Effective doctor-patient communication. Episode 64

Monika Rachtan
Hi, Monika Rachtan. I would like to welcome you very warmly to the next episode of the programme "Patient First". We all know that talking to a doctor is very important, because this conversation allows us to learn more about our health, but it also allows us to be a more educated patient. And a more educated patient is a patient who is easier to treat. And today I am going to talk to Justyna Tyminska, MD, PhD, about conversations with doctors, about patient-doctor communication. Good morning, doctor.

Justyna Tyminska
Good afternoon. Thank you very much for the invitation.

Monika Rachtan
She is a specialist in family medicine. She also teaches students about communication precisely on the patient-doctor line, and she specialises mainly in this communication. Is that right?

Justyna Tyminska
Yes, I think it is the work of the GP that has created such a need for specialisation in communication, because if we have 15 minutes per patient and we have to diagnose them and explain how they should be treated, that is the kind of field that needs good communication.

Monika Rachtan
Well, yes, of course. And here it's also very important that not only doctors try to communicate well, but I think it's also very important that patients are able to answer the doctor's questions in such a way that the information is useful to the doctor, right?

Justyna Tyminska
By all means. Full agreement. The problem is whether the doctor is open enough to make it easy for patients to talk about their health. Because sometimes patients are embarrassed to bring up certain topics when they encounter a doctor who does not show understanding or empathy for them.

Monika Rachtan
I would ask what to do in such a situation, when we sit down in front of the doctor and feel that the conversation is not going well, that we are not really able to open up to the doctor. What do you do in such a situation? Do you actually try to make contact or go to another specialist?

Justyna Tyminska
It seems to me that patients deal with this differently. Some start, and there are more and more such patients, to fight a little for their rights, to talk about their emotions, that they feel misunderstood and would like to talk about their problem in a different way. The more closed-minded ones, on the other hand, will often not tell us that they felt bad in our office. And indeed, what you said, they will go to another specialist.
Monika Rachtan
Up until a few years ago, I think a lot of patients thought of the GP in such a way that this is the kind of doctor you go to for a prescription and a referral. And that's basically it. Well he himself doesn't really know how he should treat me, so he sends me to a cardiologist. A pulmonologist, another specialist was also such an ugly term, that it's just a pen that writes various, as I said, prescriptions and referrals. How does your doctor today look at the position of GPs in this whole healthcare system?

Justyna Tyminska
We were certainly treated with a bit of a pinch of salt by patients, perhaps less so, more so by doctors from other specialties. And also in the system, our position was really not that strong. This changed with the introduction of coordinated care, a programme that allowed us doctors to be more independent. Diabetes and cardiology pathways have been introduced, which allow us to refer patients for tests that were previously reserved only for specialists. And through this, we can take better care of patients in the primary care system. This has a very positive effect on patients, because when we take good care of a patient in primary care, we send them to specialists in other fields when they actually need it.

Monika Rachtan
We have already talked a lot about this coordinated care in our programme, but I think it is worth reminding patients every time that there are already some facilities in our country that are implementing this coordinated care. And these facilities are not few at all, because from what I remember, there were data that more than 30% have already joined coordinated care. Have these figures changed, or are there now even more of these facilities?

Justyna Tyminska
I think that more and more facilities are joining in. I don't have the most up-to-date data, but the Polish Society of Family Medicine conducts extensive training and courses, and as many doctors as possible are starting to take an interest in this and introduce this coordinated care in their facilities. And this is gratifying.

Monika Rachtan
Well, yes, but precisely from the patient's perspective. The patient would probably like to know whether his or her institution, the one he or she has in his or her locality, conducts this coordinated care, and would also like to find out what real benefits he or she obtains. When, for example, a doctor looks at her patients and can say that before coordinated care came in, that is, three years ago, a diabetes patient waited a very long time for this, for that, and today it looks different. Can we give such an example?

Justyna Tyminska
Yes, we can consult this patient with other specialists. We have such an easier pathway, we can consult, we can talk to specialists about a subject, there is more time to educate that patient. We can better supervise how he takes his medication and whether this diabetes is controlled. As a result, we have better care. This is something that we used to do manually and it cost us a lot of effort. Now it is much simpler.

Monika Rachtan
On the website of the Polish Society of Family Medicine, but also on the website of the National Health Fund, you can check information on coordinated care and where it is implemented. Patient pathways. There, all this information is available to patients and it is reliable information written by experts.

Justyna Tyminska
It is worth reaching out to them.

Monika Rachtan
We warmly encourage you to visit. The website of the Polish Society of Family Medicine. There is a lot of educational material there, and there is also a bookmark for both the doctor and the patient, so you can use these materials. I said at the beginning that it is very important to talk to the doctor. The doctor said that often a primary care doctor, a family doctor, has 15 minutes per patient. This is not much. Is it even possible to talk to a patient in that amount of time so that they are educated? And for the doctor to get all the information to guide the diagnostic procedure and treatment?

Justyna Tyminska
Yes, it is possible, but communication skills need to be applied. Active listening, which means listening to what the patient is talking about. Research shows that if we let the patient speak so loosely without interrupting them, which is very difficult. The longer we are in the profession, the more competent we are and we already know after the first few sentences what ails the patient. At least that is what we sometimes think. Consequently, if we do not interrupt the patient, he is able to tell us what his problem is within one minute and 76 seconds. Therefore, time is not at all our enemy here and once we know what the patient is suffering from, we are then left with a physical examination and then explaining to the patient what needs to be done. And we can do all this in 15 minutes.
Monika Rachtan
And from the patient's side, what should be communicated to the doctor? What? What should the patient pay attention to, so that the doctor also has a complete set of information about the patient and, above all, can treat the patient safely, but also effectively.

Justyna Tyminska
I think that, above all, it is important for patients to prepare themselves before the appointment, i.e. to think a little bit about how I am going to tell the doctor about my symptoms, which symptoms are most important to me or which ailments are causing me the most problems at the moment. It is useful to know what medicines you are taking and from when. We doctors realise that it is often difficult for patients to give all the information because they don't know which one might be relevant. I also think that the pandemic has helped us a lot in that patients have started to listen to their bodies a little bit more, because it is then easier to tell them from when there was a cough, from when there was a fever. And this is important information for us. On the other hand, patients should not be afraid either. If they forget something, it is up to us to ask them.

Monika Rachtan
Well, exactly, but do the patients? Often you get the impression, doctor, that when they are in your office, that because of the flurry of thoughts that they have, that they walk into the doctor, they want to convey as much as possible, they want to say as much as possible. And then they leave. I didn't say that, I didn't say that, I didn't say that. Maybe it's worth making a list before you go to see your GP, so that you can tell them all about the most important problems.

Justyna Tyminska
The list is very good. I recommend it especially to young parents. And even without a recommendation, young mothers come to me and I am even a bit embarrassed sometimes that they have a list. It's great that you have a list and one by one I tick off the list for myself. Because indeed, young parents have many questions. It is our job as doctors to ask at the end of the visit: did you understand everything? Is there anything else you would like me to repeat? Is there anything you haven't mentioned yet? This is also part of the art of interviewing, which we learn in our studies.

Monika Rachtan
It's a bit of an ideal situation, because I think it's rare in GP practices that they have the time to do that. So that they still ask at the end precisely if everything is understood and if we can come back to something, because there is already another patient knocking there who has made an appointment. But if we are in front of the parents, in front of the young parents, let's immediately clarify what we were talking about. A family doctor versus a paediatrician? Today there is a shortage of paediatricians in surgeries. It is often the case that there is a longer wait for this appointment. When is there such an outpatient clinic? I call it a combined clinic, where both a GP and paediatrician are present. Sometimes another specialist is on duty. They are the ladies' registrars. They ask, they say you don't have the paediatrician you usually go to, but I can provide an appointment with Dr X, Y, Z. Who is a family doctor and now a pure child. I there should go to this family doctor. However, is there a paediatrician dedicated to your child?

Justyna Tyminska
A family doctor can provide health services from toddler to old man. We can say it like that. So he should provide these services. Not every GP wants to see children. It may be that he or she will say that he or she does not feel able to do so. There may be a situation like that. Then he or she should The doctor who refuses to provide the services must identify a doctor who will provide those services and cannot refuse when there is actually a life-threatening condition. This is a situation where that doctor does not refuse. In contrast, more and more GPs are dealing with children. They are no longer afraid of providing services to young patients, so these situations can happen in the public space.

Monika Rachtan
It is often said in the media that the family doctor is the kind of doctor who has known us for generations, knows the whole family, and has an impact on the health of the whole family. What is your doctor's assessment? Is this a reality? Is this a fact? Or is this just a wish that we would have? And this reality looks very different.

Justyna Tyminska
At the time, when I decided to specialise in family medicine, that's what was most appealing, which was that I could have an impact on the whole family. And that was my wish, which I, for example, managed to put into practice. Because the family for me is such an interconnected system and every member has an impact on it. And that health is a very important part of family life. And the moment a mother comes to me again with a child who has a respiratory infection and ends up on antibiotic therapy. And when I reflect on the cause and, for example, we find that it is allergic in origin, we switch on the right medication and the child stops being ill, then we have a positive impact on the family. The child can go back to kindergarten, the mum is under less stress, she can go back to work. Same for the dad. There is less risk of losing his job and these situations are very common. And they give me as a GP a great deal of satisfaction when I actually have a positive impact on the whole family.

Monika Rachtan
And is it worth us as patients, when we are deciding which family doctor to choose, that we choose this doctor for a little bit longer and that we actually come to him or her as a whole family. So that this family doctor knows mum, dad, that's right, son, daughter. That this doctor's work is then so much more comprehensive.

Justyna Tyminska
Yes, this is a very good solution, especially as we can, by looking at the wider family, sometimes make a diagnosis based on an ailment in another family member. Such a simple example is when a child comes in with skin lesions that suggest a coagulation disorder and I start taking a history of possible such problems. A clotting disorder in the family turns out to be nowhere to be found, but when the mother is asked, for example, about her periods, it turns out that she often has very heavy periods, that her deliveries were very bloody and it turns out that we come to a diagnosis of a deficiency of, for example, some clotting factor. Therefore, as I said, a system of communicating vessels, which certainly also makes the doctors' job easier.

Monika Rachtan
And when you think about your patients who come to see their family doctors, do they take that family doctor more seriously nowadays, that they are actually prepared for that visit, that they come with the hope that that doctor is able to help them, that that doctor is not going to send them somewhere else to see another specialist. It's just that this matter will be dealt with in the surgery that they open the door in. When they close, they will already be sure that everything is ok.

Justyna Tyminska
If we build trust, if we create that doctor-patient relationship, then by all means. Patients prefer to come to us in primary care rather than, as they say, running around to other doctors. And they value very much the fact that we have known them for many years. Because it's also the case that if we come to work on a particular area, it takes a year, sometimes two years, before we know the whole community. So this work that we do together, this effort is not in vain, and the patients value this kind of collaboration very much, so it is indeed possible, as long as this relationship is created between us.

Monika Rachtan
In big cities like Warsaw, Poznan, Wroclaw, Krakow, we very often use private medical care, we use big clinics, and it seems to me that in such places it is difficult to keep such a permanent family doctor, because every time I come, I end up with a different doctor, because my doctor either doesn't work in the morning, or she is working somewhere else today, or she doesn't work here anymore. And it rotates so much. How does your doctor look at this situation?

Justyna Tyminska
Indeed, this is a shortcoming of private, outpatient health care, because patients also report that they constantly have to explain things again, from the beginning. And this rotation of doctors, especially in paediatrics, these check-ups, when a child has been examined on Monday by one doctor and will be examined on Wednesday by another, what is important in such establishments, if we work in such establishments, is to keep very good medical records, so that our colleague can help the patient in three days' time, but also to educate patients about what to do if things get worse, so that they know where to go. There is no escaping this. Private outpatient health services are tempting in that it's the doctors who can work one or two days a week, rather than every day. And I think this is the reason why there is a problem with such continuity of care in these facilities.

Monika Rachtan
And what are the most challenging moments in a GP's work?

Justyna Tyminska
I think it is difficult, such a moment that comes. I won't say that for everyone, but for me, for example, there was a moment that came once, that there were too many of these problems. That my work is connected with measuring myself all the time for several hours, with a lot of problems. And then it's a bit difficult to reconcile also such a personal life, in which there are also problems. So this overwhelming of problems is, I think, so quite difficult. I wonder if I should do it again, because I'm so lost in it. I've got to think about how much we'd get through one more time, one more time, and I'd say it more nicely somehow.

Monika Rachtan
Doctor, and what are the most challenging moments in a GP's work?

Justyna Tyminska
Above all, we measure ourselves against the pressure of time, that is, that we manage this 15-minute time, that we use our communication skills. This is a huge effort. Often we sit down in the office and we have our first break in a couple of hours, and during that time a very big intellectual effort takes place to help the patients. The second thing is that we face many different problems throughout the day. Sometimes we also live through these problems. These are our patients who are ill, struggling with cancer, and that stays with us somewhere.

Monika Rachtan
Sebastian Golab, a young doctor who will now be starting his specialisation in psychiatry, was a guest on our programme. He said that already as students doctors experience professional burnout. After several years in primary care, where actually these patients come with different problems. Well of course it's burnout. And it's this flurry of cases that starts to come in and then there's this bit of a routine at work.

Justyna Tyminska
Routine can occur. There can also be situations where patients start to annoy us a little bit and then we have less patience for them. What was a problem until recently, I think also in primary care, was the lack of development opportunities. Today, with the thriving Polish Society of Family Medicine under the leadership of Professor Agnieszka Mastalerz snapshots. We have opportunities to develop as family doctors. There is a lot of research going on and this is something that certainly enlivens our work, makes us feel that we have an impact on the development of medicine, and I think this is very important for us.

Monika Rachtan
The family doctors just under the care of Prof. Agnieszka Mastalerz-Migas and under the leadership of Perhaps I should say so. They are developing beautifully. I have seen that there is a lot of research on vaccination, antibiotics, resistance, harm, overuse of antibiotics, that these are topics of great interest to family doctors, also topics related to mental health, many publications, so in fact here these opportunities for development are expanding. And I also think that this is when GPs are more visible among these other specialists, right?

Justyna Tyminska
I think yes, But also our potential is not wasted, because if you imagine that we are able to very quickly put together a large group of patients, it can be hundreds, thousands of patients, that we can lead to a study, these are really very tempting places to develop just scientifically.

Monika Rachtan
I was reading the opinions of various doctors, also young doctors above all, who answered the question why to choose a specialisation in family medicine. And in one of the answers I read this sentence Because the patient does not die. But these patients from medicine, from the family medicine doctor's office also leave. Are these difficult situations when you have treated a patient for 10 years, for example for chronic diabetes or for heart failure? And then comes the news that the patient has unfortunately passed away. Does this also affect family doctors?

Justyna Tyminska
Yes, I think every doctor is affected by this situation. Indeed, we have such a close relationship with the patients, but also if. the patients are in the wards for a very long time, then the doctors have to deal with this as well. Everyone copes in different ways. Some do better, some worse. But indeed in primary care such cases do occur. But it is not the oncology department, because I think that is a place that really requires a very high level of competence and is very taxing for the doctor.

Monika Rachtan
It's true. We've hosted a number of oncologists on the programme who have told us what their job is like, how difficult it is and how taxing it is. And clear. I think that here it is difficult to compare the two specialities. But still coming back to the patient-doctor relationship and the patient GP relationship. When is it? When it gets to the point where the patient is wasting the doctor's time. Why do I ask this? Because there are usually a lot of chairs in GP corridors and these chairs are all filled. And it is often said that many of the problems we come to the GP with could actually be solved by ourselves, by thinking a little better about our behaviour we could take advice from a pharmacist or a doctor. I observe that there are many such visits that, de facto, would not need to take place at all, that other patients could benefit from.

Justyna Tyminska
It is difficult to say which visit is unnecessary. This is such a very controversial topic in my opinion, because if a patient comes to me and has a problem, I am there to help him. If I say that he should be able to cope on his own, then maybe education has failed somewhere. Therefore, if we educate the patients, and I do this very often, then they will come at the right time. And here's an example I always teach parents that if we have a young child, they have a fever, who has no other complaints, it's very important to do a general urine test and there's nothing more satisfying than a mum who comes in on the second day of a fever with a general urine test that mum has done and it cuts it short. So in my opinion it's that they come in. Of course, there are certainly people who come to chat, but it's not as many as is commonly reported. A lot of people come because they just can't cope with certain problems. And that education, I think, is the key.

Monika Rachtan
In the course of education, I will ask why this urine test on the second day is done in children when there is a high fever.

Justyna Tyminska
We are afraid of a urinary tract infection, which can just be asymptomatic and, if untreated, can lead to, for example, potentiated nephritis.

Monika Rachtan
That is to say, we already know why it is worth performing such a study. It is a test that costs a dozen or so zlotys, saves and in.

Justyna Tyminska
It is not at all painful for the child.

Monika Rachtan
It is also worth remembering this examination. Some people, a small proportion, come to their GP to have a chat. When you look at the problems patients bring to their GP, do you get the impression that many of them have psychological problems or disorders and don't always talk about it or try to discuss it with their patients?

Justyna Tyminska
Of course. Here, first and foremost, we should always take a closer look at patients who come in because of various types of pain, be it a sore shoulder or a backache. And then it's worth asking ourselves whether there isn't, so to speak, anxiety somewhere underneath the lid. And it's worth talking about. And how? Just how at work, how are the children? It may turn out that such a simple, straightforward conversation and showing interest will show us where the problem really is. And very often patients like I persuade or convince them more that they can help themselves. And now I think there is such a thing in today's world. I think that this is also the social consent and people are more willing to go to a psychologist and sometimes even to a psychiatrist without being afraid of the negative evaluation of society.

Monika Rachtan
And how do patients react when you initiate such a conversation? Does it still happen that they shut up straight away and don't want to talk to the doctor about it at all, or rather.

Monika Rachtan
Increasingly open?

Justyna Tyminska
It depends on how you talk about it. First of all, you have to start gently and I think make the patient aware that the cause may lie precisely in some unresolved problem, for example in the family, and give a solution. It is best to refer to some specific specialists, some. Have the names of people with whom you also work, so that you can also be sure that patients end up in good hands. I've never had such a negative reaction during a conversation when I've prepared the patient for it.
Monika Rachtan
There is a lot of talk today about health education. We will have a subject at school aimed at children. More and more activities are being carried out by the Ministry of Health to better educate precisely on health. How do you look at this problem? In fact, can all that the people in power are planning to do be a cure for our ignorance?

Justyna Tyminska
I think the need for health education in our society is great. Especially in such a group of young adults. I observe that young parents have problems with the administration of antipyretics. They do not know how to deal with fever, how to deal with mild respiratory infections. Therefore, we could eliminate such unnecessary visits with education. Moreover, I believe that our society is at a very good time ready to educate itself. Since the 1990s, Poles have already started to take health matters into their own hands. The kind of middle class that was forming treated it as a tool for higher earnings, for a career, for better jobs. And this fashion for a pro-healthy lifestyle continues to this day. As a result, I feel that patients want to know more about their health. If they know more about their health, they will know how to help themselves with simple issues and relieve the burden on the healthcare system at the same time.

Monika Rachtan
That is to say, those unnecessary visits I spoke of a few minutes earlier are nevertheless there, they are happening in practice and could be eliminated precisely by educated patients. Because when we have a fever and the symptoms of a typical cold, it is absolutely not necessary to have an antibiotic prescribed by a doctor. The GP will often, if we go to him or her, write us over-the-counter medicines on a slip of paper that we can get from the pharmacist, so we just need to be aware of that and feel safe about not going to the doctor.

Justyna Tyminska
We simply need to know what we have to do. This is the most important thing. We doctors, by educating patients, give them the tools to take charge of their health.

Monika Rachtan
That is, at such a visit you happen to say that when a patient comes in with a typical, let's call it, cold, you educate the patient so that the next time there is a fever of up to 38 degrees and only a cough for a week or six days, he or she can calmly go to the pharmacy, buy syrup, lie down, rest and not go to the doctor.

Justyna Tyminska
Yes, as much as possible. Patients really appreciate printed recommendations and just take them with them. We ask if they print the recommendations or have them on the patient portal. Sometimes they have recommendations in apps of various kinds, but they like to have a printed one and they admit that they use what they have previously learned. And that's what it's all about.

Monika Rachtan
An educated patient who is able to talk to the doctor, who asks the doctor good questions, is a patient who is easier to treat and who is also able to treat himself. What if I were to ask you on behalf of patients who happen to hide information from their GP? It is well known that every visit begins with an interview, when the doctor asks about various things. Are there any patients in your practice who still go to see another specialist privately and do not say that they are taking medication for high blood pressure or any cardiovascular drugs? Does this generate any problems for the GP?

Justyna Tyminska
There are patients who don't tell, maybe don't pass the buck and sometimes won't tell us. I rather feel that this stems from a fear of being judged by the doctor. If we create an open atmosphere in the surgery, this patient, if he or she does not feel judged, will tell us. I, for example, follow this rule. If I talk to patients about follow-up appointments, when a patient comes in who has received treatment from another doctor, he comes to me for a follow-up appointment and then I establish whether he has taken all the medicines on that list. Such a simple question and it turns out that one he could not buy because it was not available. One he had, but from a different company because the lady in the pharmacy said it was a substitute and it turns out that there was indeed a problem with adherence. Asking the question in this way if you have managed to take all your medication causes the patient to start telling me and I find out a lot more. The problem of non-adherence is quite large, but it is not at all because patients did not want to comply, it is due to many different reasons. These are worth identifying.

Monika Rachtan
They have encountered various bugs in the system and problems with the availability of medicines, which we have quite a problem with.

Monika Rachtan
Has there ever been a time when a patient surprised your doctor in the surgery? Were there any problems that might have surprised the doctor?

Justyna Tyminska
Surely patients can surprise me with something, but I can't think of anything like that right now. I try to create such an atmosphere that patients are not ashamed to discuss even intimate issues. If an examination of the genitals or intimate area is necessary, this can be arranged so that the patient feels comfortable. Close the door, explain what the examination will consist of. There are patients who may refuse certain examinations, but they have every right to do so.

Monika Rachtan
What are the most interesting stories from your GP practice that you recall as you look back over the years of your practice?

Justyna Tyminska
We have already talked about the psychological issue. I had a situation like this that was memorable. It was a man whose daughter was getting ready for her wedding. His daughter's wedding was going to be in six months' time. A very important event. We talked about the various illnesses that affected him, and we couldn't find a starting point. It turned out that he was very stressed about this wedding and didn't want to attend because his ex-wife would be at the wedding with his new partner. I talked to him about the need, necessity or possibility of psychological help. It worked. He registered, attended the wedding and then came to see me and we looked at pictures from the wedding. That's the impact you can have on a family. An open conversation at the surgery can really change lives. I also remember a mum who had an adult son deployed to Afghanistan. We had a conversation about her concerns, which made a big impression on me. On the one hand, there was a lot of talk about it on TV, and on the other hand I saw the other side of the coin. I also remember a mum who came for a patronage visit with her son.

Monika Rachtan
First visit.

Justyna Tyminska
The first clinic visit, when we have more time, 40 minutes, and can discuss more topics. A very important first visit where we look at what kind of mental state the mother is in. We talked about career and she said she was going to make a career out of motherhood. It was a beautiful expression, especially as they had been trying for this son for many years and it was possible thanks to IVF. The office is full of different people's stories, which can be very inspiring and often have an impact on my life, forcing me to think deeply.

Monika Rachtan
A GP is a bit of a psychologist who has to face different situations. You never really know what the patient is going to come in with.

Justyna Tyminska
Yes, it is a bit of a conundrum.

Monika Rachtan
Today, GPs are more appreciated by other specialists, but above all by patients. They have a lot of options, a wide basket of services they can use. It used to be that you would go to a GP and hear: "I can't give you a referral because it has to be a cardiologist, an endocrinologist." And today you really have a lot of tools. Why not, if it's been a long time since we've been to the GP, we feel reasonably well, go for a preventive check-up, talk to them? We encourage such visits.

Justyna Tyminska
I think it is. Let's encourage these visits, but let's also talk about the fact that vaccination in adults is a very important issue. If there's nothing wrong with us, we'll get examined and everything will be fine. It might be worth thinking about vaccination. We have flu and pneumococcal vaccinations for adults. This vaccination calendar no longer only applies to children, but also to adults, and we can do this in primary care too.

Monika Rachtan
Flu vaccination is quite popular, there are people who come to get vaccinated every year. There are people who choose to get that vaccination. But I think the booster vaccination against whooping cough is not so popular anymore, as well as pneumococcal. Are such vaccinations being implemented?

Justyna Tyminska
Of course, they are being implemented. However, once again, we are falling short in terms of education. This is very important and programmes such as today's are an opportunity to make patients aware of these possibilities. You have to look at your primary care doctor and see what's new.

Monika Rachtan
Your family doctor really has superpowers and can take care of your health in the context of prevention, but also of solving many problems, seemingly only health-related, as well as those related to family life. Today my guest was Dr Justyna Tyminska, a family doctor and a specialist in patient-doctor communication. Thank you very much, doctor.

Justyna Tyminska
Thank you very much for the invitation.

Monika Rachtan
Thank you for your attention. This was the 'Patient First' programme, and my name is Monika Rachtan. Thank you.