1. PHYSICIAN/PATIENT RELATIONSHIP Assist.Prof.Dr. Mehmet KARATAS Dept. of History of Medicine and Ethics

2. The Elements of Physician/Patient Relationship Communication Patients informed consent Approaching the patient in a humanistic manner Being beneficial, not harming Equal medical services Privacy

3. Assertive Physician Behavior Pyhsician is centered and authoritative. Physician talks in manner of command. Physician commands in first person singular. For example; problem?, undress, lay, open, cough. Physician doesnt want their commands, diagnosis, and methods of treatments to be complained about or rejected.

4. Assertive Physician Behavior Physician behavior: I know this job, what I say is what counts Patient must be docile, must not ask questions or object. Physician: You need to have an operation. Patient: When? Physician: Now.

5. Assertive Physician Behavior Patient: Is there any alternative treatments? Physician: No. Patient: I am afraid of operations. I am not ready for this, another type of treatments... Physician: There is none, its your choice do whatever you want.

6. Consultative Physician Behavior “That is not mine, but your problem. You will make the decisions and I can guide you.” Patient is active. Physician doesnt take responsibility. S/he answers the questions the patient asked.

7. Consultative Physician Behavior Patient: Is it spinal disk herniation that I am suffering? Physician: May be. Patient: Do I need to have an operation? Physician: Yes you may need.

8. Consultative Physician Behavior Patient: I wonder if getting a physical therapy would help me. What do you think? Physician: Yes. You may try physical therapy. Patient: What can you suggest? Which one is suitable for me? Physician: Both of them might be suitable for you. Its your decision

9. Participatory Approach Model It is the ideal approach. Patient’s aim is to recover and physician’s aim is to cure. Information is gathered together, combined, and problems are put forth. For the solution, physician and patient work together. Both sides take and share responsibility.

10. Parcipatory Approach Model The relationship is based on mutual respect and trust. Physicians answer patients questions. The physician makes sure that the active participation of the patient in medical decisions and treatment process is provided.

11. Participatory Approach Model Physician: I listened your complaints, but I need more information. Because of that if you consent, I want to examine you. I am going to examine you in this way. To better undertstand your situation I will have to perform these examinations. I need to take an x-ray, will that be a problem for you?

12. Participatory Approach Model I’m thinking of pursuing this method of treatment. This treatment may have the side effects. During this treatment I will need you to comply with certain things, we will treat you together.

13. To have a successful communication between patient and physician; The neatness on overall appearance The first address, salutation Speaking the patient with eye contact Facial expression, tone of voice, style (Must be chosen according to the patients’ age, sociocultural, emotional and mental situation)

14. Patients’ Problems Have an unwittingly relationship. The patient get affected emotionally by the illness s/he has. Due to the ilnness, the patient has anxiety, shyness, disappointment Because of the adverse events patient experienced, patients may have anger, wrath and even hostility.

15. Physicians’ Problems Heavy work load, heavy on-call duty, sleep deprivation, physical and mental fatigue Negative working conditions Risk of getting sick Fee Personal problems

16. What does the patient want? For the doctor to spend enough time Clean and sanitary working conditions No financial problems between the patient and the doctor Up to date on modern science physicians Love, respect, compassion, trust Not to wait for hours at the clinic doors

17. What does the Physicians want? To spend enough time with the patient Clean and sanitary working conditions No financial problems between the patient and the doctor To be updated on modern medicine To be treated with respect Patients waiting for long hours

18. Physician/Patient Relationship Power of attorney agreement Work agreement

19. Legal Basis Geneva Declaration Human Rights Declaration International Code of Medical Ethics The Law on the Practice of Medicine and Medical Sciences Medical Ethics Charter Patients Rights Directive

20. Geneva Declaration Age, illness, disability, creed, ethnic origin, gender, nationality, political opinion, race, sexual orientation, or social status should not alter the way a physician handles patients

21. The Universal Declaration of Human Rights “All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood”

22. Patients’ Rights Directive Race, language, religion, creed, sex, political opinion, philosophical belief, and differences in economic and social situation can not be taken into account

23. The duties of the Patient Comply with the recommendations of the physicians’ prescribing To ask questions on subjects which are not clear Give full and complete information about a medical condition To abide by the rules of health institutions

24. Ethical Dilemmas Patients choosing harmful actions Child / patients unable to make decisions Ethical issues concerning the termination of life Ethical issues concerning the beginning of life

25. The end of Physician/Patient Relationship Patient choosing another physician The physician not wanting the patient Physician referring the patient to another specialty

26. References F. Başak ÇAKMAK/Bilal GÜNENÇ, İnönü Üniversitesi Tıp Fakültesi, translation Tolga GÜVEN, Marmara Üniversitesi Tıp Tarihi ve Etik AD ders notları Gürkan SERT, Hasta Hakları Robert M VEATCH, Medical Ethics Emine ATABEK, Mebrure DEĞER, Tıbbi Deontoloji Konuları Hasta Hakları Yönetmeliği, 1998 Klinik Araştırmalar Hakkında Yönetmelik, 2011 Çağlar Boyu Tıp, Roche Yayınları http://en.wikipedia.org/wiki/Main_Page