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The Doctor-Patient Relationship

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Presentation on theme: "The Doctor-Patient Relationship"— Presentation transcript:

1 The Doctor-Patient Relationship
From Sociology as applied to Medicine

2 Doctor Patient Contacts
500,000 GP consultations every working day The nature of the relationship determines the success or otherwise of the contact Central to this is the exchange of information

3 Communication and Diagnosis
Patients who feel at ease and who are encouraged to talk freely are more likely to disclose the real reason for consulting

4 Communication and Treatment
Advice reassurance and support from the doctor can have a significant effect on recovery The placebo effect

5 Consultation Styles It’s serious isn’t it doctor?

6 Parsons’ “Ideal Patient”
Permitted to: Give up some activities and responsibilities Regarded as being in need of care In Return : Must want to get better quickly Seek help from and cooperate with a doctor

7 Parsons’ “ Ideal Doctor”
Apply a high degree of skill and knowledge Act for the good of the patient Remain objective and emotionally detached Respect the position of privilege

8 Conflict of Interest Interests of patient v society
Interests of patient v other patients Problems of confidentiality

9 Types of D-P Relationship
Physician control Patient Control Low High Low Default Paternalist High Consumerist Mutuality

10 Paternalism The traditional D-P relationship
Doctor Takes on role of “parent” Patient submissive Shift towards Mutuality

11 Patient controlled consultation
“You’re paid to do what I tell you!!”

12 Patients beliefs and expectations
Influenced by: Previous experience, literature, the media; Family and friends; Cultural influences; Social significance. These beliefs influence outcomes

13 The doctor’s consulting style
Doctor centred consultation style: Paternalistic - doctor is the expert and patient expected to cooperate Tightly controlled interviewing style aimed at reaching an organic diagnosis.

14 The Paternalistic Approach
“If I’ve told you once I told you 1,000 times, stop smoking!!”

15 The Doctor’s consultation style
Patient Centred consultation style Less authoritarian - encourages patient to their own feelings and concerns Open questioning, interested in psycho-social aspect of illness

16 Patient centred clinical interview
Doctor - history examination investigation results in a differential diagnosis Patient - ideas expectations feelings results in an understanding of patients beliefs Integration

17 Length of Consultation
Average 8 minutes Makes patient centred consultation styles more difficult.

18 Patient influences on consultation
The patient’s ability to exercise and control depends on a number of factors: Social and educational level Sex Membership of an ethnic minority

19 Summary An intigrated approach to information gathering.
Seeking to identify physical psychological and social factors Is likely to produce a better outcome.

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