Physicuan Patient Relationship Flashcards
(29 cards)
What is the importance of a Physician Patient Relationship?
The interaction of the researcher with the participants may have produced a positive change in mood…Future studies should be designed to…determine whether (acupuncture) alone can lead to reduced waist circumference or if improvement in mood must be in combination with (acupuncture) to initiate waist circumference reduction.
What is IFC?
IFC = Interferential Current Therapy (electrical stimulation of muscle motor nerves)
What is treatment relationship?
Physician duties are owed only if in a treatment relationship
• Existence of relationship creates these duties
- How do we determine whether a relationship exists?
- Bilateral contract: Patient requests assistance and physician agrees
What is reciprocal autonomy?
Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction.
What are the rights and responsibilities of the physician. Once a relationship is formed?
- standard of care
- confidentiality
- non-abandonment
- informed consent
What are the rights and responsibilities of the Physician?
• Informthepatient:
– Nature of the disorder
– Available treatments (including recommendation)
– Probable course if untreated
- Listentopatient’sconcerns,addressthemobjectively,andrespect his/her decisions
- Mayrefusetreatmentthatconflictswithhis/hermoralorethical principles but must respect the patient’s wishes and make appropriate referrals
What are the rights and responsibilities of patients?
PatientsBillofRights(1972)
– Right to receive complete information
– Right to refuse treatment
– Right to know about a hospital’s financial conflicts of interest
• PatientSelf-DeterminationAct(1991)
– Patients must be given written information about their health care decision making rights and the institutional policy on advance directives
What are the 3 main goals of Doctor-Patient communication ?
3 main goals of doctor-patient communication:
- Create a good interpersonal relationship
- Facilitate exchange of information
- Include patients in decision making
Overall goal: Build trust so the patient will work with the physician
What are the correlations of good doctor-patient communication?
Informed patients have greater sense of well-being and control
Associated with: – greater ability to tolerate pain – faster recovery from illness – enhanced psychological adjustment to illness – decreased length of hospital stay
What are the benefits of good-doctor patient communication?
• Benefitsofgooddoctor-patientcommunication
– Helps patients regulate their emotions
– Facilitates comprehension of medical information
– Allows for better identification of patients’ needs, perceptions and expectations
– Increases the likelihood of patients being satisfied with their care, sharing pertinent information, and adhering to the treatment plan
• Patients’ agreement with doctor about the nature of the treatment and need for follow-up is strongly associated with their recovery
How does Doctor-Patient Communication correlate to other factors (surveys)?
• Surveys: Patients want better communication with their doctors
• Doctors overestimate their communication ability
– 75% of orthopedic surgeons surveyed believed that they communicated satisfactorily with their patients (Tongue et al., 2005)
– 21% of the patients reported satisfactory communication with their doctors (Tongue et al., 2005)
• Better communication = lowered risk of malpractice suit
What is doctor patient communication?
Relationship to Malpractice Claims Among Primary Care Physicians and Surgeons (Dr. Wendy Levinson): The doctors who had never been sued:
• Spent 3+minutes longer with each patient than those who had been sued (18.3 vs. 15)
• More likely to make“orienting” comments(e.g.,“FirstI’llexamine you, and then we will talk the problem over” or “I will leave time for your questions.”)
• More likely to engage inactive listening(e.g.,“Goon,tellmemore about that.”)
• More likely to laugh and be funny during the visit
What are the methods to improve patient communication?
Open/receptive body language
– Sit facing the patient
– Maintain appropriate eye contact – Use a pleasant, encouraging tone
Empathy
– Take time to understand their home life, socioeconomic situation, culture
– Show interest, encouragement, warmth, courteousness, and respect
How to communicate information to patients?
- Tell adults the complete truth about diagnosis and prognosis
- Use vocabulary words the patient will understand
- Speak to adult patients directly, not through relatives or staff
- Do not discuss patient care with friends/family members without the patient’s permission
- Before beginning a procedure, explain it to patient
- Do not offer premature reassurance
- Do not attempt to “scare patients into treatment”
- Do not order a course of action; provide info and let the patient decide
What are the barriers to effective communication?
Past relationship schemas (beliefs, expectations, perceptions) influencing how we form current relationships
Transference
– Relationship schemas that the patient experiences – Can be positive or negative
Counter transference
– Relationship schemas that the physician experiences – Can be positive or negative
What are the barriers of effective communication?
Positive Transference
– E.g., The patient likes her physician because the physician reminds her of her grandfather whom she respected and admired
Negative Transference
– E.g., The patient dislikes her physician because the physician reminds her of an uncle who sexually abused her
Positive Countertransference
– E.g., The physician likes her patient because the patient reminds her of her best friend from high school whom she admires and respects
Negative Countertransference
– E.g., The physician dislikes her patient because the patient reminds her of an ex-husband who abused her
How can objectification/dehumanization for barriers to effective communication?
• Objectification/Dehumanization
– Using the patient as a teaching tool in a teaching hospital in direct
view of patient
– Discussing case with colleagues in listening range of the patient
• Do not define the patient by his/her disease:
“Patient with Alzheimer’s disease”
vs. “Alzheimer’s patient”
How can sensory and cognitive impairment become a barrier to effective communication?
Sensory Impairment
– Be prepared to utilize a sign language interpreter or written materials
Cognitive Impairment
– Provide written instructions for memory impaired patients
– Determine patient competency to understand and comply with treatment recommendations, refer for evaluation if needed
What are possible language and cultural differences?
• Language and Cultural Differences
– Enlist interpreters, translators
– Be receptive to cultural beliefs, explanations, and prohibitions
How should doctors address non-conforming gender identities?
• Insensitivity to non-conforming gender identity and sexual orientation
– Be open, ask questions, and educate yourself
What are the race effects of effective communication?
Race Effects
– Racial disparities in treatment and minority distrust of healthcare
professionals
What are the barriers to treatment adherence?
• Poor relationship with physician
– Perception of the physician as cold and unapproachable
– Anger at the physician
– Anger at the practice due to poor overall experience
- Believing that the financial and time costs of care outweigh the benefits
- Symptom resolution (i.e., seizures stop; BP normalizes)
- Complex treatment schedule
What are the fears of treatment adherence?
• Fears
– Loss of bodily integrity from medication side effects
– Dependency on others
– Loss of masculinity (explains why someone may play through an injury)
– Loss of work time, fear of losing their livelihood
How can denial/avoidance prevent treatment?
Refusal to admit being ill or to acknowledge severity
