EVALUATION OF PSYCHIATRIST’S COMMUNICATION WITH PSYCHOSIS PATIENTS

: Evaluation of the physician-patient relationship is very important in determining priorities in medical practice and medicine. For this purpose, in this study the psychiatrist’s communication with psychotic patients as a sensitive group was evaluated. A questionnaire was administered to 210 patients in a psychiatric clinic of Inonu University Hospital in Turkey to determine how the examination is performed in the facility for outpatients in the psychosis unit. According to the study conducted, it was observed that the evaluation score of the psychiatrist’s communication with psychotic patients increased positively with increasing consultation duration. Our work is particularly noteworthy because it deals with a sensitive area, such as a group of psychiatric patients. The scores were obtained based on data from the evaluation of the questionnaires, which showed that the communication between the psychiatrist and the psychotic patient was conducted in a sensitive and careful manner, and without ethical problems.

The principles of beneficence, non-maleficence, justice, and autonomy are accepted as international ethical principles. The greatest damage that may occur while providing health care is the death of the patient. Medical faculty students are trained to be a benefit to their patients during medical education. In this process, it is also in the direction of "primum non nocere" (non-maleficence) principle which is included in Hippocratic teachings to provide health services without deteriorating the current situation of the patients. Beneficence and non-maleficence ethical principles have complementary processes. Anyone willing to benefit from health services under the justice principle shall be entitled to any ethnic origin, material status, gender, nationality, country, religion, profession, and it is necessary to ensure that all patients are available without any discrimination. Autonomy requires that patients be included in the decision-making process by adding them to their diagnosis and treatment processes (8).
Approaching patients in the direction of ethical principles in the provision of health care services will prevent many problems from occurring. One of the most important steps in accessing the physician's diagnosis and treatment processes is physician-patient communication. Communication can be seen as the main element of medical care. In the last two decades, the communication between the physician and patient has greatly attracted attention. Descriptive and experimental studies have shed light on this communication process (9).
One of the main features of communication is who is at the center. In general, there are important differences between the observed and criticized relationship of the physician in the center or the relationship of the patient in the center. At the physician's center, the time to separate the patient is very small and the physician insists on the first symptom expressed by the patient. The physician, who is reluctant to devote time to the patient's emotions, will lead to closer contact with the patient and avoid a real connection with human beings. It is important to listen and tolerate the processes of silence, to interpret the patients'

Introduction
The evaluation of the physician-patient relationship has an important place in medical practice and medical ethics. In the Geneva Declaration of the World Medical Association in 1948, the physician's priority should always be the health of the patient. The International Code of Medical Ethics states that the physician is obliged to present all the scientific knowledge with the traditional approach of the physician-patient relationship, which is rejected by both legal and ethical circles. Patient autonomy is often a problem. After all, many patients cannot make decisions about the health care that will be offered to them (1)(2)(3)(4).
This research aimed to evaluate the communication problems of psychiatrists with psychotic patients and the ethical considerations in this process.
Psychotic patients in the psychiatric patient group are also considered to be a sensitive group in which this dilemma can be experienced. Physician-patient communication emerges as an important process before these patients are transferred for treatment. It may be necessary for the physician to communicate with the persons accompanying the patients in this sensitive group. The fact that a physician has good communication skills can facilitate his/her communication with psychotic patients who are unknown.
Having theoretical knowledge about medical ethics in the provision of health services does not mean that appropriate behavior will be demonstrated. Ethics is about the behaviors that people make on the social scale and which have consequences that affect others and the thinking processes that shape them. As a subfield of philosophy, it deals with what ethics is, what goodness means in terms of behavior, and what is good; aims to formulate the ideal behavior of the human being (5)(6)(7).
Ethical values are the criteria for thinking processes that determine behavior in mind, and they provide a source of rules governing behavior at the community level. Ethical rules are those that are more concrete than ethical principles and are derived from ethical principles, which guide be-only by psychiatric patients. The physician may also have communication problems with a patient with an illness for any reason. But a healthy communication with the physician's patient will have consequences for the benefit of the patient (19,20).

Methods
Our study was planned to evaluate the psychiatrist-psychosis patient interview with a questionnaire. A physician who has received communication training was employed to observe the prepared questionnaire survey, the process was carried out in the Psychiatric Unit Clinic of the Inonu University Medical School. Interpretation of the questionnaires was done by other authors. The first three questions of the questionnaire are "sex", "age" and "interview duration". The next conditions, to explain them to the patient, and to be informed (10,11).
Questioning technique is important in the ability of a physician to empathize and listen effectively. The emphasis on psychiatry emphasizes the mental state of another human being. The physician who can see through the eyes of the patient is considered to have taken an important step in communication (10,12).
Effective relaxation is to make the patient feel that all of what he says is perceived. Behaviors such as repetition, approval, and maintaining eye contact with the patient are important (10,13).
Psychotic patients were found to be around 36 years of age and an average of 15 minutes of physician/patient interview with these patients. The shortest interview time was 7 minutes. According to the research we conducted, it was seen that the evaluation score of the physician-patient communication improved in the positive direction as long as the duration of the physician's interview with the patient was prolonged (  When there is a communication problem, it is most likely that the patient will suffer from this process. Physicians and patients should be able to establish communication properly for both diagnosis and treatment. In particular, the communication of the physician with a sensitive group of patients needs to be realized with more importance.
Physician-patient communication evaluation surveys at other clinics will provide us with information about this process. It is possible to benefit from these findings by going out of the way.
If our study had been conducted with a validated questionnaire, it could be ensured that the research was more original. In another research to be done later on the subject; it is important to determine the gender of the physicians and to determine their communication with the patients. In addition, comparing the outcomes of different outpatient clinic/physician communication evaluations will provide us with important results.
We did not find any other literature evaluating psychiatric patients and psychiatrist communication in Turkey. However, if we were to examine the study of informed consent from schizophrenia patients that we thought might be related to the topic, the study of Combs and colleagues found that the group of patients with schizophrenia had a low evaluation score in this process (21). As a result of this literature review, it was seen that there was no study similar to our research.
Although the work of Combs and colleagues is not communication work, the informed consent process necessarily requires communication. It has been determined that our literature surveys have more patient satisfaction studies.
In addition to the possibility of speech disorders in schizophrenia patients (22), communication skills are very important to the physician who can experience communication problems even in patients without speech impairment.
female patients has a minimum score of 55 and a maximum score of 71, while communication with male patients has a minimum score of 54, and a maximum score of 74 points (Table 2).
It is understood from the answers given to the related questions that communication is important in the study of psychiatric patients. Significant results were seen in both female (P = 0.006) and male (P = 0.040) psychotic patients. In addition, it was significant for both females (P = 0.008) and males (P = 0.049) that the physician understood his/her words.
The questions that gave meaningful results evaluation of the interview between the physician and the female patients were the question of whether the doctor verbally understood what was explained (P=0.01), the doctor does not interrupt the person who spoke (P=0.021), the question of whether the doctor understood what was explained (P=0.045), and the doctor has avoided judicial expressions (P=0.028). It is thought that the gender of the physician may also be effective in generating these results. For example, in the evaluation of the interview of the physician with the male patients, it was seen that the doctor who gave meaningful results talked without giving advice (P = 0.037).

Discussion
Considering that a maximum of 75 points and at least 15 points could be taken from our questionnaire in this survey which was conducted to evaluate the communication between psychiatric physicians and psychotic patients, it was seen that 64 points were obtained for female patients and 63 points for the male patients.
Our work has been particularly featured because it was created in a sensitive area, such as a psychiatric patient group. According to our research, physicians should score 45 points in their communication with a patient, indicating that the ethical problems that may arise due to the inability of the physician/patient to communicate can be reduced.
A questionnaire survey was conducted at a University Hospital Psychiatry Department through to be provided without any sensitive and careful ethical problem.
It has been argued that the data we obtained may lead to useful conclusions in the physicianpatient relationship. Especially, it has been tried to put into question whether psychiatrists' ethical problems are caused by evaluating communication with psychotic patients.
This study in which the psychiatrists tried to show the sensitivity that they showed in their communication with psychosis patients, should be evaluated and compared with the questionnaires of the physicians and the patients other than psychiatric patients, and communication problems in health service presentation will be determined and solutions will be found.
Acknowledgments: I would like to thank the authors of publications related to this research.
Financial support and sponsorship: Nil.

Conflicts of interest:
There are no conflicts of interest.
In the study we did, the duration of the interview with the patient and the psychiatrist was at least 7 minutes and at most 35 minutes. As the time allocated to the patient increased, the score of the communication questionnaire increased positively. In our study, the patients were separated for an average of 15 minutes. It is clear that in the physician/patient communication, it would be beneficial for the patient to perform the interview by allocating a suitable patient for each patient.
The principles are mostly generic, but their implementation can be particularly challenging in psychiatry. They may guide further empirical research on effective communication in psychiatry and be utilised using different personal skills of psychiatrists (23).

Conclusion
Our work is important because the psychiatrist/ psychosis patient interviews were conducted on a sensitive group. The scores obtained based on the data obtained from the evaluation of the questionnaires showed that the communication between the psychiatrist/psychosis patient was tried