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 dayThe nature of the relationship determines the success or otherwise of the contactCentral 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 recoveryThe placebo effect
5 Consultation StylesIt’s serious isn’t it doctor?
6 Parsons’ “Ideal Patient” Permitted to:Give up some activities and responsibilitiesRegarded as being in need of careIn Return :Must want to get better quicklySeek help from and cooperate with a doctor
7 Parsons’ “ Ideal Doctor” Apply a high degree of skill and knowledgeAct for the good of the patientRemain objective and emotionally detachedRespect the position of privilege
8 Conflict of Interest Interests of patient v society Interests of patient v other patientsProblems of confidentiality
9 Types of D-P Relationship Physician controlPatient Control Low HighLow Default PaternalistHigh Consumerist Mutuality
10 Paternalism The traditional D-P relationship Doctor Takes on role of “parent”Patient submissiveShift 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 cooperateTightly 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 styleLess authoritarian - encourages patient to their own feelings and concernsOpen questioning, interested in psycho-social aspect of illness
16 Patient centred clinical interview Doctor - history examination investigationresults in a differential diagnosisPatient - ideas expectations feelingsresults in an understanding of patients beliefsIntegration
17 Length of Consultation Average 8 minutesMakes 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 levelSexMembership of an ethnic minority
19 Summary An intigrated approach to information gathering. Seeking to identify physical psychological and social factorsIs likely to produce a better outcome.