Doctor-patient relationship : Doctor-patient relationship Dr.Sitaram Gupta Need and rational : Need and rational Learning objectives : Learning objectives By the end of this session students should be able to:
Describe the different types of doctor-patient relationships;
Social factors influencing this consultation;
Outline some of the sociological perspectives on the doctor-patient relationships. Contents : Contents Introduction
Types of D-P relationship
Barrier of good communication
Art of interview
Take home massage Stop and think! : Stop and think! In what ways are relationships between doctors and their patients different from other social relationships (e.g. between student and librarian or between passenger and bus driver? Social relationships : Social relationships Perhaps patient has just met her doctor, but within seconds she tells the doctor very intimate personal details about her health.
within a minutes, she is prepared to remove her clothes and submit to a physical examination. Social relationships : Social relationships This is a one-way process, it would be highly inappropriate if the doctor started to discuss her own bowel movements or if the patient asked her personal questions.
The doctor-patient interaction is shaped by their differing social roles and their different needs. Slide 8: Current practice of “Consultation” Patients are likely to rely on the doctors because of their lower education and social status and their high dependency on medical deliberation, and obedience to authority;
while doctors dominate the consultation process and the decision-making because they are the legalized profession, i.e. supported by our social institution ? The status and power of physicians may encourage patient’s dependency
and, influence how they perceive their health. Slide 9: Disadvantages of the current practice Restricts the patient’s inclination to help themselves.
Restricts the patients in giving their own opinion.
Reinforces the patient’s sick role.
Reinforces the hierarchical relationship between
doctor and patient.
5. Assumes the doctor knows everything about the patients
rather than the patient knowing his or her own condition
better (e.g. pain) Slide 10: Types Doctor-Patient Relationship Physician control
Patient Control Low High
Low Default Paternalist
High Consumerist Mutuality Slide 11: Paternalism The traditional D-P relationship
Doctor Takes on role of “parent”
But currently shift towards Mutuality Slide 12: The Paternalistic Approach “If I’ve told you once I told you 1,000 times, stop smoking!!” Slide 13: Patient-controlled consultation “You’re paid to do what I tell you!!” Slide 14: Doctors’ barriers to effective communication lack of specific knowledge;
lack of counselling skills;
lack of time;
lack of appropriate resources. Slide 15: Patient barriers to effective communication Educational level
Membership of an ethnic minority Developing a REAL relationship : Developing a REAL relationship Have an „open” attitude: whatever is going on between us in interaction is important and intimate, no matter what is being discussed.
Develop in the interviewee a feeling that he/she is being treated
Concentrate all your attention on the interviewee
Help the interviewee to express those contents which are important for the diagnosis
Create a calm and unhurried atmosphere
Listen kindly with empathy
Do not express surprise First minutes… : First minutes… Try not to be late…
Concentrate fully and only at the patient
Take care of the patients comfort
Organize the environment
Pay attention to the physical distance
Introduce yourself… The Art of asking questions : The Art of asking questions The first question: general, open, refer to the interviewee’s general life situation or the presenting problem
What brings you here?
What can I do for you?
What is your problem?
Why are you here? (in the hospital)
Could you tell me a bit more about … The Art of asking questions : The Art of asking questions Narrowing down the questions (general to specific)
Progression (relatively benign to personal)
Leading questions (indirect)
Postponed questions (change of context, better moment)
Projective questions („some people…”, description of interpersonal situation) Language… : Language… The language must be matched to:
interviewee’s intelectual level
Avoid the proffesional language and shortenings When the interview comes to a close… : When the interview comes to a close… Check whether all problems have been discussed and leave some time for their discussion
When time is up – communicate it directly instead of constantly checking the time or „suggesting” that you have to go (e.g.. By gathering the notes impatiently)
Try to summarize the interview
Finish the conversation stressing your interest in the interviewee and in what has been said
You can ask the patient to evaluate the conversation
Say good-bye, get up and thank the interviewee for coming. How to maintain the rapport? : How to maintain the rapport? Verbal signals:
„Yes”, „I understand”, „Yhym”
„Could you tell me more about this?”
Tilt of the head
Synchronisation Slide 23: Recommendation Communication and Diagnosis
Patients who feel at ease and who are encouraged to talk freely are more likely to disclose the real reason for consulting Slide 24: Communication and Treatment
Advice reassurance and support from the doctor can have a significant effect on recovery
The placebo effect Recommendation Take home message : Both patient and doctor could participate in
discussion and planning for treatments.
2. Increase health knowledge and understanding
3. Treat patients in a humanistic and adult manner
? Empowerment of the pts Take home message Slide 26: Thank you