6 Doctor Patient Relationship For Batch 18
6 Doctor Patient Relationship For Batch 18
6 Doctor Patient Relationship For Batch 18
Introduction
It is an emotional association (clinical encounter) between the doctor and a patient which arises when the doctor in a professional capacity ; interact with the patient The relationship begins when a person who is ill or believe that he is ill consult a doctor. The success or otherwise depend on various factors including the nature of the relationship that exist between the doctor and the patient.
Parsons model
Parson saw the doctor and patient as fulfilling necessary functions in a well balanced and maintained social structure Sickness is considered to be a necessary, occasional respite, providing a brief exemption for patient from social responsibilities
Patients role
When sick, a patient is allowed the privileges of convalescence-he or she is not held responsible for poor health and is excused from everyday responsibilities In order to enjoy these privileges, the patient must seek technically competent help and comply with medical advice passive and dependent
Doctors role
Be guided by rules of professional practice Applying a high degree of skill and knowledge to the patients The doctor legitimates the patients illness and determines the course of treatment. In doing so, the physician is compelled by professional ethics to act only in his or her sphere of expertise, to maintain an emotional detachment and distance from the patient, and to act in the patients best interest professionally dominant and autonomous
Give up some activities and responsibilities Regarded as being in need of care and unable to get well by his own decision & will Obligations (In Return) : Must want to get better quickly Seek professional medical advice and cooperate with the doctor.
Parsons, 1951
Expectations
Patient expects from doctor....
A cure Medication To be listened to Sympathy Advice- he understands The answer A sick note What they want (agenda) Comfort A chat No harm Professionalism & Respect To be told what to do To feel better The truth
Expectations
Doctor expects from patient... Trust Compliance to treatment Agreement The truth Respect They want to get better To be listened to To obey the Rules!
Doctor may... Become annoyed Become stressed Not be thorough Dread seeing patient again Refuse to see patient again Refer pt to another doctor (Balint calls this the collusion of anonymity ) Not listen
Paternalistic relationship
Traditionally characterized medical consultation Autocratic model It is assumed that Dr knows best High physician control and low patient control The doctor is dominant and takes on role of parent Patient submissive Shift towards Mutuality
Communication in Paternalistic
Between doctor and patient
Foundation for diagnosis and treatment (elicit & convey information) Relationship has a therapeutic effect placebo effect of drug Doctor-centered consultation (Paternalistic style)
Closed nature questions e.g. How long have you had the pain? & is it sharp or dull? Diseased centered model talk
Paternalistic Relationship
If Ive told you once I told you 1,000 times, stop smoking!!
Active involvement of patients as more equal partners (meeting of experts) Both parties share power and responsibility, exchange of ideas & sharing of belief systems, need each other and will work towards choices and actions satisfying to them both Open questioning, interested in psycho-social aspect of illness history & examination investigation results in a diagnosis Hence there is integration
COMMUNICATION
Between doctor and patient Patient-centered approach (Mutuality) Encourage & facilitate their patients to participate
Use of open questions e.g. tell me about your pain, how do you feel? & what do you think is the cause of the problem? Active listening skills, requires more time (participative style)
Advantages
Patients can fully understand what problem they are coping with through physicians help Physicians can entirely know patients value Decisions can easily be made from a mutual and collaborative relationship
Disadvantages
Physicians do not know what certain degree should they reach in communication If the communication is fake, both physicians and patients do not have mutual understanding, making decision is overwhelming to a patient
A consumerist relationship
The patients take the active role and the doctor assume a fairly passive role. Trying to satisfy the patient need in term of referral to the hospital, usage of medication and sick leave.
Relationship of default
When patient and physician expectation are at odds Or when the need for change in the relationship cannot be negotiated The relationship may come to a dysfunction standstill Passive role by the patient and the doctor Lack of sufficient direction in consultation Ineffective in dealing with the illness. Commonly occur in managing chronic illness e.g. diabetes mellitus and hypertension,
Influence of time
Shortage of time is a major constraint paternalistic approach Less attention paid to social and psychological aspect Unnecessary prescription issued Increase in the number of visits Thus more time required for participative patient centered consultation, listen to patients worries and concern
Confidence
Trust
Knowledge
Accuracy of Diagnosis
Effective Treatment Compliance
IN SUMMARY
Relationships based on openness, trust and good communication will enable you to work in partnership with your patients to address their individual needs. To fulfil your role in the doctor-patient partnership you must: a. be polite, considerate and honest b. treat patients with dignity c. treat each patient as an individual d. respect patients' privacy and right to confidentiality e. support patients in caring for themselves to improve and maintain their health f. encourage patients who have knowledge about their condition to use this when they are making decisions about their care.