thereby achieve fortitude (5). Historically Christian authors have defined patience as "the most exalted virtue" and as "the greatest of virtues" (6). In the ethical training of the doctor, training in virtues must be prioritized more than in principles, morality and good, scientific knowledge and morality gain importance (7) Patience like all virtues has two opposite vices, one is impatience and another is the hardness or insensitivity of the heart.

Is patience taught at home and at school?

The vast majority of learning is acquired in the first years of life both at home and at school, and behaviors, attitudes and values ​​are internalized. Currently, in most cases, parents have delegated socialization to teachers with the consequent loss of the family's socializing power. At school, they insist on promoting respect with classmates and teachers as the basis of communication, but it is regrettable that this is not accompanied by sowing patience (8).

Is it possible to educate in patience?

A Training Guide for Understanding and Developing Patience was developed at Baylor University (9). They asked 5 questions before starting the training:

1. How do you define patience?

2. List the benefits you believe the practice of patience brings.

3. Is it difficult for you to be patient in your daily life?

4. How motivated are you to develop patience? (List from 0 to 10).

5. Why do you want to be patient?

Three practices are recommended at the Mayo Clinic that help develop mindfulness and improve patience:

1. Stress reduction, based on mindfulness (REBAP), strengthens areas of the brain that regulate emotions and process learning and memory. It includes breathing, stretching and perception exercises.

2. Meditation, it has been shown that people who meditate have higher volumes of gray matter in the areas of the brain that regulate response control.

3. Mindful movement, yoga, aikido, tai chi, and qigong are all forms of conscious movement that strengthen the body and mind. It reduces stress, negative thoughts, and depression (10).

The calm is the stationary silence, it is the internal physical tranquility, absence of anxieties and worries. It is a degree of control, silence and parking of the processes. Patience is a gift, but it is also an attitude that allows you to see things as they are without any negative attitude. The impatient person is filled with anguish and makes whatever movement he thinks is necessary to speed up the process. Patience is the ability to learn to wait for something or someone without getting upset during the wait, knowing how to manage emotions well (2).

If you practice patience, you will learn to enjoy “transitional” moments such as traffic lights, waiting in hospitals, queues at supermarkets, or elevator rides.

How is patience taught in medical schools?

Patience when it comes to acting is not being rushed, dedicating the time that is convenient to each person (11).

Mentors have used a variety of teaching methods and have found that patients in telling their story to students make use of interprofessionalism, stimulate reflection, share perspectives, and guide problem solving, using patience and communication (12- 14).

Is patience necessary to communicate?

Patience is important in communication, especially with children, very sick people, those with severe intellectual disabilities, in intercultural situations, the elderly, and with difficult patients (15, 16).

The communicator must develop verbal and non-verbal skills. Among the first are clarity, precision, properly articulate sounds. Among the non-verbal ones we have to listen carefully, manage the patterns and silences, observe the faces and have patience to progress gradually and continuously (17). We cannot put aside and it is necessary to emphasize the art of listening (4).

There are patients with whom communication becomes difficult, motivating individual conflicts because they are difficult patients, other times due to deficiencies in the doctor-patient relationship. The ability to empathically interact with patients has been proposed to avoid frustration in this relationship (18).

Why is patience necessary in medicine?

Communication must be effective and adapted to the needs of each patient, it requires training, habit and skills, it is not innate, nor is it simply based on kindness. In many medical centers, users state that the waiting time, lack of communication, understanding and patience of the doctor with the patient, as well as of the patient with the doctor, are relevant aspects to be resolved since they cause misinformation, patient dissatisfaction, and put treatment at risk (19-21).

Is it possible to profile the doctor who communicates with patience?

Greet the patient with a Hello, go ahead, welcome; shakes hands, smiles, maintains good eye contact looking into the patient's eyes, offers welcoming gestures, oral communication is warm and clear, tone of voice is cordial, gestures are measured, and shows empathy.

Are the patients patient?

Patience is the ability to learn to wait for something or someone without getting upset during the wait, knowing how to manage emotions well. The true patient is the one who tolerates evils without having committed or devised them. The impatient person is filled with anguish, is disturbed while waiting, probably takes his cell phone eager to fill the time that passes while waiting his turn in the consultation (20, 22).

We understand that there are values ​​in life that take time to arrive: wisdom, patience, learning to deliberate, decision-making, respect, honesty, emotional maturity and integrity of the human being.

The patience of the doctor and the patient

In the doctor-patient relationship, problems will be assessed with tact, patience, clear communication and respect. Communication is the primary act of health medicine in a clinical encounter and patience is required from both the giver and the recipient. According to Burford, the appropriate clinical encounter is one that combines three aspects: Knowledge, confidence, and effectiveness (19).

What relationship exists between the binomial patience, communication, and ethics?

In a practical ethic for health professionals, good patient care is guaranteed, but also the good health of the professional and within the basic attitudes or virtues so that professionals can take good care, they should not lose the values ​​that give meaning to their activity and patients must be treated as subjects with rights.

To the basic ethical principles: dignity, autonomy, integrity are added the virtues of adequate communication, dedication, trust, patience, humility, honesty, respect, knowledge of the other and courage. Social values ​​are added along with other proposals (23).

conclusion

Patience and communication make up a binomial that has barely been taken together, but that increasingly show us greater utility in the medical field. Communication needs patience, which acquires excellence in special cases, especially with children, the elderly, intercultural problems, and even more so if patients are difficult to deal with in the doctor-patient relationship. Fortunately, patience can be educated and medical schools are looking for ways to implement it. A profile of the doctor who communicates with patience and who is not alien to ethics has been developed.