The Doctor-Patient Relationship From Sociology as applied to Medicine

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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