34. DOCTOR-PATIENT RELATIONSHIPS (PART 1)

Question 1

1. What are the three types of practices in medicine that are associated with doctor-patient relationships?

Answer 1

1. The progression from bedside medicine to laboratory
   medicine
2. Patient-Centred Medicine
3. Evidence-Based Medicine

Question 2

2. When did the progression from bedside to laboratory medicine happen?

Answer 2

• during the early 19 century

Question 3

3. What was the focus of bedside medicine?

Answer 3

• if focused on the manifestation of the disease
• it focused on the symptoms of the disease alone
• it did not focus on the cause of the disease
• it did not focus on its internal and hidden causes

Question 4

4. What can be said about the diagnosis and the treatment that happened with Bedside Medicine?

Answer 4

• they were both rather subjective
• they were based on the Doctor’s Understanding

Question 5

5. What caused the progression from bedside medicine to laboratory medicine?

Answer 5

• more and more patients were being hospitalised
• there became a centralised approach to medicine

Question 6

6. What were the effects of the progression from bedside medicine to laboratory medicine?

Answer 6

• there became a general agreement about which diagnosis and therapy were to be used
• there was en emphasis on pathology
• an emphasis on the underlying causes and the internal
  causes
• there was a shift to laboratory medicine
• this was the beginning of evidence based medicine
• it brought about a importance of laboratory tests
• these would be used to see how the disease should be
  managed

Question 7

7. In the past clinical experience guided treatment, what happened if a drug worked in clinical practice?

Answer 7

• it would be used again

Question 8

8. What kind of medical shift has occurred in recent times with regards to Evidence-based medicine?

Answer 8

• a shift towards establishing an objective effectiveness of practice and treatment
• evidence is now coming from research and trails
• evidence is no longer just coming from everyday practice

Question 9

9. What kind of turn happened in the 1980s in Medicine?

Answer 9

• there has been a systematic turn to Patient Centred
  Medicine
• this is the combination of biological, psychological and social perspectives

Question 10

10. How does Patient Centred Medicine work?

Answer 10

• patients provide information to their doctors
• the doctors decide on a diagnosis
• patients are actively engaged in the management of
  the their own condition

Question 11

11. For which kind of diseases is a Patient-Centred approach most appropriate for?

Answer 11

• Chronic diseases
• these involve the long term collaboration between doctors and patients
• there is much patient-doctor communication
• there is much patient involvement

Question 12

12. Within Society, do patients and doctors have roles to fulfil?

Answer 12

• yes
• the doctors have to provide the best treatment they
  possibly can using their knowledge
• they have to provide fair treatment
• the patients have to adopt the sick role

Question 13

13. What are the obligations of a patient who has adopted the Sick Role (according to Parson’s Model)?

Answer 13

• the patient must want to get well as quickly as possible
• they should seek medical help
• they are excused and understood by society for their actions

Question 14

14. What are the rights of a patient who has adopted the Sick Role (according to Parson’s Model)?

Answer 14

• the patient is allowed to withdraw from daily activities
• they are regarded as unable to get better by their own
  decision and will
• they have autonomy over themselves throughout this
  whole process

Question 15

15. What are the obligations of the doctor within the Sick Role (according to Parson’s Model)?

Answer 15

• they must apply a high degree of skills and knowledge
• they must act for the good of the patients
• they must act for the good of the community
• they must be objective
• they must be emotionally detached
• they are guided by the rules of the professional
  practice

Question 16

16. What are the rights of the doctor within the Sick Role (according to Parson’s Model)?

Answer 16

• they are granted rights to examine the patients physically
• they are granted the autonomy in medical practice
• they have a position of authority in relation to the patient

Question 17

17. What did Talcott Parsons use the roles of the doctors and the patients to show?

Answer 17

• stability can be achieved in health care organisations
• the hospital is viewed as a MicroSociety
• harmony can be obtained within this MicroSociety if
  the doctors and the patients both act according to their
  roles

Question 18

18. What does stability in the Health Care organisations result in?

Answer 18

• functionality
• it allows patients to return to social activities
• the whole society is therefore stable
• this makes the whole society functional

Question 19

19. What is observed despite the roles of patients and doctors?

Answer 19

• CONFLICT

Question 20

20. Why can conflict arise between patients and doctors?

Answer 20

1. The doctors and the patients have different values
   - they struggle to find common ground
2. Confidentiality
   - doctors may breach this outside any guidelines
   - this can happen before the patient is informed
3. Doctors may not be able to determine the cause of
   the patient’s symptoms
   
   • this may frustrate the patient
4. Doctors may not be able to coordinate:
   
   • an effectively objective treatment
   • a patient-centred approach
   • a cost-effective treatment for the health care system
5. The patient may not respect the doctor’s decisions

Question 21

21. What are the four types of power and control relationships that influence doctor-patient relationships?

Answer 21

1. Paternalistic Relationship
   
   • high doctor control
   • low patient control
   • this is more a practice of the past
2. Mutuality
   - equal control
3. Consumerist
   
   • low doctor control
   • high patient control
   • this might be found in private consultations
4. Default
   
   • low doctor control
   • low patient control
   • this is the most problematic type
   • there is no one leading the process
   • the doctor and the patient cannot agree with one
     another
   • there is a lack of care on both sides

Question 22

22. What are the most common types of Doctor-Patient relationships?

Answer 22

• Paternalistic Relationship
• Mutuality

Question 23

23. What influences Doctor-Patient relationships?

Answer 23

• the doctor’s perception of their own role
• the doctor’s perception of the patient’s role
• patient expectations when playing their sick role
• younger and highly educated patients expect a more
  patient-centred consultation

Question 24

24. Which two factors is medical practice guided by?

Answer 24

• professional directives
• professional guidelines

Question 25

25. Read through this summary.
    Does everything make sense?

Answer 25

• yes