Presentation on theme: "The Doctor-Patient Relationship"— Presentation transcript:
1 The Doctor-Patient Relationship Dr. Shahida KhatoonAssistant ProfessorLUMHS, Jamshoro
2 Patient-Physician Relationship Why does it matter?Types of relationshipWhat is the ideal patient-physician relationship of the 21st century
3 Hippocrates viewed the physician as 'captain of the ship' and the patient as someone to take orders
4 Why Does It MatterThe patient-physician relationship is fundamental for providing and receivingexcellent careTo the healing processto improved outcomesTherefore, it is important to understand what elements comprise the relationship and identify those that make it "good."
5 Why Does It MatterBecause of the rapidly changing environment that characterizes health care today,we need to understand what physicians and patients must do to protect and nurture the relationship.
6 The patientpatients are individual human beings with problems that all to often transcend their physical complaints.The patient are not „cases” or „admissions” or „diseases”
7 Parsons’ modelParson saw the doctor and patient as fulfilling necessary functions in a well balanced and maintained social structureSickness is considered to be necessary, providing a brief exemption for patient from social responsibilities
8 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
9 Parsons’ “ Ideal Doctor” Apply a high degree of skill and knowledgeActs for the good of the patientRemain objective and emotionally detachedRespect the position of privilege
10 Types four prototypes of doctor-patient relationship Paternalism ConsumerismMutualityDefault
11 Types of Dr-Pt relationship Doctor controlledPatient controlled
12 Prototypes of doctor-patient relationship Physician control (Low)Physician control (High)Patient control (Low)DefaultPaternalismPatient control (High)ConsumerismMutuality
13 1.Paternalism traditional form of doctor-patient relationship Doctor takes on role of parentdoctor is the expert and patient expected to cooperateTightly controlled interviewing style aimed at reaching an organic diagnosis. passive patient and a dominant doctorFocus is on care, rather than autonomy
14 The Paternalistic Approach “If I’ve told you once I told you 1,000 times, stop smoking!!”
15 AdvantagesThe supportive nature of paternalism appears to be important when patients are very sick at their most vulnerableRelief from the burden of worry is curative in itself, and the trust and confident implied by this model allows doctor to perform “medical magic”
16 Patient controlled consultation “You’re paid to do what I tell you!!”
18 2.Mutuality The optimal doctor-patient relationship model This model views neither the patient nor the physician as standing asideEach of participants brings strengths and resources to the relationshipBased on the communication between doctors and patients
19 Patients need to define their problems in an open and full manner The patient has right to seek care elsewhere when demands are not satisfactorily met.Physicians need to work with the patient to articulate the problem and refine the requestThe physician’s right to withdraw services formally from a patient if he or she feels it is impossible to satisfy the patient’s demand
20 AdvantagesPatients can fully understand what problem they are coping with through physicians’ helpPhysicians can entirely know patient’s valueDecisions can easily be made from a mutual and collaborative relationship
21 DisadvantagesPhysicians do not know what certain degree should they reach in communication.Is the patient capable of making the important therapeutic .
22 3.Consumerismwe can simplify the complicated relationship with “buyer and seller” relationship, is it good or bad? What is your opinion?The patient can challenge to unilateral decision making by physicians in reaching diagnosis and working out treatment plansReversing the very basic nature of the power relationship.
23 Exercising independent judgment DOCTOR :Health care providers PATIENT;Health shoppers so consumer behaviorCost-consciousnessInformation seekingExercising independent judgmentDOCTOR :Health care providersTechnical consultantTo convince the necessity of medical services
24 4.DefaultWhen 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.
25 Patient Centred consultation style Dr is less authoritarian , encourages patients to express their own feelings and concerns , empathic , listen more than talk .Dr use open end questioning , show interest in psycho-social aspect of patient’s illness .
26 Length of Consultation Average 8 minutesMakes patient centred consultation styles more difficult.
27 Doctor-patient relationship in the past PaternalismBecause physicians in the past were people who have higher social status“doctor” is seen as a sacred occupation which saves people’s livesThe advices given by doctors are seen as paramount mandate
28 Doctor-patient relationship at present Consumerism and mutualityPatients nowadays have higher education and better economic statusThe concept of patient’s autonomyThe ability to question doctors
29 Principal elements that are essential to the relationship: 1-COMMUNICATION 2-OFFICE EXPERIENCE 3-HOSPITAL EXPERIENCE 4-EDUCATION 5-INTEGRATION 6-DECISION-MAKING 7-OUTCOMES
30 Communication and Treatment Advice reassurance and support from the doctor can have a significant effect on recoveryThe placebo effect
31 CommunicationSeven Essential Elements in Physician-Patient CommunicationBuild the doctor-patient relationshipOpen the discussionGather informationUnderstand the patient’s perspectiveShare informationReach agreement on problems and plansProvide closure
32 Gathering data to understand the patient Nonverbal skillsAttentive and interested body postureFacial expressionAppropriate eye contactTouch
34 Who are “difficult” patients? What characteristics make a patient “difficult”?Mental health disordersMultiple symptomsChronic painFunctional impairmentUnmet expectationsLower satisfaction with careHigh users of health care services4. Jackson JL, Kroenke K. Difficult patient encounters in the ambulatory clinic. Arch Intern Med. 1999;159:5. Hahn SR, Thompson KS, Wills TA et al. The difficult doctor-patient relationship: somatization, personality and psychopathology. J Clin Epidemiol. 1994:47:6. Hinchey, SA, Jackson AL. A cohort study assessing difficult patient encounters in a walk-in primary care clinic, predictors and outcomes. J Gen Intern Med Jan 25.Dr. Tom O’Dowd coined the term “heartsink patient”BMJ, 1988
35 ConclusionRelationship between patients and doctors are often unstated, and thy are dynamicAs conditions change, the kind of relationship that works best for a patient may changeDoctors and patients should choose a “relationship fit”effectiveness of the patient-physician relationship directly relates to health outcomes.
36 Communication with pt includes An intigrated approach to information gathering.Seeking to identify physical psychological and social factorsWill likely to produce a better outcome of health care.