Doctor patient relationship

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Doctor – Patient Relationship Man Mohan Harjai

The Doctor-Patient Relationship:

The Doctor-Patient Relationship Dr. Man Mohan Harjai Shri Mata Vaishno Devi Narayana Superspeciality Hospital


Hippocrates viewed the physician as 'captain of the ship' and the patient as someone to take orders

Patient-Physician Relationship:

Patient-Physician Relationship Why does it matter? Types of relationship What is the ideal patient-physician relationship of the 21st century

Why Does It Matter :

Why Does It Matter The patient-physician relationship is fundamental for providing and receiving excellent care to the healing process to improved outcomes Therefore, it is important to understand what elements comprise the relationship and identify those that make it "good."

Why Does It Matter :

Why Does It Matter Because of the rapidly changing environment that characterizes health care today We need to understand what physicians and patients must do to protect and nurture the relationship

The Patient:

The Patient P atients are individual human beings with problems that all to often transcend their physical complaints The patient are not “ cases” or “ admissions” or “ diseases ”

The Parsons’ model:

The Parsons’ model Parson saw the doctor and patient as fulfilling necessary functions in a well balanced and maintained social structure Sickness is considered to be necessary, providing a brief exemption for patient from social responsibilities

Parsons’- Ideal Patient:

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 Patient:

Parsons’- Ideal Patient -Apply a high degree of skill and knowledge -Acts for the good of the patient -Remain objective and emotionally detached -Respect the position of privilege

4 Types of Doctor Patient Relationship:

4 Types of Doctor Patient Relationship Paternalism Consumerism Mutuality Default

Control based Doctor Patient Relationship:

Control based Doctor Patient Relationship -Doctor controlled -Patient controlled

Prototypes of doctor-patient relationship:

Prototypes of doctor-patient relationship Physician control (Low) Physician control (High) Patient control (Low) Default Paternalism Patient control (High) Consumerism Mutuality


Paternalism Traditional form of doctor-patient relationship Doctor takes on role of parent Doctor is the expert and patient expected to cooperate Tightly controlled interviewing style aimed at reaching an organic diagnosis Passive patient and a dominant doctor Focus is on care, rather than autonomy

Advantages of Paternalistic Approach :

Advantages of Paternalistic Approach The supportive nature of paternalism appears to be important when patients are very sick at their most vulnerable Relief from the burden of worry is curative in itself, and the trust and confident implied by this model allows doctor to perform “medical magic”


Mutuality The optimal doctor-patient relationship model This model views neither the patient nor the physician as standing aside Each of participants brings strengths and resources to the relationship Based on the communication between doctors and patients


Mutuality Patients need to define their problems in an open and full manner The patient has right to seek care elsewhere when demands are not satisfactorily met Physicians need to work with the patient to articulate the problem and refine the request The physician’s right to withdraw services formally from a patient if he or she feels it is impossible to satisfy the patient’s demand

Advantages of Mutuality Approach :

Advantages of Mutuality Approach Patients can fully understand what problem they are coping with through physicians’ help Physicians can entirely know patient’s value Decisions can easily be made from a mutual and collaborative relationship

Disadvantages of Mutuality Approach :

Disadvantages of Mutuality Approach Physicians do not know what certain degree should they reach in communication Is the patient capable of making the important therapeutic decisions

Consumerism :

Consumerism We can simplify the complicated relationship with “buyer and seller” relationship The patient can challenge to unilateral decision making by physicians in reaching diagnosis and working out treatment plans Reversing the very basic nature of the power relationship

Consumerism :

Consumerism PATIENT : Health shoppers so consumer behaviour Cost-consciousness Information seeking Exercising independent judgment DOCTOR : Health care providers Technical consultant To convince the necessity of medical services


Default When patient and physician expectation are at odds, or when the need for change in the relationship cannot be negotiated, the relationship may come to a dysfunction standstill


Patient Centred consultation style Dr is less authoritarian , encourages patients to express their own feelings and concerns , empathic , listen more than talk Dr use open end questioning , show interest in psycho-social aspect of patient’s illness

Patient controlled consultation:

Patient controlled consultation “You’re paid to do what I tell you!!” "nothing about me without me."

Doctor controlled consultation:

Doctor controlled consultation “If I’ve told you once I told you 1,000 times, stop smoking!!”

Length of Consultation:

Length of Consultation Average 8 minutes

Doctor-patient relationship in the past:

Doctor-patient relationship in the past Paternalism Because physicians in the past were people who have higher social status “Doctor” is seen as a sacred occupation which saves people’s lives The advices given by doctors are seen as paramount mandate

Doctor-patient relationship at present:

Doctor-patient relationship at present Consumerism and mutuality Patients nowadays have higher education and better economic status The concept of patient’s autonomy The ability to question doctors

Principal elements essential to the relationship:

Principal elements essential to the relationship Communication Office Experience Hospital Experience Education Integration Decision Making Outcomes

Communication and Treatment:

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


Communication Seven Essential Elements in Physician-Patient Communication Build the doctor-patient relationship Open the discussion Gather information Understand the patient’s perspective Share information Reach agreement on problems and plans Provide closure

Gathering data to understand the patient:

Gathering data to understand the patient Nonverbal skills Attentive and interested body posture Facial expression Appropriate eye contact Touch

Communication with pt includes:

Communication with pt includes An integrated approach to information gathering Seeking to identify physical psychological and social factors Will likely to produce a better outcome of health care

Who are “difficult” patients?:

Who are “difficult” patients? What characteristics make a patient “difficult”? Mental health disorders Multiple symptoms Chronic pain Functional impairment Unmet expectations Lower satisfaction with care High users of health care services Dr. Tom O’Dowd coined the term “ heartsink patient ” BMJ, 1988

Conclusion :

Conclusion Relationship between patients and doctors are often unstated, and thy are dynamic As conditions change, the kind of relationship that works best for a patient may change Doctors and patients should choose a “relationship fit” Effectiveness of the patient-physician relationship directly relates to health outcomes



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