Doctor patient relationship Flashcards
Ethical Principles it involves
Autonomy
Beneficence
Non‐maleficence
Justice
Autonomy
the principle that ensures that patients are afforded the chance to make
informed, un‐coerced decisions
Beneficence
The principle that obligates doctors to do everything they can that would
benefit or help the patient
Non‐maleficence
the principle of “primum non nocere” (first, do no harm) which
obligates doctors to do as little harm as possible
Justice
the principle of fairness. In health care Justice normally refers to distributive
justice, which is fairness in distribution of resources
Models that describe doctor/patient roles in the relationship:
o Paternalistic model‐ The Guardian
o Informative model‐ Competent Technical Expert
o Interpretive model‐ Counselor or Advisor
o Deliberative model‐ Friend or Teacher
The commencement of the doctor patient relationship is established when?
the relationship exists
when Informed Consent has been offered‐ bona fide intent to examine/treat is established
In casual situations, one can avoid the appearance of a doctor patient relationship by:
o Avoiding in‐depth inquiry to the nature of the patient’s problem
o Avoiding examination or any form of treatment (even as benign as a brief massage)
o Avoiding recommending a specific therapy
o Avoiding promising anything to the patient
o Clarify in conversation that any ideas expressed are without the benefit of a complete evaluation, which is absolutely necessary before any sound advice could be offered
Obligations of a physician in the doctor/patient relationship:
o Abiding the legal requirements of practice
o Within‐scope competent practice
o Billing and communication that is ethical, legal and accurate
o Truthful and patient‐centered advocacy
o Ethical care of the patient (abiding the boundaries)
o Protecting from unauthorized disclosure all protected health information
o To honor the Dr./Pt relationship until it is formally terminated through release from
care, and to ensure that legally appropriate behavior survives the relationship
Recall that when conflicts in payment policies vs. best care approaches exist, the physician must
behave thus:
o First duty is to patient
o Efficiency and best practices should prevail for the patient
o Advocate for the patient
o Do NOT violate the law or the contractual obligations of an insurance plan
o Do NOT falsify or “substitute” care or documentation to achieve both agendas
Patients want their doctor to:
o Care about them as people o Be competent o Be effective o Be efficient o Be an advocate in “the system”
Elements of caring:
o Empathy
o Arrange to meet healthcare needs
o Respectful and nonjudgmental
Recall the elements of effective communication:
o Active and engaged listening‐ not controlling or interrupting them
o Give information in appropriate doses (inform as needed)
o Choose words carefully and check for meaning
o Be direct and straightforward but not abrupt
o Be consistent in your verbal and nonverbal behaviors
o Exhibit a soft but confident tone, slow pace, and comfortable appearance
Communication dynamics: What drives patient’s perceptions of your caring:
o Talking constitutes up to 75% of a Dr./Pt interaction but only 7% of the conveyance of
humanistic qualities…
o 22% of humanistic quality is conveyed by “tone of voice”
o 55% is conveyed by visual perception
Empathy
o Empathy is driven by recognition and understanding of another’s viewpoint.
o Not adopting or internalizing the perspective of the individual who is in need
o Maintaining an Objective state of awareness
o Understanding of circumstances, emotions and behaviors without losing objective
ability to evaluate and contextualize the patient’s feelings
o Being able to interact in a way that honors the moment‐ by‐ moment changing
experience of the patient (sensitive) but not be compelled to act based on that
awareness (objective)
