The doctor-patient relationship is a central part of health care and medical practice. The doctor-patient relationship forms one of the foundations of contemporary medicine ethics.
Video Doctor-patient relationship
Importance
A patient must have confidence in the competence of their physician and should feel that they can confide in him. For most doctors, establishing good relationships with patients is important. Some medical specialties, such as psychiatry and family medicine, emphasize doctor-patient relationships rather than others, such as pathology or radiology, which have little contact with patients.
Patient-physician relationship quality is important for both parties. The values ​​and perspectives of doctors and patients about the disease, life, and time available play a role in building this relationship. A strong relationship between physicians and patients will lead to frequent, qualified information about patient illness and better health care for patients and their families. Improving the accuracy of the diagnosis and increasing the patient's knowledge about the disease all come with a good relationship between the doctor and the patient. If such a relationship is bad, the ability of the physician to make a full assessment is compromised and the patient is more likely to disbelieve the proposed diagnosis and treatment, leading to decreased compliance to actually follow medical advice that results in poor health outcomes. In these circumstances and also in cases where there are actual medical disagreements, the second opinion of another doctor may be sought or the patient may choose to go to another physician who they trust more. In addition, the benefits of a placebo effect are also based on the subjective assessment of the patient (consciously or unconsciously) of the credibility and skill of the physician.
Michael and Enid Balint jointly pioneered the study of physician patient relationships in the UK. Michael Balint "The Doctor, His Patient and the Illness" (1957) describes some detailed case histories and becomes seminal text. Their work is continued by the Balint Community, the Balint International Federation and other Balint national societies in other countries. This is one of the most influential works on the topic of doctor-patient relationships. In addition, a Canadian doctor known as Sir William Osler was known as one of the professors of "Big Four" at that time Johns Hopkins Hospital was first established. At Johns Hopkins Hospital, Osler has discovered the world's first medical residency system. In terms of efficacy (ie treatment outcomes), the doctor-patient relationship appears to have "a small but statistically significant impact on health care outcomes". However, due to the relatively small sample size and the minimal effective test, the researchers conclude additional research on this topic is necessary. Recognizing that patients receive the best care when they work in partnership with doctors, the UK General Medical Council issues guidelines for patients "What is expected of your doctor" in April 2013.
Maps Doctor-patient relationship
Aspects of relationships
The following aspects of a doctor-patient relationship are the subject of comment and discussion.
Informed consent
The standard medical practice to show respect for patients and their families is for doctors to be honest in informing their healthcare patients and to directly seek patient consent before giving treatment. Historically in many cultures there has been a shift from paternalism, the view that "doctors always know best," with the idea that patients should have a choice in the provision of their care and be given the right to provide informed consent for medical procedures.. There may be a problem with how to handle informed consent in a doctor-patient relationship; for example, with patients who do not want to know the truth about their condition. In addition, there are ethical concerns about the use of placebo. Does giving sugar pills lead to undermining trust between doctors and patients? Is deceiving the patient for his own kindness in accordance with a respectful and conscientious doctor-patient relationship? Such questions often arise in the health care system and the answers to these questions are usually far from clear but must be informed by medical ethics.
Collective decision-making is the idea that as patients provide informed consent for treatment, the patient is also given the opportunity to choose between the treatment options provided by the physician responsible for their health care. This means doctors do not recommend what the patient should do, but the patient's autonomy is respected and they choose what medical treatment they want to do. An alternative practice for this is for doctors to make a person's health decisions without considering the purpose of one's care or putting the person's input into the decision-making process is very unethical and contrary to the idea of ​​autonomy and personal freedom.
The inclusion spectrum of a physician from a patient in treatment decisions is well represented in Ulrich Beck's "World at Risk . At one end of this spectrum, Beck's Negotiated Approach to risk communication, in which communicators maintain open dialogue with patients and resolve compromises in which both patient and doctor agree. Most physicians use this variation of communication model to some extent, because only with this technique can doctors maintain open cooperation of patients. At the opposite end of this spectrum is the Technocratic Approach to risk communication, where physicians use authoritarian control over patient care and encourage patients to receive treatment plans with which they are presented in paternalistic ways. This communication model puts the doctor in a position of omniscience and omnipotence over the patient and leaves little room for the patient's contribution to the treatment plan.
Doctors excellence
Doctors can be viewed as superior to patients simply because doctors tend to use big words and concepts to place themselves in a position above the patient. The doctor-patient relationship is also complicated by the suffering of the patient ( patient derived from the Latin patior , "suffering") and limited ability to lighten itself, potentially resulting in a state of desperation and dependence to the doctor. A doctor should be aware of these differences to build good relationships and optimize communication with patients. In addition, having a clear perception of these differences can greatly assist patients in future care. It may be more beneficial for the physician-patient relationship to have a form of joint treatment with the patient's empowerment to take on a large degree of responsibility for his care.
Those who go to the doctor usually do not know the exact medical reason why they are there, which is why they go to the doctor in the first place. So that patients can not understand what's going on with their body, because they can not understand the lab results or their doctors do not share or explain it, it can be a frightening and frustrating situation. the discussion of laboratory results and the certainty that patients can understand it can cause a patient's feelings to be reassured, and thereby can bring positive results in a doctor-patient relationship.
Beneficial or fun
Dilemmas may arise in situations where determining the most efficient treatment, or avoiding the avoidance of treatment, creating disputes between doctors and patients, for a number of reasons. In such cases, doctors need a strategy to present unfavorable treatment options or unwanted information in a way that minimizes strain on the doctor-patient relationship while benefiting the patient's overall physical health and best interests. When the patient can not or will not do what the doctor knows is the right treatment, the patient becomes disobedient. Compliance management training becomes important to provide positive reinforcement of unpleasant choices.
For example, according to a study in Scotland, patients want to be addressed by their first names more often than at present. In this study, most patients liked (223) or did not mind (175) called by their first names. Only 77 people did not like being called by their first names, most of whom were over 65 years old. On the other hand, most patients do not want to call a doctor by his first name.
Some familiarity with doctors generally makes it easier for patients to talk about intimate issues such as sexual subjects, but for some patients, a very high level of intimacy can make patients reluctant to reveal such intimate problems.
Transitional care
The transition of patients between health care practitioners can degrade the quality of care in the time required to rebuild the right patient-physician relationship. Generally, the doctor-patient relationship is facilitated by continuity of care with respect to the personnel present. Specialized integrated care strategies may be needed when many health care providers are involved, including horizontal integration (linking the same level of care, such as a multiprofessional team) and vertical integration (connecting different levels of care, eg primary, secondary and tertiary care).
Turn-taking and conversation dominance
The process of switching between health care professionals and patients has a huge impact on the relationships between them. In most scenarios, the doctor will go into the room where the patient is detained and will ask questions involving the patient's history, examination, and diagnosis. This is often the basis of the relationship between doctors and patients because this interaction tends to be the first they have together. This can greatly affect the future of the relationship throughout the patient's care. All speech acts between individuals strive to achieve the same goals, share and exchange information and meet each participant's conversational goals.
Research conducted in medical scenarios analyzes 188 situations where interruptions occur between physicians and patients. Of the 188 situations analyzed, the study found that physicians were far more likely (67% of the time, 126 times) than patients (33% of the time, 62 times). This suggests that doctors practice the form of conversational dominance in which they see themselves far superior to the patient in terms of importance and knowledge and therefore dominate all aspects of the conversation. A question that comes to mind considering this is if the interruptions block or improve the patient's condition. Constant interruptions from patients while doctors are discussing treatment options and diagnoses can be detrimental or lead to less effective efforts in patient care. This is very important to note because this is something that can be overcome in a fairly simple way. The study was conducted on doctor-patient interruptions also showed that men were much more likely to interrupt out of turn in later female conversations. This can also cause problems if female doctors try to convey messages because women are statistically more likely to interrupt conversations less frequently than their male counterparts.
Other Individuals involved
Examples where other people present at a doctor-patient meeting can affect their communication are one or more parents present at a minor visit to a doctor. It can provide psychological support for the patient, but in some cases it may compromise the doctor-patient confidentiality and prevent the patient from revealing an uncomfortable or intimate subject.
When visiting a healthcare provider about a sexual issue, having a partner pairing is often necessary, and usually a good thing, but it can also prevent disclosure of certain subjects, and, according to one report, increases stress levels.
Having a family around when faced with difficult medical conditions or treatments can also lead to complications. Family members, in addition to patients in need of care may not agree on the necessary treatment. This can cause tension and discomfort for patients and doctors, putting further strain on relationships.
How to bed
A good bedside way is usually one that comforts and comforts the patient while remaining honest about the diagnosis. Sound tone, body language, openness, presence, honesty, and concealment can all affect sleep. Poor bedside ways make the patient feel dissatisfied, worried, scared, or alone. Bedside ways become difficult when a health care professional should explain the patient's unfavorable diagnosis, while keeping the patient from worrying.
Dr Rita Charon launched the narrative drug movement in 2001 with an article in the Journal of the American Medical Association. In the article he claims that better understanding of patient narratives can lead to better medical care.
Researchers and Ph.D.s in the journal BMC Medical Education conducted a recent study that yielded five key conclusions about patients' needs from their healthcare providers. First, the patient wants their provider to provide a guarantee. Second, patients feel anxious to ask their provider questions; they want the service provider to tell them that it's okay to ask. Third, the patient wants to see their lab results and the doctor explains what they mean. Fourthly, patients simply do not want to feel valued by their provider. And fifth, the patient wants to be a participant in medical decision-making; they want the provider to ask them what they want.
An example of how body language affects patients' perceptions of care is that the time spent with patients in the emergency department is felt longer if doctors sit during the meeting.
Example in fiction
- Gregory House (from House show ) has a spicy and insensitive bedside way. However, this is an extension of his normal personality.
- In Gray's Anatomy , Dr. Burke praised Dr. George O'Malley to care for Dr. baby. Bailey by saying "it speaks with a good bedside way."
- Doc Martin from the English TV series Doc Martin is a good example of a doctor with a bad bedside way.
- Dr Lily Chao from the British TV series Victim is another example of Doctor Foundation with poor bedside manner, while his colleague Dr. Ethan Hardy has a better one.
- In Lost , Hurley tells Jack Shephard that her attitude to the bedside "sucks". Later in the episode, Jack was told by his father to put more hope into his words, which he did while operating on his future wife. The comments continued in other episodes of the series with Benjamin Linus sarcastically telling Jack that "his side ways left something to be desired" after Jack gave him a strong negative diagnosis.
- In Closer , Larry, the doctor tells Anna when they first met that she's famous for her bedside attitude.
- In Scrubs , JD is presented as an example of a doctor with a large bedside manner, while Elliot Reid is a poorly-spaced or no-nap doctor at first, until he evolves over a period of time his position in the Sacred Heart. Dr. Cox is an interesting subversion, because it works brashly and uncharacteristically while still inspiring patients to do their best to help the healing process, like a sergeant. The event also commented that most of the time a doctor needs to be in the presence of a patient before he knows everything there is to know is about 15 seconds.
- In Star Trek: Voyager , Doctors often praise themselves at the charming bedside she developed with the help of Kes.
- In M * A * H *, Hawkeye Pierce, Trapper John McIntyre, B.J. Hunnicutt, and Sherman Potter all have curious and funny bedside ways that are meant to help patients deal with traumatic injuries. Charles Winchester did not initially have a bed-like attitude, acting with separate professionalism, until the severity of his work helped him develop a sense of compassion for his patients. Frank Burns has poor bedside ways, constantly minimizing the seriousness of his patients' wounds, accusing them of cowardice and persuading them to return to the front lines.
Patient behavior
Source of the article : Wikipedia
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