Doctor-patient relationships W12

Question 1

three types of practicing medicine which associate with doctor-patient relationships:

Answer 1

1. From bedside to laboratory medicine
2. Patient-centred medicine
3. Evidence-based medicine

Question 2

From bedside to laboratory: time, medicine characteristics (3+details)

Answer 2

early 19th century medicine

• focused on manifestation of disease – not its internal and hidden causes
• diagnosis and treatment were rather subjective
• shift to laboratory medicine – the importance of laboratory tests, emphasis on pathology and underlying causes due to more and more patients were hospitalised => centralised approach to medicine – consensus to diagnosis and therapy

Question 3

Evidenced-based medicine characteristics (3):

Answer 3

• in the past: clinical experience guided treatment – if a drug worked in clinical practice it was then used again
• shift in recent times is toward establishing an
  objective effectiveness of practice and treatment
• evidence from research and trails, not from everyday practice

Question 4

Patient-centred medicine: time & characteristics

Answer 4

Since the 1980s

• systematic turn to “patient centred” medicine – combined biological, psychological and social perspective
• Patients provide information for diagnosis and are actively engaged in the management of their condition
  -n owadays people have chronic diseases and a patient-centred approach is more appropriate - long-term collaboration with doctors

Question 5

Parson’s model of the sick role and doctors’ role
The Sick Role

Obligations/ Expectations (2)

Answer 5

➢ Patients must want to get well as quickly as possible
➢ They should seek medical help

Question 6

Parson’s model of the sick role and doctors’ role
The Sick Role

Rights

Answer 6

➢ Allowed to withdraw from daily activities
➢ Regarded as unable to get better by his own decision and will

Question 7

Parson’s model of the sick role and doctors’ role
The Doctors’ Role

Obligations/ expectations (4)

Answer 7

➢ Apply high degree of skills and knowledge
➢ Act for the good of patients and community
➢ Be objective and emotionally detached
➢ Be guided by rules of professional practice

Question 8

Parson’s model of the sick role and doctors’ role
The Doctors’ Role

Rights (3)

Answer 8

➢ Granted rights to examine patients physically
➢ Granted autonomy in medical practice
➢ Has a position of authority in relation to the patient

Question 9

Reasons f/ conflicts b/w patients & doctors (5):

Answer 9

1. Diff values b/w doctors and patients
2. Confidentiality (doctors may breach it outside any guidelines and before informing the patient)
3. Doctors may not be able to determine the cause of patients’ symptoms – patients may be frustrated
4. Doctors may not be able to coordinate effectively objective treatment, a patient-centred approach, and a cost-effective treatment for the healthcare system
5. Ineffective communication

Question 10

4 types of doctor-patient relationships:

Answer 10

• Paternalistic relationship: high doctor control, low patient control

• Mutuality: equal control

• Consumerist: low doctor control, high patient control (this might be found in private consultations)

• Default: low doctor control, low patient control

Question 11

3 main models of treatment decision-making:

Answer 11

• Professional choice (doctor decides)
• Shared choice (to achieve concordance)
• Consumer choice (patient decides)

In reality there is a mixture of these three, while the professional choice is more likely to be observed in emergencies

Question 12

Basic communication skills for history taking (9):

Answer 12

1. Initiate the consultations: Introduce yourself and Explain the purpose of the consultation
2. Consent and confidentiality: Obtain consent and Ensure confidentiality
3. Use of closed (lead to given answers) and open questions (allow patient to narrate):
4. Check patients’ perspective: Check what the patient think by using an open question
5. Empathise (RAAV): Recognise - pick up the cues, Accept - non-judgemental, Acknowledge - confirm that the emotion is there, *Validate * - confirm that the emotion is valid
6. Signpost: Prepare the patient of the area you are exploring next
7. Check patient’s understanding: ask the patient how they understand medical terms, conditions, management etc, ask the patient if everything is clear, ask the patient to summarise what you have told them
   8,9. Summarise & Close the consultation: Summarise so to make sure that you have understood well; Close the consultation by mentioning what are you going to do with the information and by thanking the patient

Question 13

Basic communication skills for information giving (5):

Answer 13

1. Avoid jargon, use simple language
2. Organise the information, do not jump from one issue to another
3. Give the information in small chunks
4. Do not scare the patient, start with something positive
5. Check patient’s understanding