Lecture 5 Flashcards
Ethics of the Doctor/Patient Relationship
Once thought to be a “sacred” relationship, but is now more legally bound
Ethical underpinnings seen everywhere in medicine!
Autonomy, consent, confidentiality, professionalism, responsibilities…
Describe professionalism
Following an occupation as a means of living
Often implies a “learned vocation” (training and qualifications)
The conduct, aims or qualities that characterize a professional (moral code) –> control and application of expert knowledge
While a profession holds a monopoly over the work, society has expectation
‘way of life’ with a moral value
Conforming to the ethical standards of a profession, employing sound knowledge and conscientiousness
Medical Professional: Physicians
from the Moodle article
- subordinate their own interests to the interests of others
- adhere to high ethical and moral standards
- respond to societal needs/social contract
- evince core humanistic values (honesty, integrity, compassion, caring, altruism, empathy, respect for others, trustworthiness)
- exercise accountability for themselves and colleagues
- demonstrate a commitment to excellence
- exhibit a commitment to scholarship and advancement of their field
- deal with high levels of complexity and uncertainty
- reflect upon their actions and decisions
The Diagnostic Relationship
Patient reveals private, sometimes vulnerable information (S)
Patient agrees to physical and laboratory examination (O)
Dr uses this info to determine diagnosis and formulate what to do (A and P)
* These relationships are inherently one-sided and imbalanced!
Conventional Model of the Doctor/Patient Relationship
- Patients are passive recipients of a beneficent practice
- Paternalism (autonomy tries to address this)
- Problem of managed care and time constraints
Holistic Model of the Doctor/Patient Relationship
Dr. seeks to understand the whole person.
- Dr. facilitates the patient’s own healing process (stimulate the vis medicatrix naturae)
- Greater reliance/expectation of patient’s responsibility
- Patient consents to involvement
- Patient participation is central
What is a Therapeutic Relationship?
working on more than physical, relationship dynamic itself is healing.
The relationship itself is health promoting/helpful to the patient
- The sharing of information about ourselves as patients to our physicians is a very vulnerable, intimate process that frequently involved the revealing of our innermost selves in the course of seeking healthcare. - Edward Gerbecz, MD
What is the Physician’s promise to the patient?
Physician’s Fidelity:
- to be of service
- to not abuse the power imbalance, rather to empower patients
- to maintain and be clear about professional boundaries
- be warm AND professional
- appropriately intimate” and “appropriately detached”
What are a couple psychological traps?
Transference & Counter-transference
What is transference?
Patient develops/projects feelings ;they have about a significant person in their life towards the doctor (eg parentification, mistrust, awe, dependence, “guru” status, rage)
–> Dr needs to recognize when this is happening and discuss this with the patient. Some counseling theories actively utilize transference in working with a patient.
What is counter-transference?
doctor develops/projects/redirects feelings towards the patient, leading to emotional entanglement.
Dr’s feelings/response may be “positive” (leading to eg favoritism, romaticism) or “negative” (leading to eg firing a patient)
–> Dr needs to realize this and work on emotions outside of clinical setting!)
“Clean well-lit room Standard”
If you feel you can’t talk to anyone, its probably unethical!
(from psychology ethics code text)
Boundaries: “Appropriately Intimate and Appropriately Detached”
Doctor is able to empathize with the patient’s suffering, bring comfort, establish trust
- doctor shuold have a perspective and be able to provide expertise
- challenging when: patient is needy, our own feelings come up in various ways with patients
Source: Julie Stone “Ethics and the Therapeutic Relationship”
Because holistic practice connotes helping people to become more integrated in a physical emotional and spiritual level, a physician who can only deal with patient on anything other than the physical level cannot be a “good” physician. How a physician responds to a patient on a personal level may be as integral to the success of the therapy as being technically proficient.”
Notes about inappropriate sexual relationships with patients.
personal conversation instead of work non-sexual bodily contact outside of clinical context social encounters Big problem! big problems of professional privilege role reversals double-bind for patient - pressured end up living in secrecy
