Doctor and patient relationship Flashcards
Why is the doctor-patient relationship important?
Significantly impacts adherence to treatment
Affects patient satisfaction or confidence, influencing the return of a patient in need
What are Jewson’s medical cosmologies?
What makes up the social context of the consultation?
Patient characteristics: increasing patient knowledge e.g. internet. Gender, SES, education, ethnicity and race
Doctor characteristics: speciality, gender, models of health and illness
Culture clashes: doctor and patient health beliefs, biomedical vs psychological models of illness, expectations
Rise of CAM: declining status and trust in the medical profession
Changing policy and organisational context and priorities: patient responsibility over health, self-management, increase in patient choice and consumerism in healthcare
What is Parson’s sick role?
Sees illness is a form of deviance which threatens the stability of society
These people have rights:
- Excused from normal activities and responsibilities
- Regarded as being in need of care and absolved of responsibility for their illness
Obligations:
- Want to get well - temporary
- Seek professional advice and cooperate with it
What are the four elements of the depth of the doctor-patient relationship from the patient perspective?
Knowledge
Trust
Loyalty
Regard
There are two sides to this:
the patient’s opinion of the doctor
the patients perception of the doctor’s opinion of them
What are the interpersonal aspects of the doctor patient relationship?
Unspoken exchanges
Flow of relationship exchanges that run alongside formal consultations
How practitioners guard against confusions and limitations to practice that may arise
Know how they can be used to therapeutic advantage
What do Bruc and Bond say about empathy in the relationship?
Goes beyond demonstrating understanding of the patient to demonstrating the ability to predict them
How does is the internal frame of reference involved in the relationship?
The skill of listening to, and understanding patients is based on choosing to acknowledge the separateness between ‘me’ and ‘you’
Inside patient’s internal frame of reference rather then remaining in your own external frame of reference
What are the dynamics of communication within the consultation?
Morgan
Consultation depicted in terms of the relative power and control of doctors and patients
Style varies with who makes decisions, level of patient involvement, use of medical jargon, socio-economic utterances (humour, reassurance, social talk)
How has power and access to information changed the dynamic?
Used to be a steep inequality between doctor and patient
Increasing desire for more information
Need to be transparent about what doctors don’t know, consultation on more equal terms
Changed the way medicine is practiced
What is the model of doctor-patient interactions by Russell?
All about power dynamics
Paternalistic: High doctor control, low patient control
Default: low doctor and patient control
Consumerist: Low doctor control, high patient control
Mutualistic: High doctor and patient control
Conflict: medium control for both, competing
What is a paternalistic relationship?
Communication style: intrusive/prescriptive - patient control: low, doctor control:high
Doctor centered - responsible for decision making
Follows biomedical model of disease - doctor is expert, disease is a biological phenomenon with identifiable cause
What are the criticisms of the paternalistic style?
- Patient is expected to be the passive recipient of care
- May be appropriate in certain clinical contexts
- Overlooks patient’s own knowledge and experiences
- Can result in low patient satisfaction and comlaints
- May impact adherence
- May lead to conflict if patient tries to take more control
What is the mutualistic style?
Patient and doctor control: high
Involves mutual respect with patient more active role
Doctor acknowledges patient beliefs, knowledge and experiences as important
Patient centered
Shared decision making
