A: of related things and can’t catch him/her, you

A: Introduction:A good communication skill is the ability to deliver an information to your patients clearly and simply.

It’s about transferring and receiving words openly, and being able to read your patients.  Extracting a history of patients tell a different stories and different truths depending on the questions i ask and the concerns i raise. That’s why there is always something patients can hide and will be new for you in his family history.

History is like a display to monitor. It provides a different senses and different story as they become a believable listener and authentic speakerRemember that these are non-verbal as well as verbal. Your physical place with regards to the patient’s and your body language all add to the result of the discussion.

Be calm and smile. If they have waited a long time in the waiting area, an apology is appreciate, it will give you a much better start good communication and shows a respect for their individuality.Avoid writing while the patient is talking, if they are mentioning a lot of related things and can’t catch him/her, you need to slow them down, mention it to the patient so that they understand that you are still listening and caring . In a patient interview be attentive, staying focused.

There may be hidden concern such as a worriedness about chronic disease that needs to be discovered.  Reading, writing, speaking, and listening are mandatory for a good communication skills essential for real communication in any environment, work and everywhere. Always try to establish trust between both parties, speak clearly, recognize problems, use body language and voice tone and be a good listener.

B-Background (Presenting complains, Diagnosis process, Initial treatment. Current situation) Patient SAS is a Saudi citizen, married , 57 years old, he was a school principle lived in Al Khobar city, SAS follow up with the clinic since he was 30 years old complaining with a short breathing. His breathing became worse with age factor and got gradually poorer as age get older. The short breathing became 10 out of 10 without medicine that means very dangerous, although 5 out of 10 with medicine. Also, when he started to exercise his inhalation became worse and when he also using the stairs. This symptom associated with losing of smell and taste sense of anything. SAS Mothers died at age of 62 and she was a diabetics and high blood pressure, but she did not died because of diabetes and blood pressure but due to heart attack.

SAS father’s is still alive but he also diabetics and high blood pressure. The patient has two sisters and two brothers. He is the elder one .Briefly, three of his brothers and sisters have the same symptoms of asthma. The patient has four children two daughters and two sons.   SAS got several diagnosis includes the examination of ear, nose, lungs breathing and also x-ray for thoracic cavity include short of breathing caused by asthma so eventually the patient SAS has severe asthma.

The patient SAS advised to change his daily lifestyle which includes his exercise, sleep, diet and other habits. Furthermore, he has been communicated about the medication which will be described and given later on. Now the condition of patient is under control, but he is highly concerned about his condition that get worse and worse, because the first time he came to the doctor he asked him about his life cycle and what will happen later on, the doctor advised him to take it very relaxed and follow all the instruction that going to be given by him for better future. C: Biological aspects:The asthma is the inflammation and narrowing of bronchial tubes and it is a chorionic condition cause lower of airflow and oxygen to income to lungs, it is association with sound in breathing or whistling sound and maybe snoring in sleeping, if you have the asthma and exposed to some substance like dust and smoke you will get unregulated breathes because you have sensitive of these substances and you may be have severed condition.There are many things caused asthma but we have two types of asthma: first one relate to allergy it is called allergic (atopic) asthma that caused by allergy, the second one is non allergic (non-atopic) asthma caused by stress, exercises, illness and weather condition.

In biologically the allergic asthma caused by allergy of animals such as sheep, dogs and cats, they irritate the airways and righted them so it becomes more inflamed this will lead to short of breathing, wheezing, coughing and more production of mucus, that because the immune reaction and the cells of immune system work inappropriate way so that cause unwanted reaction. There is a protein in lungs called hedgehog (Hh) people with asthma have more hedgehog protein than normal people so if we reduce the amount of the hedgehog we can treat the asthma.The patient SAS have the type two mention asthmas that caused by exercises and effort and it is not allergic asthma.Extreme weather condition, changes in weather can caused severe asthma some people having asthma become more severe asthma in some certain time of year, first cold, dry air is the most common cause of asthma, the second hot and humid air in some places and the third and last wet and windy weather, also irritants in the air like stay with someone who exposed to smoke, air pollution and stress.The perspective of treatment that refers to asthma depend on two types of treatment pharmacological and non- pharmacological and also the behavior condition.We have two type of non- pharmacological include the first and second prevention, in first prevention the intervention plays a significant role before the disease occur and reduce the incidence it is include: avoid allergy substance, weight loss, avoiding smoking people and exercise there are many exercises for getting cope with asthma including breathing and relaxation exercises such as yoga and walking the patient SAS used to walk every day at 7 PM that prevent the asthma symptoms and increase the level of breathing and health . Second prevention intervention occur after the disease to reduce the symptoms and it is impact that include: avoid allergy substance for not become worst such as house dust, some chemical substances, smoking areas, dietary for children and obese people and avoid the hard effort like the patient SAS recommended to use the elevator rather than stairs because that requires an effort and the SAS is old in age.In the other hand, there are many medications have effective, people with asthma use two types of medicines: quick relief medicines and long term control medicines and also immunotherapy treatment.

Quick relief medication is used after the first sign of symptoms to reduce and over it immediately such as anticholinergics and short-acting inhaled beta2-agonist, they are bronchodilators, that’s mean they expand and open the airways passage to the lungs and that will improve the level of breathing, and help to easily move of mucus by enabling it to move freely by coughing out of the body. Long term control you have to take it every day to prevent the symptoms and asthma attack such as cromolyn sodium, anticholinerics and methylxanthines. The immunotherapy treatment includes two types allergy shots and sublingual tablets, allergy shots is used when the symptoms arise because an allergy which they have an effective response and sometimes lead to cure it. The sublingual tablets which the patient SAS is used are takes before months of the allergy time or seasons, it can use for three years and not recommended for uncontrolled asthma patients also SAS used to take cortisol which helps to relieve the sense of smell and taste.  D: Ethical issues:I was in a clinic with a doctor when the patient SAS get in and set with us, the patient SAS has been waiting for one and half hour to be seen by physician, SAS was very upset for delay but the doctor was very kind because he welcomed and shake hands the patient SAS and deliver some jokes to create more healthy environment , build a strong communication and trustful, the patient SAS was very restrictive and more serious, the doctor accept that because SAS has been waiting for a long time and after that the doctor start the questions and got through the observation.

 While myself and my colleagues were taking our notes for observation, the patient SAS felt uncomfortable because there are a lot of thing SAS want to mention it to the doctor, the doctor gave the patient SAS a piece of paper to write things that could be considered as a top-secret, after the patient SAS left the clinic,  one of classmates asked the doctor what SAS has wrote in the paper, the doctor said, This is part of patient confidentiality and I do appreciate all concerned that what happened in the clinic must be respected and kept top secret between you and the patient and does not share it to another else. We were so happy to the patient SAS for the good observation and feedback and it’s part of patient right. Also, we do thanks a doctor for his great reaction, the doctor reaction was very professional and formal because he understood that patient SAS was very annoyed for the time that he postponed, the doctor apologized to the patient and explained the process of each patient and the analyzing took so long to provide a good and accurate diagnosing. Also the doctor stated and promised to the patient that will not face it again, the patient SAS understood that and accept that.E: The legal issues:Worldwide, all procedures that takes place by the hospital must be approved by official association to identify the healthcare standard and avoid any failure that could lead to government consequences.

In general, it is different standard from country to country but that not mean there are many country allowed for illegal procedure.From my knowledge about the consent for procedure and it is important against mistakes and legal error, in my case for the patient SAS when the doctor asked for branchial thermoplastic, then he told that will be done after taking permission from him, and the doctor asked the SAS to disclose his back to examine the breathing and let us to check the condition together. This way in asking patient to consent is the correct way to protect the doctor from any legal error, the last thing also the doctor asked the patient to let us to observe when he came to clinical room. When the patient left the clinic room after examination, we have asked the doctor to see the patient SAS file to take the good and correct information about his case, but doctor refused that and said this is a confidential information, and it shouldn’t be shared to another else, even if someone from the patients relative asked about the patient case I will refuse to tell anything to them.

F: Sociological aspect:In my opinion, the access to health care in Saudi Arabia is very easy and there is nothing difficult with that, also with foreign people who live here have a large and wide of services, me as Saudi citizen the health care is available and distributed in any place and that according to the city and needs of citizens, also there are a lot of companies that rolling in the providing high level of health care. I asked the patient SAS about the health care center and said it is took only 5 minutes for an appointment. Economically, as I said SAS is a school principle and has a good income, and does not has any loan to pay, so he will not face any problems with the payment, but the Saudi government provide the health services for free so SAS does not require to pay anything to get the health services all the costs of Saudi citizens are free.The culture where the patient live has effect on the way that the patient thinks about the disease, and how to deal with it.

The patient SAS is Muslim and live in alkhobar, he actually treats his disease by modern way not old way. The doctor said anything the patient belief we should to respect it as well as Muslims.I would like to explain that the condition of live will affect the state of asthma and it’s severity, but the patient SAS has a good quality of life and family state, so he maintain a good health situation. G: self-care and lifestyle: The patient SAS was graduated from king Faisal university and the last job assigned to him was a school principle, during the discussion that held between us in the waiting area that he lost both senses of smell and taste and It was affected him psychologically for a month but he recovered himself and adapted that for whole life.Nowadays, he retired from his job and stayed home. SAS arranged himself with his new retirement life style by exercises, dietician and traveling. H: patient’s perspective:I liked the patient SAS that he has concerned about his condition, he has searched about his chronic disease and knew everything that will gauge or relief the symptoms, even he sit with us and explained the physiological change after he has the asthma.

The patient SAS has believed that everything he got is from the god and accepted his condition. He acknowledged that he felt so proud that family support was highly appreciated, because he and three of family member has also the same asthma.   I: own perspective:It was the most beautiful and experiment moment in my life, when the doctor asked the patient SAS about what complained he felt.

It was like the moment about 15 years back where we have learned in the medical school, he tried to explain the most accurate information from the patient to deliver the appropriate diagnosis. As result, I have learnt from the doctor how to deal with the patient and how the behavior and formal way will give you a good reflect from the patient.The clinic was very impressed and organized, the light was very shiny and decorated. The environment was healthy and the place was well structured for each clinic. Overall the clinic is designed, secured and the privacy for the patient meet their needed.

J: conclusion:   The patient SAS has asthma that affect his breathing and bronchioles due to that he has change his lifestyle, after the diagnosis and examination the result showed that he has a severe asthma which measured as a chronic disease, but he has controlled himself by medication dose and another daily activities. Concisely, the knowledge that I had in the hospital was one of the best experienced that been improved my thinking about the progress of treatment for each patient from in tell the end.