Doctor-patient relationship Flashcards
An indigenous healer
Shaman
Who was the god of healing?
Apollo
Who was associated with health and disease?
Asklepios
Who was the first person to believe that diseases were caused naturally and not because of superstition?
Hippocrates
What did Hippocrates promote?
Natural theories of health and sickness and natural modes of healing
Evolution of medical theories
- Preternaturalistic: divine punishment
- Hippocratic revolution
- Naturalistic: ontological/functional concepts
- 1940s, 1960s socio-cultural
What do Hippocratic doctors pledge?
To do no harm: demonstrates the physician’s devotion to his art rather than fortune
What is the physician excellent at in the modern age?
- Anamnesis [complete clinical history of a patient]
- Differential diagnosis
3 reasons why the doctor-patient relationship is important
- Bioethical reason
- (Neuro)ethical reason
- Legal reason
What were the 2 trigger events that led to human research subject protection?
- Nurember war tribunal (1947)
- Syphilis study in Tuskegee GA, USA 1932-1972
Describe the Syphilis study in Tuskegee GA, USA 1932-1972
- 600 low-income AA males, 400 of whom were infected with syphilis were monitored for 40 years
- free examinations given, but the patients were not told about their disease
- even though there was a treatment for syphilis in the 50s, the participants were denied treatment unit 1972
Who created the Belmont report?
the National Commission for the Protection of Human Subjects of Biomedical and Behavioural Research was created after the National Research act of 1974
What are the 3 basic ethical principles?
- Autonomy
- Beneficence
- Justice
What is autonomy?
Individuals should be treated as autonomous agents: need to be informed about treatments and all risks and benefits
What is beneficence?
Do no harm, maximum possible benefits and minimize potential harm
What is justice?
Fair distribution of burdens and benefits of research
What is the placebo effect?
The positive physiological or psychological changes associated with the use of inert medications, sham procedures or therapeutic symbols within a healthcare encounter
What are placebos?
Inactive substances used to compare results with active substances
What are sham treatments?
Doctor goes through the motions without performing the treatment
What did sham surgeries prove in a review in 2014?
The sham surgeries provided some benefit in 74% of the trials
What is an open injection?
Injection carried out by a doctor at the bedside who told the patient that the injection was a powerful analgesic
What is a hidden injection?
The same analgesic dose was performed by an automated infusion machine which started without the doctor/nurse
What was seen about hidden/open injections?
The analgesic dose to reduce the pain by 50% was much higher for hidden infusions that for open ones
Which 4 painkillers were studied in the open/hidden injection study?
- Metamizole
- Ketorolac
- Tramadol
- Buprenorphine
What does an open injection activate?
The endogenous opioid systems through expectation pathways
What are dopamine pathways?
Expected reward for a behaviour performed
What is stressed-induced analgesia?
It is a well-known phenomenon when soldiers are wounded in battlefield but feel no pain until the battle is over
What is anxiety- induced hyperplasia?
The modulation of pain by emotion and context is widely recognised. Fear and pain can exacerbate pain
What is nocebo hyperplasia?
How anxiety is turned into pain: attention is focused on pain and cholecystokinin
What factors mediate the placebo effect?
- associative learning/ conditioning processes
- Cognitive factors such as the patient’s expectation of a benefit from a treatment
- quality of doctor-patient communication
What promotes enhanced health and well-being?
Social contact
Where is dopamine produced?
In the ventral tegmental area (VTA)
Where is dopamine sent?
to the amygdala, nucleus accumbens, prefrontal cortex and hippocampus
What is serotonin responsible for?
Feelings of satiation
What are part of the mesolimbic pathways?
- Nucleus accumbens
- Amygdala
- Hippocampus
What does the amygdala mediate?
Decisions about reliability of people and situations in 1/10th of a second the brain judges the reliability of a face
What increases confidence and trust?
Oxytocin
What is a mirror neuron?
A neuron that fires both when an animal acts and when the animal observes the same action performed by another
Neurotransmitters involved in the placebo response
endogenous opioids
endocannabinoids
dopamine
cholecystokinin CKK
Instead of administering drugs, what is something equally good that a physician can do?
Empathy and motivating them positively
What is medical malpractice?
A legal cause of action that occurs when a medical or health care professional deviates from standards in hi/her profession, thereby causing injury to a patient
What is defensive medicine?
Refers to the practive of recommending a diagnostic test or medical treatment that is not necessarily the best option for the patient, but an option that mainly serves the function to protect the physician against a patient as a potential plaintiff
What forms can defensive medicine take?
- Assurance-bureaucratic behaviour
- Avoidance behaviour
What is defensive medicine a burden on?
health care costs
What is assurance-bureaucratic behaviour?
involves the charging of additional services
What is avoidance behavior?
Occurs when providers refuse to participate in high risk procedures or circumstances
What increases the risk of non-adherence in patients?
poor physician communication
Which routine visits tend to be longer?
With no-claims primary care physicians were longer than claims primary care physicians
What is the range of consultation time?
22s in Bangladesh
22.5 min in Sweden
What is the average consultation time?
5 min or less
What can medical literacy do?
Improve doctor-patient communication and therefore the patient’s health
