Doctor's Interpersonal Communication on the Quality of Life of

Diabetes Mellitus Patients

Pimpin Tanadi, Ermi Girsang*, Sri Lestari R. Nasution and Chrismis Novalinda Ginting

Faculty of Medical, Universitas Prima Indonesia, Indonesia

Keywords: Interpersonal communication, quality of life, diabetes mellitus.

Abstract: A doctor's communication competence determines the level of success in helping the treatment of a patient's

illness. Preliminary survey results show that many patients consider doctors rarely greet patients at the

beginning of a consultation session, so that it has a direct impact on patients who are afraid to express their

complaints. This study aims to analyze the effect of interpersonal communication in improving the quality of

life of patients with diabetes mellitus. This type of research was a type of quantitative survey with a cross-

sectional approach with a sample of 60 respondents. The variables included in the study were openness,

empathy, supportive attitude, positive attitude, equality, and quality of life of patients. Data were analyzed

using chi-square test and logistic regression test. The results showed that the variables that influence the

improvement of the quality of life of patients with diabetes mellitus on average around 55 - 72%. These results

indicate that the quality of doctor communication still needs to be improved. This improvement is expected

to be able to improve the quality of life of DM patients who are currently still around 43.3%.

1 INTRODUCTION

Diabetes mellitus is currently increasing in number

and is one of the world's health problems including in

Indonesia. The International Diabetes Federation

(IDF) reports that currently, around 425 million

adults (20-79 years old) are living with diabetes

mellitus, and by 2045 it is expected to increase to 629

million. The proportion of people with type 2 diabetes

mellitus increased by 79% in adults living in low and

middle income countries. In addition IDF also said

that more than 1,106,500 children live with type 1

diabetes mellitus and more than 21 million live births

(1 in 7 births) are affected by diabetes mellitus during

pregnancy. Diabetes mellitus also causes at least 727

billion dollars for health expenditure in 2017 or 12%

of total expenditure for adults (Cho, 2018).

Some data about diabetes mellitus in Indonesia is

also quite astonishing. In 2017 Indonesia was ranked

5th for the country with the highest number of people

with diabetes mellitus in the world with 114,069

fatalities (International Diabetes Federation, 2017).

In addition, Basic Health Research (Riskesdas) in

2007 and 2013 also conducted interviews to calculate

the proportion of diabetes mellitus at the age of 15

years and over. Defined as a person with diabetes

mellitus if a doctor has been diagnosed with diabetes

or has never been diagnosed with diabetes by a doctor

but in the last 1 month experiencing symptoms of

frequent hunger, frequent thirst, frequent urination

with large amounts and weight loss. The results of the

interview found that the proportion of diabetes

mellitus at Riskesdas 2013 almost doubled compared

to 2007. For North Sumatra province itself the

proportion of diabetes mellitus also increased, in

2013 the number of people with diabetes mellitus

diagnosed by doctors reached 160,913 people

(Ministry of Health, Republic of Indonesia, 2014).

Management and control of chronic diseases such

as diabetes mellitus is very important because of the

dangerous complications, as well as a large economic

burden if the disease is not controlled. The role of

health workers and doctors in helping patients with

diabetes mellitus control their blood sugar is very

important because this is a chronic disease (Masriadi,

2016). In diabetes mellitus, basically the real doctor

is the patient himself. The patient determines when he

should seek treatment, when to check blood sugar

levels or how to regulate diet. Therefore, diabetic

patients really need the figure of a friend to manage

the disease through a doctor.

According to the Law of No. 29/2004 concerning

Medical Practice, doctors, specialists, doctors,

specialists, dentists and specialist dentists have

Tanadi, P., Girsang, E., R. Nasution, S. and Ginting, C.

Doctor’s Interpersonal Communication on the Quality of Life of Diabetes Mellitus Patients.

DOI: 10.5220/0010286500350041

In Proceedings of the International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical (HIMBEP 2020), pages 35-41

ISBN: 978-989-758-500-5

graduated from medical or dental education, both

domestically and abroad, which are recognized by the

Government of the Republic of Indonesia in

accordance with statutory regulations. In the medical

profession, doctor and patient communication is one

of the competencies that must be mastered by doctors.

The communication competence determines success

in helping treat a patient's illness. During this time,

the communication competence of a doctor can be

said to be often overlooked.

In Indonesia, some doctors feel they don't have

enough time to talk with their patients, so they can

only ask as needed. This causes the doctors tend not

to get enough information to establish the diagnosis

and determine further planning and action. While in

terms of the patient himself, patients generally feel in

a lower position before the doctor (superior-inferior),

so that the patient is feel afraid to ask questions and

tell stories or just answer according to doctors'

questions (Foursanalitywati, 2015; Turnip et al,

2020).

In general, the definition of communication is the

process of delivering ideas, hopes and messages

conveyed through certain symbols that contain

meaning carried out by the messenger addressed to

the recipient of the message. The application of the

definition of communication in the interaction

between doctor and patient is interpreted as the

achievement of understanding and agreement that is

built by the doctor with the patient at each step in

solving the patient's problem (Adriyani, 2018; Wijaya

et al, 2019).

Kurzt (1998) suggests two approaches about

communication in the field of medicine. First is the

disease centered communication style or doctor

centered communication style, where communication

is based on the doctor's interest in trying to establish

a diagnosis, including investigation and clinical

reasoning about signs and symptoms. The second

approach is an illness centered communication style

or patient centered communication style, where

communication is based on what the patient feels

about his illness which individually unique

experience. The aim is to create comfort and

satisfaction for both parties to create effective

communication between doctors and patients (Kurtz,

1998).

A doctor's communication ability to have good

communication skills with his patients has different

goals. There are three types of goals for the doctor's

communication with his patient, namely, creating

good interpersonal relationships, exchanging

information, and making medical decisions. The

goals that are considered the most important in

solving patient's health problems especially in

patients with chronic diseases such as diabetes

mellitus that is creating good interpersonal and

communicative relationships will have a positive

impact on patients such as the realization of patient

knowledge and understanding, adherence to

medication and measurable health outcomes (Konsil)

Indonesian Medicine, 2006). In building good

interpersonal relationships, it takes important

elements, namely intimacy, attention, lack of tension,

and non-verbal expressions from doctors and patients.

In particular, good doctor and patient interpersonal

relationships will increase when the context of the

doctor's communication capabilities with patients

takes place with doctor friendliness, courtesy

behavior, social behavior and empathy behavior

during consultation (Larasati, 2019).

The results of the initial survey of several patients

who were willing to be interviewed found that many

patients considered doctors rarely greet patients at the

beginning of a consultation session, so this had an

impact on patients who were afraid to express their

complaints. Similarly, doctors do not provide

opportunities for patients to ask questions. The

average patient complains of not having enough

courage to ask about his illness in detail, so that in the

end it only follows the direction of the doctor. The

same applies to patients' complaints that doctors feel

less empathetic, such as eye contact with patients

during consultation sessions, or doctors who are

reluctant to touch in the sense of shaking hands with

patients. Yet through empathy with small things like

that, could be one of the factors that foster a sense of

trust in others. This study aims to analyze the effect

of interpersonal communication in improving the

quality of life of patients with diabetes mellitus.

Many patients with chronic diseases such as

diabetes mellitus have difficulty achieving optimal

blood glucose control, communication by medical

personnel plays an important role in supporting

patient health. Medical personnel may be more

successful when providing behavioral change

counseling based on psychological principles of self-

regulation, for example, setting goals, achieving

additional performance, and planning actions in

managing diabetes (Mulder, 2017).

Based on the review above, researchers feel that

until now there has been no research that examines

the effect of doctor communication on the quality of

life of patients with chronic diseases such as diabetes

mellitus. So in this study will summarize in detail

about how much impact the doctor's communication

in improving the quality of life of patients with

diabetes mellitus, and what communication factors

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical

influence the improvement of the quality of life of

patients with diabetes mellitus itself.

2 METHOD

The type of research used in this study was a

quantitative survey using a cross-sectional approach.

The study was conducted at Dr. R.M. Djoelham City

of Binjai, which began in July-September 2019. The

population was all DM patients who were

hospitalized. From the medical records of general

inpatients there were 157 people and using an

accidental sampling technique, 60 respondents were

selected with criteria must be DM patients who

routinely undergo treatment / therapy more than once

as evidenced by medical records. In addition,

thepatients must be able to communicate well (can

read and write), be willing to be a respondent.

Figure1. Scheme of Research Process

Primary data were directly obtained through

interviews with respondents who were undergoing

DM treatment. Primary data include respondent

characteristics, doctor communication variables

(doctor's openness, doctor's empathy, doctor's

supporting attitude, doctor's positive attitude and

doctor's equality) and DM patients' quality of life

variables. Interviews were conducted based on a

questionnaire that had previously been tested for

validity and reliability. The doctor communication

variable contained 23 question items and 14 question

items for the variable quality of life of doctor patients.

Measurement results of the questionnaire using the

Guttman scale. The scale developed by Louis

Guttman is a scale that requires firm answers from

respondents, such as yes or no, true or false, ever or

never, and others. Evaluation of answers on the

Guttman scale, for a positive answer or yes given a

score of 1, while for a negative answer or not given a

score of 0. To anticipate the results of measurements

that are not absolute 100% or 0%, the researchers

used a range of percentage scale. The percentage

range in this study is <70% which means no role and>

70% is meant to play a role. The results of the

questionnaire were then analyzed using the chi-

square test to see the relationship between the

independent variables and the dependent variable.

Followed by logistic regression tests to see the effect

of the entire independent variable on the dependent.

The research procedure can be seen in Figure 1.

3 RESULTS

3.1 Validity and Reliability Analysis

Primary data were obtained directly through

interviews with respondents who were undergoing

DM treatment. Primary data include respondent

characteristics, doctor communication variables

(doctor's openness, doctor's empathy, doctor's

supporting attitude, doctor's positive attitude and

doctor's equality) and DM patients' quality of life

variables. Interviews were conducted based on a

questionnaire that had previously been tested for

validity and reliability. The doctor communication

variable contained 23 question items and 14 question

items for the variable quality of life of doctor patients.

Measurement results of the questionnaire using

the Guttman scale. The scale developed by Louis

Guttman is a scale that validity test is done using the

Pearson correlation method (Pearson Correlation)

where a question item can be said to be valid if the

product moment correlation coefficient value is

greater than the r table. From the test results of 25

questions for the doctor communication variable, 23

items were declared as valid statements, while the

remaining 2 question items were invalid. In 14 items

the statement of quality of life of DM patients was

declared valid. Furthermore, the reliability

measurement uses Cronbach's Alpha as a reference,

where if it is greater than 0.600 then the variable is

declared valid. The test results show the Cronbach's

Alpha value of the doctor communication variable



Preliminary Survey

Research Proposal

Research Design:

Cross Sectional Analysis

Population and Sample:

157 and 60 Respondents

Research Sites:

RSUD dr. Djoelham Binjai

Data Collection

Data Input and Coding

Data Analysis

Chi Square & Logistic Regression

Independent Variable:

Openness, empathy,

supportive attitude,

positive attitude, and

doctor's equality

Dependent Variable:

DM Patients Quality of

life

Analysis Results

Conclusions and Recommendations

Doctor’s Interpersonal Communication on the Quality of Life of Diabetes Mellitus Patients

and the quality of life of DM patients has a value >

0.6, which means that each variable was reliable.

Table 1. Characteristics of Respondents

No Characteristics n %

Sex

Female

Male

80,0

20,0

2 Age

≤40 years old

>40 years old

6,7

93,3

3 Level of education

High School

College

60,0

40,0

4 Type of work

Government employees

Entrepreneur

Housewife

Other types of work

18,3

25,0

16,7

40,0

5 Income

≤ Rp. 3.000.000

> Rp. 3.000.000

13,3

86,7

Table 1 shows frequency distribution of

respondent characteristics based on demographic data

which includes gender, age, education, occupation

and income. The characteristics of respondents

consists of 60 observed respondents, the majority of

respondents were female of 48 people (58.5%), aged>

40 years there were 56 people (93.3%), SLTA 36

people (60,0%), there were 24 other types of work

(40.0%), with income> Rp. 3,000,000 there were 52

people (86.7%).

3.2 Assessment Doctor’s Interpersonal

Communication

Based on the results of the questionnaire assessment

on doctor’s interpersonal communication indicators,

showed that of the 82 respondents, the majority of

respondents rated physician openness as good

(63.3%), the empathy of the doctor was good

(68.3%), the attitude of supporting the doctor was

good (71.7%), the positive attitude of the doctor was

good (63.3%), and the doctor's openness was also

categorized as good (55.0%). The results of

questionnaire measurements can be briefly seen in

Figure 1.

Figure 1 Measurement results of the questionnair

3.3 Chi Square Analysis

Table 2 shows the cross tabulation between the

independent and dependent variables. It is known that

based on the doctor's interpersonal communication,

the majority of patients consider doctors to be good

enough to serve diabetic patients. This can be seen

from several communication indicators such as

openness of doctors who are considered good

(63.3%), empathy of a good doctor (68.3%), good

doctor supportive attitude (71.7%), good doctor's

positive attitude (63.3%) and doctor's equality with

patients who are also good (55.0%). Furthermore,

from the results of the chi square analysis it is known

that only the variables of physician openness and

doctor empathy have a value of p <α, it can be

concluded that only physician openness and empathy

are related to the quality of life of patients with

diabetes mellitus and can proceed to further analysis.

Whereas the variables of supportive attitude, positive

attitude and equality have a value of p> α, so it was

concluded not having a significant relationship with

the quality of life of patients with diabetes mellitus.

In the results of the analysis with chi square it was

known that only the variables of physician openness

and doctor empathy have a value of p <α, it can be

concluded that there was a significant relationship

between openness and empathy variables with the

quality of life of DM patients. While the variables of

supportive attitude, positive attitude and equality

have a value of p> α, it can be concluded that there

was no significant relationship between the variables

of supportive attitude, positive attitude and equality

with the quality of life of DM patients. More details

can be seen in Table 2.

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical

Table 2. Chi square analysis results

Quality of Life for DM

Patients

value

Good Not good

n % n %

Doctor's

openness

Goo

22 57,9 16 42,1 0,003

Not goo

4 18,2 18 81,8

Empathy

the doctor

Goo

22 53,7 19 46,3 0,025

Not goo

4 21,1 15 78,9

Attitude

supports

Goo

21 48,8 22 51,2 0,249

Not goo

5 29,4 12 70,6

Positive

attitude

Goo

21 51,2 20 48,8 0,095

Not goo

5 26,3 14 73,7

ualit

Goo

13 39,4 20 60,6 0,603

Not

13 48,1 14 51,9

In the results of the analysis with chi square it was

known that only the variables of physician openness

and doctor empathy have a value of p <α, it can be

concluded that there was a significant relationship

between openness and empathy variables with the

quality of life of DM patients. While the variables of

supportive attitude, positive attitude and equality

have a value of p> α, it can be concluded that there

was no significant relationship between the variables

of supportive attitude, positive attitude and equality

with the quality of life of DM patients.

3.4 Logistic Regression Analysis

Based on the candidate test results with chi square

obtained the results of the independent variables

openness, empathy, supportive attitude and positive

attitude have a p value <0.25. It can be concluded that

the independent variables of openness, empathy,

supportive attitude and positive attitude can be

continued to multivariate logistic regression analysis.

Multivariate analysis used is multiple logistic

regression analysis with prediction models that aim to

obtain a model consisting of several independent

variables that are considered best for predicting the

occurrence of the dependent variable. Variables that

are considered influential in the multivariate model

are variables that have p values <0.05.

In Table 3 shows the final model of the influence

of the variables openness and empathy) on improving

the quality of life of DM patients. The analysis

showed that the variables of physician's openness and

empathy had p value <0.05. This means that only the

two independent variables have a significant effect on

improving the quality of life of DM patients.

Table 3. Multivariate final model

Variable B

Wald

p value OR

Openness

0,2

3,711 1 0,006

3,50

Empathy

0,3

5,292 1 0,001

4,52

Predictions of improving the quality of life of DM

patients affected by openness and empathy can be

explained as follows: in physicians' openness the

regression coefficient (𝛽) or OR was positive,

meaning that the better the doctor's openness was

likely to improve the quality of life of DM patients by

3,501 times higher when compared with doctor's

openness that was not good. In the doctor's empathy

variable the value of the regression coefficient (OR)

or OR was positive, meaning that the better the

empathy of the doctor has the opportunity to improve

the quality of life of DM patients about 4,520 times

higher when compared to the poor quality of life.

4 DISCUSSION

One element that will bring good relations between

doctors and patients is openness in communication.

In the element of openness, the doctor has the full

duty of making the patient believe in the services

provided by the doctor, so that the patient wants to

open himself honestly on the condition of his illness.

The effect of interpersonal communication between

doctor and diabetic patient which is seen from

openness starts from the interaction between doctor

and patient providing information about the patient's

health condition, about the procedure that the patient

must undergo during diabetes treatment and about

service facilities. Besides that, the doctor also

provides an explanation and understanding of the

benefits of treatment to patients during the

consultation session.

In the hospital studied, researchers saw that

interpersonal communication made by doctors while

conducting therapy was effective. Even under certain

conditions, some patients are still reluctant to give an

immediate description of their physical health.

Doctor’s Interpersonal Communication on the Quality of Life of Diabetes Mellitus Patients

According to several doctors interviewed, even

though it looks difficult, patient openness is needed

in the management of diabetes. Where there must be

a willingness to open up and reveal hidden

information such as being honest in terms of diet,

physical activity carried out up to taking medication

regularly. This is supported by the opinion of

Claramita (2013) who revealed that regardless of the

level of education, the form of communication that is

highly desired by many patients in Indonesia is more

open communication with their doctors.

Another aspect of interpersonal communication

that also plays a role in improving the quality of life

of diabetic patients is empathy from the doctor.

Empathy is one's ability to "know" what other people

are experiencing at any given moment, from that

other person's point of view. In the case of diabetes,

the empathy aspect is seen from the situation where

the doctor feels something like that experienced by

his patient. Empathic doctors are able to understand

the motivation and experience, feelings and attitudes

of patients, as well as the hopes and desires of patients

for the future.

Based on the findings and analysis, researchers

see that most patients feel very satisfied with the

empathy of the doctor who handles the treatment.

This can be seen by doctors intensely asking patient

complaints, paying attention to patients, and

understanding how they feel. Many diabetic patients

feel happy because they have the opportunity to

discuss their health problems. Patients feel given the

right to speak and get involved in their treatment.

Some patients even revealed that the main reason for

choosing the same hospital for their treatment was

satisfaction with the doctor's empathy when serving

their patients.

Ideas related to the development of physician

empathy for patients have previously been carried out

in a variety of different conditions as in the research

of Hussain (2020), revealing the motivational

interview method and promoting in-depth

understanding related to health management for long-

term conditions to patients can provide better results.

Basically, a very high level of patient satisfaction will

arise if the doctor understands and responds to what

the patient feels. The maximum level of empathy can

result in patient openness, and can even help the

doctor penetrate into the patient's soul where no other

treatment can achieve it, in other words empathy is

the most powerful therapeutic tool for diabetic

patients to improve their quality of life.

5 CONCLUSIONS

Based on the findings and analysis, it was found that

both physician communication and the quality of life

of DM patients studied were in the majority in the

good category. On the openness variable of doctors,

38 people (63.3%) rated good, 41 people (68.3%)

rated the variables of empathy and positive attitude of

good doctors, 43 people (71.7%) rated the attitude of

supporting physicians as good, 33 people (55.0%)

rated the doctor's openness variable as good and as

many as 26 people (43.3%) rated the quality of life of

DM patients to be good.

Furthermore, it can be concluded that the

variables that influence the improvement of the

quality of life of DM patients were physician

openness (p value = 0.006 <α), and doctor empathy

(p value = 0.001 <α). While attitudes supporting

physician variables (p value = 0,150> α), positive

doctor attitudes (p value = 0,421> α), and physician

equality (p value = 0,310> α) have no effect on

improving the quality of life of DM patients.

REFERENCES

Adriyani S., 2018. Buku Ajar Komunikasi Dalam

Keperawatan. Bandung: PT Refika Aditama,.

Beverly, Elizabeth A., PhD., 2018. Patient-Doctor

Communication and Diabetes Self-Care; Journal of

Clinical Outcomes Management. 2018 November;23

(11). Diakses pada 26 April 2020.

Cho NH, Shaw JE, Karuranga S, et al. IDF Diabetes Atlas:

Global estimates of diabetes prevalence for 2017 and

projections for 2045. Diabetes Res Clin Pract 2018;

138: 271–281.

Claramita, Mora. Doctor–patient communication in

Southeast Asia: a different culture. Adv in Health Sci

Educ (2013) 18:15–31, DOI 10.1007/s10459-012-

9352-5.

Farah A. 2019. Effects of Doctor Interpersonal

Communication on Low Satisfaction Levels of

Inpatients; Jurnal Komunikasi: Malaysian Journal of

Communication 35(1):57-70DOI: 10.17576/JKMJC-

2019-3501-05 Project: Communication apprehension

Among Tourism and Social Science Students. Diakses

pada 25 April 2020.

Firdous J and S. Hiba. 2019. Good communication between

doctor and patient improves health outcomes; EJMED,

European Journal of Medical and Health Sciences Vol.

1, No. 4, October 2019. Diakses pada 26 April 2020.

Fourianalistyawati E. Komunikasi Yang Relevan Dan

Efektif Antara Dokter Dan Pasien. J Psikogenes 2015;

1: 82–87.

Hussain, Saad, Mir. Role of Health Literacy and

Motivational Interviewing in Building Insight for Self-

management of Diabetes Mellitus. World Family

HIMBEP 2020 - International Conference on Health Informatics, Medical, Biological Engineering, and Pharmaceutical

Medicine/Middle East Journal Of Family Medicine

Volume 18 Issue 2 February 2020. Diakses pada 16

Juni 2020.

Jalil Aisha, Rubeena Zakar, Muhammad Zakria Zakar3 and

Florian Fischer. 2017. Patient satisfaction with doctor-

patient interaction: study of mixed methods among

patients with diabetes mellitus in Pakistan; BMC

Health Services Research (2017) 17:155. DOI

10.1186/s12913-017-2094-6. Diakses pada 25 April

2020.

Junaid, A., & Rafi, M. 2019. Communication Barriers

Between Doctors, Nurses and Patients in Medical

Consultans at Hospitals of Lahore Pakestan. Pakistan

Armed Forces Medical Journal, 69(3), 560-65.

https://www.pafmj.org

/index.php/PAFMJ/article/view/ 3027. Diakses pada 25

April 2020.

Kementerian Kesehatan. Info Datin: Situasi dan Analisis

Diabetes. Jakarta, 2014.

Kholil Syukur, Lahmuddin Lubis, Syafruddin Ritonga.

2019. Implementation of Communication Therapy at

Dr. Hospital Pirngadi; Budapest International

Research and Critics Institute-Journal (BIRCI-Journal)

Volume 2, No 4, November 2019, Page: 645-656 e-

ISSN: 2615-3076 (Online), p-ISSN: 2615-1715

(Print).DOI: https://doi.org/ 10.33258/birci. v2i4.673.

Diakses pada 26 April 2020.

Konsil Kedokteran Indonesia. Komunikasi Efektif Dokter-

Pasien. 2006.

Kurtz S, Draper J, Silverman J. Teaching and Learning

Communication Skills in Medicine. Oxon: Radcliffe

Medical Press, 1998.

Larasati TA. Komunikasi Dokter-Pasien Berfokus Pasien

pada Pelayanan Kesehatan Primer Patient Centered

Communication in Primary Care. J Kedokt Univ

Lampung 2019; 3: 160–166.

Masriadi. Epidemiologi Penyakit Tidak Menular. Jakarta:

Trans Info Media, 2016.

Mulder C, Anne Marike Lokhorst. 2017. Effective Nurse

Communication with Type 2 Diabetes Patients: An

Overview; Western Journal of Nursing Research. DOI:

10.1177/0193945914531077. Diakses pada 25 April

2020.

Passaribu B. 2019. Effect of Doctor's Interpersonal

Communication on Patient Satisfaction at Royal Prima

General Hospital Medan; International Journal of

Research & Review (www.ijrrjournal.com) 164 Vol.6;

Issue: 11; November 2019. Diakses pada 25 April 2020.

Pemerintah Republik Indonesia. Undang-Undang Nomor

29 Tahun 2004 Tentang Praktik Kedokteran. 2004.

Sarah. 2020. Impact of Communication in Health Care;

Institute for Healthcare Communication. Diakses pada

26 April 2020.

Susan C, Baker. Bernadette M, Watson. 2018. How

Patients Understand Their Doctor's Communication:

Implications for Patients' Willingness to Communicate;

Journal of Language and Social Psychology.

https://doi.org/10.1177/0261927X15587015. Diakses

pada 25 April 2020.

Tanveer Fahad, Sana Shahid2, Muhammad Mansoor

Hafeez. 2018. Impact of Doctor's Interpersonal

Communication Skills on Patient Satisfaction; Isra

Medical Journal | Volume 10 - Issue 5 | Sep–Oct 2018.

Diakses pada 26 April 2020.

Trinth Daniel. 2019. Trust Factors: The Role of

Interpersonal Communication and Physical Touch in

the Patient Physician Relationship. Thesis. Honors

Baccalaureate of Science in Biochemistry & Molecular

Biology. Diakses pada 26 April 2020.

Turnip, A., Andrian, Turnip, M., Dharma, A., Paninsari, D.,

Nababan, T., Ginting, C.N., 2020. An application of

modified filter algorithm fetal electrocardiogram

signals with various subjects, International Journal of

Artificial Intelligence, vol. 18, no., 2020.

Wijaya, C., Andrian, M., Harahap, M., Turnip, A., 2019.

Abnormalities State Detection from P-Wave, QRS

Complex, and T-Wave in Noisy ECG, Journal of

Physics: Conference Series, Volume 1230, (2019)

012015. doi:10.1088/1742-6596/1230/1/012015.

Doctor’s Interpersonal Communication on the Quality of Life of Diabetes Mellitus Patients