Patient-Doctor Relationships

Question 1

What are the 3 main ideal types of patient-doctor relationships?

Answer 1

1. Paternalistic - doctor led
2. Shared - partnership
3. Informed - patient led

Question 2

What are the key elements of Paternalistic Model?

Answer 2

• Dr makes systemic enquiry + asks specific Qs
• Patient is passive
• Info flows largely from doctor to patient (often minimal amount)
• Expectation patient will agree as Dr knows best
• Appropriate in some scenarios e.g. emergency, patient preference

Question 3

What are the key elements of Shared Model?

Answer 3

• 2 way exchange of info
• Both participants bring expertise (doctor = medical, patient = personal)
• Each participant seen as having some limitations
• Reach action/treatment decision together
• Challenge = create comfortable enough environment

Question 4

What are the key elements of the Informed Model?

Answer 4

• Doctor communicates all info, risk, benefits + treatment options (key contribution)
• Patient makes informed treatment decision
• Patient is active + expects to make decision (sole prerogative)
• Not common in UK
• Eg’s = private health, cosmetic plastic surgery

Question 5

What is the current thinking on doctor-patient relationships?

Answer 5

Shared model advocated

Shared decision making = key element of person-centred care

Need repertoire of doctor-patient relationships as 1 does not fit all

Question 6

What is the key ethical value for all relationships?

Answer 6

Respect

Question 7

What is the doctor’s primary concern?

Answer 7

Care of your patient - requires developing relationship with patient, making decisions in best interest of patient from their perspective, respecting their preferences/values, requires dialogue

Question 8

What are the major ethical principles involved in the 3 patient-doctor relationships?

Answer 8

1. Paternalistic = Beneficence
2. Informed = Autonomy
3. Shared = Beneficence + Autonomy

Question 9

What are the aims when negotiating with patients to achieve shared decision making?

Answer 9

Review the importance of:
Ideas
Concerns
Expectations

Highlight the benefits - consultations feel more satisfying, patients more engaged, better outcomes, creates less workload overall, reduced patient anxiety