doctor-patient relationships

Question 1

Why did doctors survive through the year when they could not provide solutions?

Answer 1

because doctors based their therapeutic values on their approach and relationship with the patient which could induce placebo effects of reduced stress and pain alleviation

Question 2

what 2 bioethical events triggered the need for the protections of patients?

Answer 2

Nazi experiments in WWII
- nuremberg war tribunal (1947) 23 leading german physicians were trialed for crimes against humanity in horrifying procedures in concentration camps without their informed consent
Syphillis study in Tuskegee (1932-1972)
- 600 low-income african-american males, including 400 with syphilis, were monitored for 40 years
- when a cure was proven to work, the physician denied the cure to continue the research, many died due to syphilis

Question 3

what was the belmont report?

Answer 3

1978, report to protect patients in medical testing:

• respect for persons autonomy (there has to be consent, patient is free to refuse, informed consent process)
  
  • individuals with diminished autonomy are to be protected
• benefice (do not harm, benefits are to be maximised and harms minimised, risk/benefit assessment)
  
  • finds recognition if christianity as expression of charity
• justice (fair distribution of burdens and benefits of research, selection of research participants)

Question 4

what was the OHRP?

Answer 4

1947, national commission of protection of human subjects of biomedical behaviour research

Question 5

what lies behind the euro-ethical reasons for doctor-patient relationships?

Answer 5

placebo effect

Question 6

what is the placebo effect?

Answer 6

ability of self-suggestion to put in circulations endorphins capable of modulating pain receptors and other functions to reduce pain/illness perception
created through cognitive factors (patient’s expectations)
ex. amygdala mediates decisions about reliability of people (faces) -> first impression

Question 7

what is the experiment behind placebo effects testing?

Answer 7

open and hidden pain treatments;

• open treatments are administered by doctor, require half analgesic to provide pain relief
• hidden treatment is administered by machine while the patient doesn’t know when it starts

Question 8

what is the reward relate behaviour?

Answer 8

motivation to act towards a positive stimulus or away from a negative one
- neurological roots-> basal ganglia, mesolimbic, dopaminergic pathways

Question 9

what is the role of the dopaminergic pathways?

Answer 9

allow the patient to create expectations before and event (before visiting the doctor) which is positive may provide relief

Question 10

pain processing path

Answer 10

• ascending path manages sensitive-discriminatory components (pain is detected)
• descending manages emotional component (feeling of pain)

Question 11

what is a medical malpractice?

Answer 11

legal cause of action when medical professional causes injury to its patient

Question 12

what actions do doctors take to prevent medical malpractices?

Answer 12

• defensive medicine: practice of recommending diagnosis/treatment which are not the best option but suggested as option -> protection against potential legal action
• assurance-bureaucratic behaviour: charging of additional unnecessary services
  
  • reduce adverse outcomes
  • deter patients from filling malpractice claims
• avoidance behaviour: providers refuse to participate in high risk procedures or circumstances