Patient-Practitioner Relationships

Question 1

the doctor-patient interaction has been seen as ‘problematic’. explain the consequences of this

Answer 1

1) One fifth of parents of ill children left a consultation without a clear understanding of the diagnosis
2) Nearly half left without understanding the cause of the illness;
3) A quarter of these parents had not reported their greatest concerns
- Communication failures strongly associated with non-adherence to medical recommendations. so we need to move towards to patient-centred consultations

Question 2

Talcott Parsons- “the sick role” contains within itself customary rights and obligations based on the social norms that surround it. The theory outlined two rights of a sick person and two obligations. outline the sick role and stating the rights and obligations

Answer 2

rights:
1) Patient temporarily excused from normal role
2) Patient not responsible for own illness
obligations:
3) Patient must want to get better
4) Patient must cooperate with competent help

Question 3

discuss the Criticism of Parsons’ sick role

Answer 3

1) Patients not always passive- depends on the character and severity of the condition.
2) Some interventions require physically intrusive procedures, but others necessitate self-medication and more active patient involvement
3) too rigid of a model
4) not good for chronic conditions
5) biased in favour of medical profession
6) does not account for patient beliefs and behaviour
7) patient too define their illness.

Question 4

what is Patient-centred care?

Answer 4

1) Patient-centred care encourages focus on patients and their concerns rather than merely diseases and their assessment
2) Practitioners are encouraged to see the illness through the patient’s eyes.

Question 5

outline the three-function model for the medical interview recommended by Cohen-Cole and Bird

Answer 5

1) ) a data-gathering phase (where the patient’s psychosocial context is considered)
2) a rapport-development phase
3) an educational and motivational phase: the practitioner also works to resolve any areas of conflict to negotiate an agreement on the therapeutic outcome.
- communication skills, empathy and involvement are prioritised over authority and paternalism.

Question 6

outline the Calgary-Cambridge approach to consultations

Answer 6

1) Initiating the session (establishing initial rapport and identifying the reasons for the consultation)
2) gathering information (exploring the problem and understanding the patient’s perspective);
3) providing structure to the consultation
4) building the relationship
5) explanation and planning ( aiding accurate recall and understanding, gaining a shared understanding by incorporating the patient’s perspective, and shared decision-making)
6) closing the session

Question 7

with regards to Sharing power (Emanuel and Emanuel 1992) , what is a mutual relationship and how does it differ from a paternalistic relationship?
- what happens in the consumerist model?

Answer 7

1) In a mutual relationship power is balanced, the purpose of the visit is negotiated, the patient’s valued are explored and the doctor plays an advisory role to guide patient decisions.
2) In a paternalistic relationship, the doctor holds on to the balance of power, controlling the agenda for the visit, goals and outcomes, acting as a guardian without explicitly exploring the patient’s interests.
3) In the consumerist model, patients set the goals and agenda, making the decisions and determining outcomes with the doctor becoming a technical consultant.

Question 8

for each of the following state who holds the power and outline the role of the doctor:

1) Paternalistic relationship
2) Mutual relationship
3) Consumerist relationship

Answer 8

1) Paternalistic relationship: Power is with doctor
- Doctor acts as guardian
2) Mutual relationship: Power is balanced
- Doctor plays advisory role
3) Consumerist relationship: Power is with the patient
- Doctor acts as consulting technician

Question 9

what is Shared decision making?

Answer 9

1) Shared decision making involves a two-way exchange of information between the practitioner and the patient and includes a discussion of preferences for health states, therapeutic options and outcomes.
- shared deliberation to arrive at a mutually-agreed decision.

Question 10

according to a report by the health foundation Choosing an appropriate treatment with full patient involvement can be a complex process, and It involves a number of steps. outline the steps involved in shared decision making

Answer 10

1) recognise and clarify the problem
2) identify potential solutions
3) discuss options and uncertainties
4) provide information about potential benefits, harms and uncertainties of each option
5) check understanding and reactions
6) agree a course of action
7) implement the chosen treatment
8) arrange follow-up
9) evaluate the outcome.

Question 11

when is shared decision making particularly appropriate?

Answer 11

1) when there is more than one reasonable course of action and no one option is self-evidently best for everyone
2) Shared decision making then relies on two sets of expertise; the health professional is an expert on the effectiveness, potential benefit and harm of treatment option while the patient is the expert about him/herself, their social circumstances, attitude to illness and risk and values and preferences

Question 12

To help shared decision making a variety of ‘decision aids’ have been developed: videos, leaflets, structured counselling etc. Most decision aids share 3 common features, outline these features.

Answer 12

1) providing facts about the condition, options, outcomes and probabilities;
2) clarifying patients’ evaluations of outcomes that matter most to them;
3) guiding patients through a process of deliberation so that a choice can be made matching their informed preference.