6Parsons’ “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
7Parsons’ “ Ideal Doctor” Apply a high degree of skill and knowledgeAct for the good of the patientRemain objective and emotionally detachedRespect the position of privilege
8Conflict of Interest Interests of patient v society Interests of patient v other patientsProblems of confidentiality
9Types of D-P Relationship Physician controlPatient Control Low HighLow Default PaternalistHigh Consumerist Mutuality
10Paternalism The traditional D-P relationship Doctor Takes on role of “parent”Patient submissiveShift towards Mutuality
11Patient controlled consultation “You’re paid to do what I tell you!!”
12Patients beliefs and expectations Influenced by:Previous experience, literature, the media;Family and friends; Cultural influences;Social significance.These beliefs influence outcomes
13The 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.
14The Paternalistic Approach “If I’ve told you once I told you 1,000 times, stop smoking!!”
15The 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
16Patient centred clinical interview Doctor - history examination investigationresults in a differential diagnosisPatient - ideas expectations feelingsresults in an understanding of patients beliefsIntegration
17Length of Consultation Average 8 minutesMakes patient centred consultation styles more difficult.
18Patient 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
19Summary An intigrated approach to information gathering. Seeking to identify physical psychological and social factorsIs likely to produce a better outcome.