STATUS OF PATIENT-DOCTOR COMMUNICATION IN A NEPALI HOSPITAL

Later it is analyzed and interpreted themacally with the help of pie charts and tables. Result Ethical appeals, logical appeals and emoonal appeals are found good in paent-doctor communicaon in this hospital under study. In terms of ethos, logos and pathos separately, paent-doctor communicaon in Nepali hospital appears to be good. However, there is a lack of combinaon of all these three elements in most of the respondents.


Introduc on
The dialog of thoughts and informa on verbally or nonverbally between doctors and pa ents is pa ent-doctor communica on. This study explores the persuasive quality of pa ent-doctor communica on in a Nepali hospital. With the help of the data collected, the study evaluates mainly ethical appeals, logical appeals and emo onal appeals.

Objec ve
The objec ve of this research is to evaluate the persuasive elements specifically ethos, logos and pathos of pa entdoctor communica on in a Nepali hospital.

Methodology
This is a hospital based descrip ve study. This research has used Aristotle's rhetoric: Ethos, logos and pathos. Because of the lack of big data in this area, secondary data is scanty, so an empirical tool (survey) is adopted for genera ng data. First a survey is done on 50 doctors working in the hospital, and 300 outpa ents suffering from chronic diseases. The data is collected and entered on an Excel file. Later it is analyzed and interpreted thema cally with the help of pie charts and tables.

INTRODUCTION
Communica on with the pa ent is an art. A medical professional can earn a lot of degrees, but communica ng with the pa ent always remains a problem for some of 1 them. This research studies the quality of pa ent-doctor communica on in a teaching hospital. The teaching hospital located in Dhulikhel Municipality, Kavrepalanchowk district. It provides its service for all medical programs. It serves hundreds of people in neighboring districts, too. Though some researches have been done at this hospital, big data can be scarce as it is a recent phenomenon, and given its rapid implementa on and deployment there are ongoing debates as to what cons tutes big data and its connected characteris cs. Some defini ons, such as that big data are too large to fit in an Excel spreadsheet or be stored on a single machine are quite hackneyed and unhelpful, and 2 reducing big data to merely volume. Pa ent-doctor communica on is important as no proper diagnosis or treatment occurs without proper communica on, but big data on this case are lacking as enough studies on this issue have not taken place yet. This study analyses whether doctors and pa ents interact with each other to make sense of the illnesses, and to posi on themselves in a wider medical and social reality. It examines if its importance is seen in this hospital. The main aim of this research is to know the condi on of doctor-pa ent communica on along with the brief explora on on finding out of ethos, logos and pathos, which aspects affect the quality of it at a Nepali hospital. A large part of the communica on problem may be a ributable to a gap between the percep ons of physicians 3 and pa ents. In the twenty-first century, Nepal too has a market driven society, and pa ents are like dei es. But many hospitals in Nepal are not driven by this mo o, and services pa ents received in these ins tu ons are an area that demands a en on throughout the country. Many doctors show their negligence toward the talk of the pa ent which leads them to miss the very important history of prolonged disease. The emerging evidence suggests that it provides a moderate advantage over comparison interven ons and could be used for a wide range of 4 behavioral issues in health care. This is the reason why many hospitals are destroyed which results the pa ents along with their rela ves to have trust issues towards these ins tu ons. As the result, they are 2 a racted to health care centers abroad. The agendas of doctor-pa ent communica on in Nepal reported occasionally in local newspapers cannot be ignored. Even a few of ar cles have failed to include the broad ranges of doctor-pa ent rela ons.

METHODOLOGY
Quan ta ve research design is used with descrip ve design that details characteris cs, averages, and tendencies. In this study, the ques onnaires explore percep ons of doctors, and pa ents regarding effec ve communica on between them. Informa on is being collected over one-month period (July to August 2017). Three hundred pa ents and fi y doctors are the respondents of this study. Even though the popula on is slender, the effects resonate the true plethora of the pa ent and doctor's communica on because the health center is the most important in this vicinity with many outreach facili es. Moreover, all types of doctors and pa ents go there for treatment. The informa on is collected and entered on an Excel file. Later it is analyzed and interpreted thema cally. Usually, we use in qualita ve study, verbal and wri en request are made to the authority before undertaking the study. Pa ents are asked about their percep ons regarding doctors' communica on to them with the variables of the survey. The amount of informa on doctors give to their pa ents 5 may be influenced by pa ents' personal characteris cs. Two types of variables are used in this research. For doctors, gender, age, specialty, years from gradua on, years from becoming specialist, and professional status are considered. Similarly, for pa ents' gender, age, educa on, dura on of the disease and dura on of the medical observa ons are made the criteria. Since there are contrary findings in the literature regarding the issue of the influence of communica ve behavior on pa ent outcomes, it is determined whether there was any difference between pa ents' percep on of the amount of informa on provided by the doctors. Moreover, the doctors' a tude and communica on with them, and how these factors affect 6 pa ents' sa sfac on are taken in considera on. These results are analyzed by using Aristotle's rhetoric: ethos, logos and pathos. An empirical method, a cross-sec onal survey is adopted for genera ng data. Finally, the data are churned out together in terms of ethos, logos and pathos. Data is collected and analyzed using the data analysis plan (See Appendix 1). Data-analysis processes are sufficiently described and detailed to be replicated. Data-analysis procedures conform to the research design, hypotheses, models, and theory drives the data analyses. Rhetorical triangle is essen al to persuasion: Ethos, logo, and pathos are the key elements of the triangle. Ethos means caring and competence as "if pa ents like their doctors and trust not only their technical skills, but also their commitment to advocate a plan of treatment that really is best suited for the 7 pa ents, the pa ents are more likely to comply". Pa ents' and doctors' conversa ons are evaluated by examining how much pathos, ethos and logos are expressed in their interac ons. Thus, the framework is used to extract the degree of persuasion in their conversa ons.

RESULTS
Out of 300 pa ents, 117 (39%) people were in the age group 40-50, 78 (26%) were in between 30-40 age. Half of the pa ents were illiterate. 81 pa ents had qualified SLC/+2 pass, whereas 30 people had Primary Educa on. Similarly, 21 of the pa ents had the qualifica on of Master's Degree, and 18 of pa ents had Bachelor's Degree. One hundred fi y nine pa ents were females and the rest 141 were males. Twenty-five doctors surveyed were of age group 25 to 30, 20 doctors were in the age group of 30 to 35 and 5 doctors were 35 to 40 years old. Regarding the doctors' gender, out of fi y, 40 of this hospital were found to be males and other 10 doctors were females.  By evalua ng both tables, ethical appeals, logical appeals and emo onal appeals are found not decent in pa entdoctor communica on in this hospital under study.

DISCUSSIONS
Persuasive messages might differ in content, tone and context. Variables such as age, qualifica on, gender had clear roles regarding the degree of presenta on. In some cases, it might seem more effec ve to present it later. Although most client-related variables are unrelated to outcomes (e.g., age, gender, severity), some decisions about 8 treatment format (e.g., individual vs. group) are important. Another aspect of the message that had been studied was its structure. The content of the message given to the pa ents had to be convincing so that they would be persuaded to buy, consume medicine and go for follow ups. The results of the research showed that doctors who were more educated and had training performed be er. Results indicate a posi ve impact on a tudes toward learning communica on skills and self-efficacy regarding communica on 8 in the clinical se ng. The problem of use appeals to the ra onal or emo onal aspect of the recipient target was inves gated. When people were reasonably persuasive, the appeals influenced the recipients equally. In many compelling contexts, the recipient of the message is incompetent or unmo vated. To effec vely handle ra onal complaints. In such cases, persuaders o en feared as well as emo onal persuasion from humor to compassion. On the other hand, personality factors pertaining to the receiver were important factors limi ng the impact of fear appeals. Majority doctors at the Nepali hospital believed that their recent consulta on was very sa sfying for them. Almost all achieved the goals of the sessions with the pa ents. Almost all doctors believed pa ents understood the language they used, and there was be er communica on. Majority of doctors did not understand what they are trying to do. Majority of doctors built trust with their pa ents and met pa ents' expecta ons. Bulk number of doctors had a nice rela onship with their pa ents. None strongly disagreed, nor disagreed with it. Majority of doctors had good rela onships with their pa ents. Most doctors believed that they are following for the best outcome. The pa ent doctor communica on is important in understanding the problem of the pa ent by any doctors so doctors' willingness to avoid pa ents is posi ve. The results showed that the majority of the doctors were too much busy and desired to spare their me with pa ents. Most of the doctors communicated with pa ents harmoniously whereas some of them did not understand them properly. Only a few doctors were confident about the posi ve response of the pa ents whereas other doctors were doub ul fully or partly confident about the response of the pa ents. Majority of the doctors were always cheerful to the pa ents, but some doctors became angry momentarily. Majority of the doctors appeared to be professional in communica on. Majority of the doctors fully or partly relied on the internet sources for ge ng the informa on about the pa ent's illness. The handwri ng of doctors had always been an issue since decades. They were the pharmacists who were required to understand the reports and medicines prescribed by doctors, and the doctors' honesty in overall pa ent-doctor communica on was not good. But the pa ents felt comfort in overall pa ent-doctor communica on. The results were genuine since the preeminent experts in the hospitals were always doctors. Most of the people agreed with the things the doctors asked them to do. On the basis of these responses, we analyzed the trust of overall pa entdoctor communica on in Nepali hospital. It was found that all ethical appeals, logical appeals and emo onal appeals were not excellent in pa ent-doctor communica on in Nepali hospital. It was shown that pa ent doctor communica on was very important because it associated with sa sfac on. Sa sfac on with pa ents would affect other outcome sources adherence to treatment, and ul mately be er physical health. Pa ents who were more sa sfied with their doctors are more likely to con nue receiving them and they also referred friends and family members. It was a poten ally posi ve outcome of the pa ent sa sfac on. It needs to address strengthening different aspects like Interpersonal Rela on of the hospital staffs with consumers, maintenance of hygiene and sanita on, place of examina on, 9 doctor pa ent ra o etc. For pa ent sa sfac on with providers was largely associated with doctors' interpersonal communica on skills. It was found sa sfac on was o en linked to doctors' ability to communicate with emo onal support, availability, understanding and caring to the pa ent. Doctors' success was earned with a balance between addressing medical and psychological concerns when communica ng with pa ents. Pa ents are also more sa sfied with their doctors when they were encouraged to express concerns. It did not appear to be as important as percep ons of doctors' personal skills conversely pa ents' dissa sfac on had been found to be related with lack of interpersonal warmth or friendliness on the part of the doctors, and wai ng room me. Doctors' failure to recognize pa ents' conscious and clear explana ons of medical condi on diagnosis and treatment, inappropriate use of medical jargons harmed their communica on.

CONCLUSIONS
On the basis of responses, we studied the trust of overall pa ent-doctor communica on in a hospital. Both doctors and pa ents believed that the rela onship and communica on between them is important, but it was not happening in reality. It was found that all ethical appeals, logical appeals and emo onal appeals as a whole were missing and not excellent in pa ent-doctor communica on in that hospital.

LIMITATION OF THE STUDY
Keeping in mind the big data revolu on, the major limita on of this is the necessity of restric ng the number of hospitals selected for this inves ga on. There are many hospitals established ll date, in order to examine a single ins tu on more closely, we selected to focus on pa ent-doctor communica on in a Nepali hospital. It is almost located in the central part of Nepal and popular for community service. Moreover, it is big enough to a ract a large pool of doctors and pa ents from many parts of the country.