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Doctor Patient Relationship Flashcards

1
Q

1950s

A
  1. Carl R. Rogers dev. Client-centered therapy
  2. Works of Szasz and Hollander
  3. Emphasis on Dr. pt. Interaction based on fxn
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2
Q

Activity-passivity model

A
  1. Dr. Role: do something to pt
  2. Pt. Role: recipient
  3. Clinical app: anesthesia, acute trauma, coma, etc.
  4. Prototype model: parent-infant
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3
Q

Guidance-cooperation model

A
  1. Dr. Role: tells pt what to do
  2. Pt. Role: cooperator
  3. Clinical app: acute infections, etc.
  4. Prototype: parent-child
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4
Q

Mutual participation model

A
  1. Dr. Role: helps pt help himself
  2. Pt. Role: part of partnership
  3. Clinical app: chronic illnesses, psychoanalysis, etc.
  4. Prototype: adult-adult
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5
Q

1960s

A

Balint

  1. Introduced Pt-centered medicine
  2. Role of dr as medicine
  3. Deeper dx (osteopathy)
  4. Apostolic fxn of dr. -teacher/coach
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6
Q

Models of Dr. - Pt. Relationship

A

1990s - Emanuel and Emanuel

  1. Paternalistic
  2. Informative
  3. Interpretive
  4. Deliberative
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7
Q

Paternalistic model

A

Assumed shared values

  1. Pt. Values: objective and shared
  2. Dr. Obligation: help pt. Indep of their preferences
  3. Pt. Autonomy: assenting to obj. Values
  4. Dr. Role: guardian
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8
Q

Informative model

A
  1. Pt. Values: defined, fixed, known to pt.
  2. Dr. Obligations: provide relevant, factful info
  3. Pt. Autonomy: self-understanding relevant to medicine
  4. Dr. Role: technical expert
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9
Q

Interpretive model

A

Help understand what they want

  1. Pt. Values: conflicting, requiring elucidation
  2. Dr. Obligation: interpret pt. Values and inform pt on tx
  3. Pt. Autonomy: self-understanding relevant to medicine
  4. Dr. Role: counselor/advisor
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10
Q

Deliberative model

A
  1. Pt. Values: open to dev thru moral discussion
  2. Dr. Obligation: articulating/persuading of best values (informing)
  3. Pt. Autonomy: moral self-dev relative to medical care
  4. Dr. Role: friend/teacher
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11
Q

Factors that effect relationship

A
  1. Context of problem
  2. Chronicity of condition
  3. Taking charge vs . Collaboration
  4. Facility where delivered
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12
Q

Expert in charge Rel.

A
  1. Address immediate threat
  2. Take action on pt behalf
  3. Caring my mobilizing med resources
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13
Q

Expert guide rel.

A
  1. Provides professional opinion
  2. Offer advice/tx suggestions
  3. Directive, but room for collaboration
  4. Caring by listening to pt
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14
Q

Partner rel

A
  1. Build relationship/partnership
  2. Motivate/engage pt: pt carries out to
  3. Caring w/ dialogue and empathy
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15
Q

Facilitator rel.

A
  1. Ideal for wee-controlled chronic illness

2. Dr. Motivator and facilitator

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16
Q

Pt. Centered care

A
  1. Biopsychosocial perspective = deeper dx
  2. Pt as person
  3. Shared power and responsibility
  4. Therapeutic alliance
  5. Dr. As person
  6. Considers pt. Preferences and values w/ scientific evidence
  7. Dr. Can prioritize concerns based on pt preference and med emergency
  8. 2-person medicine
  9. Pt. Centered interviewing
17
Q

Relationship centered care

A
  1. Relationships include personhood roles
  2. Affect and emotions imp
  3. Reciprocal influence
  4. Moral foundations
  5. Dimensions
    A. Clinician-clinician
    B. Clinician-community
    C. Clinician-self
18
Q

Effective relationships (Smith’s)

A
  1. Foster adherence
  2. Confidence
  3. Rapport
  4. Satisfaction
  5. Openness to negotiation
19
Q

Data

A
  1. Diabetic pts w/ empathetic drs had better control of A1C
  2. Pts w/ PCP less likely to smoke
  3. Satisfied pts 3x more likely to follow rx
  4. More info provided -> inc satisfaction
  5. Inc satisfaction -> recall, understanding, and partnership building
20
Q

Essentials for good rel

A 
1. Dr. Uses power to empower pts
  A. Empathy
  B. Respect pt as person
  C. Use understandable language
  D. Take pt seriously
  E. Pt ed
2. Caring:
  A. For pt
   1. Feel known
   2. Understands meaning of illness on pt life
   3. Goes extra mile 
  B. Dr. Self-care
3. Be aware of response/emotion
  A. Part of human condition
  B. (+) or (-)
  C. Potentially harmful
  D. Gets better w/ experience 
  E. Requires self-reflection
4. Monitor relationships
21
Q

Skills for relationship building

A 
1. Pt-centered interviewing
  A. 70% pts prefer it
2. Incorporate BATHE
  A. Background, affect, trouble and handling situation, empathy
3. Self-disclosure
4. Pt. Ed
5. Evaluating personal responses

CCP (12 decks)

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