15. DOCTORS AND PATIENTS

Question 1

1. What 2 rules are outlines in the General Medical Council’s Section 74?

Answer 1

1. TO PRACTISE SAFELY:
   
   • the doctor’s must be competent in what they do
2. THE ATTRIBUTES OF COMPETENCE OF DOCTORS:
   
   • is essential
   • but not enough

Question 2

2. What is meant by: “To practise safely, doctors must be competent in what they do” ?

Answer 2

DOCTORS MUST ESTABLISH AND MAINTAIN:
- effective relationships with patients

THEY MUST RESPECT THE PATIENT’S AUTONOMY
- they must act responsibly
- they must act appropriately
- especially if they or a colleague fall ill

REGARDLESS OF THE CIRCUMSTANCE
- they must ensure that their performance does not
suffer

Question 3

2. What is meant by: “The attributes of competence of doctors is essential, but not enough”?

Answer 3

DOCTORS HAVE A RESPECTED POSITION IN SOCIETY
- their work gives them privileged access to patients
- some of these patients may be very vulnerable

A DOCTOR WHOSE CONDUCT HAS SHOWN
- that they can not have trust placed in them
- will no longer be allow unrestricted practice
- until they can redeem themselves

Question 4

4. Who is the doctor’s first duty to?

Answer 4

• the patient
• the care of your patient is your first concern
• doctor’s owe the duty of care to their patients

Question 5

5. What does the doctor owe their patient once they assume responsibility of them?

Answer 5

• the legal duty of care

Question 6

6. What is a doctor’s secondary duty?

Answer 6

• the public

EXAMPLE:
- this was the case with the Covid-19 pandemic

Question 7

7. What are the two responsibilities to professional codes of conduct?

Answer 7

1. Responsibilities to professional Codes of Conduct
2. Responsibilities to personal Ethical Codes

Question 8

8. What are the two categories of: “Responsibilities to professional Codes of Conduct”?

Answer 8

1. Duties
2. Guidelines

Question 9

9. What is the one category of: “Responsibilities to Personal Ethical Codes”?

Answer 9

1. Conscientious Objection

Question 10

10. What model did the is a Co-Operative Model of decision making replace?

Answer 10

• this model has replaced the Authoritarian model
• this model was characterised by Traditional Medical
  Paternalism

Question 11

11. What is Patient Centred (Whole Person) Care?

Answer 11

• this takes into account the individual’s values and
  circumstances
• it looks at the aspects of their health
• it involves tailoring of their treatment
• there is an attempt to reflect the patient’s preferences

Question 12

12. What was so monumental about the development of Patient Centred (Whole Person) Care?

Answer 12

• it reflected a shift in the Philosophy of Healthcare
  systems

Question 13

13. List the 3 characteristics of a Paternalistic Approach?

Answer 13

1. THE DOCTOR IS CONCEPTUALISED
   
   • as a guardian
   • there is a Paternal Hierarchical Relationship
2. THE DOCTOR WOULD MAKE DECISIONS
   
   • often with little or no discussion with the patient
3. THE DECISION IS MADE
   
   • in the patient’s best interests
   • this decision is made from the knowledge of the
     medical facts alone
   • the patient is given selective information

Question 14

14. List the characteristics of a Patient-Centred Approach?

Answer 14

1. AN INCREASE IN THE RECOGNITION
   - of the right of patients to make their own medical
   decisions
2. IT TAKES INTO ACCOUNT
   - the patient’s health and values
   - it looks at the patient’s life circumstances
   - it looks at the patient’s lifestyle, family history and
   social life

Question 15

15. What is an Informative Doctor-patient relationship?

Answer 15

• this is one that provides relevant factual information to
  the patient
• it implements the patient’s selected intervention

Question 16

16. What is an Interpretive Doctor-Patient Relationship?

Answer 16

• this is one that provides information
• it shines a light on all the matters at hand
• it interprets the relevant patient values
• it provides the patient with facts
• this helps the patient to find their preferences

Question 17

17. What is a Deliberative Doctor-Patient Relationship?

Answer 17

• it provides information that highlights the patient’s
  values
• the patient and doctor engage in dialogue about what
  the is best course of action
• it looks at the doctor’s and patient’s preferences

Question 18

18. What are the 5 disadvantages of a Paternalistic Doctor-Patient relationship?

Answer 18

1. IT ADOPTS AN OVERLY NARROW MEANING OF WELL-
   BEING
   - as well as of the best interests of the patient
2. THE PATIENTS SUFFER ILLNESSES
   - the doctors diagnose and treat them
   - they never look at the cause
3. IT FAILS TO INTEGRATE
   - scientific and social concepts of diseases and
   illnesses
4. IT DOES NOT PLACE EMPHASIS
   - on the patient’s autonomy
5. THERE IS AN UNEQUAL POWER DYNAMIC

Question 19

19. What are the benefits of the Patient Centred Approach?

Answer 19

1. THERE IS A HOLISTIC UNDERSTANDING
   - of the patient’s problem
2. THERE IS A MORE ACCURATE DIAGNOSIS
3. THERE IS AN INCREASED ADHERENCE FROM THE
   PATIENT
   - towards the treatment
4. THE PATIENT’S RIGHTS AND AUTONOMY
   - are respected and valued
5. THE PATIENT HAS SOME SENSE OF CONTROL
   - and can exercise their own choice
6. THE DOCTOR AND PATIENT
   - share decision making
7. THE PATIENT IS SATISFIED
8. THE HEALTHCARE PROVIDERS
   - are moral and efficient

Question 20

20. What are the 3 core components of a Patient-Centred Approach?

Answer 20

1. Communication
2. Partnership
3. Health Promotion

Question 21

21. What is meant by Communication?

Answer 21

• this includes the exploration of concerns
• it requires information

Question 22

22. What is meany by Partnership?

Answer 22

• this is all about negotiating a Common Ground

Question 23

23. What is meant by Health Promotion?

Answer 23

• it looks at the overall health and well-being of the
  patient