Lecture 9 Flashcards
Physician Descriptors in US
Geography
35 million in US live in 2010s health professional shortage areas
Physician Descriptors in US
Specialization
Large % of physicians opt for specialization
beyond primary care
Medical School Experience
Tolerance for Uncertainty (Fox): 3 Kinds
– First: cannot know all the facts
– Second: knowledge base of medicine incomplete
– Third: Inner conflict b/w two while providing care • Isitmeorisitthefield?
Medical School Experience
Detached Concern
concern for patient without emotional attachment (Fox)
– Learn to intellectualize and technicalize encounters
– Some reach the point of emotional numbness
Medical School Experience
Curing Rather than Caring
Conrad (1988) analyzed for insider accounts of medical students
– Depersonalized the patient as much as possible
– No eye contact, non attention and abruptness with
patients
Medical School Experience
Stress in the First Four Years (3 categories)
– Exams
– Patient contact
– No time for others
Medical School Experience
Stressors during Internship and Residency
– Grueling Schedule: 100 hrs per week – Worries about debts: average $100K – Feelings of mistreatment – Toll of Stress: Distress (programs to assist now) • 1-8 residents increase drug use • 1-5 fear relationship will not survive • 1-3 significant depression
Medical School Experience
Career Choices
Shifting choice of specialties is common
Medical Education Curriculum: Criticisms
Five items
- Too little teaching priority is given by faculty members
- Extensive amount of departmental and research specialization = lack integrative curriculum
- Memorizing of facts = lack judgment clinical matters
- Social medicine many times ignored
- Curriculum can be out of step with reality, such as chronic illness patterns and financing of health care and analytics: lacks preventive health care, social factors, and lifestyle changes education
Physician-Patient Relationship
Definition
Encounter between Physician and Patient remains the central element of the health care system
Key Dimensions of the Phys-Pat Relationship
Three dimensions
Health has biological, psychological and social
dimensions
- Patient is seen as a whole person who is on a continuum of health
- Physicians use technical and interpersonal skill
- Doctors and patients have a negotiated order
Key Dimensions of the Phys-Pat Relationship
obligation
Physicians have an ethical obligation to patients which includes (Hippocrates)
Key Dimensions of the Phys-Pat Relationship
commitment and realization
Extent of commitment and realization of genuine therapeutic communication is up to both parties
Parson’s Model of the Physician-Patient Relationship
Three aspects
The relationship is asymmetrical: Three reasons why
– Professional Prestige: medical expertise, training, societal
legitimation
– Situational Authority: the physician established the medical practice and the patients come to them
– Situational Dependency: the patient become subservient by seeking care and playing the patient role
Competency Gap: during each encounter the knowledge and expertise gap is brought to the forefront
Physicians were supposed to use this power wisely to promote the patient’s interests and patients would accept this
Criticisms of Parson’s Model – Power Model
Freidson
Overstatesthemutualityofinterests between doctor and patient (Weberian)
Criticisms of Parson’s Model – Power Model
Conflict theorists
Conflict Theorists argue that the relationship is not Conflict Theorists argue that the relationship is not harmonious and both sides are not satisfied
Szasz & Hollander Model
Activity-Passivity Model (like Parson’s)
Doctor is expert, control communication, makes all decisions, while patient lacks knowledge and relies on doctor
Szasz & Hollander Model
Guidance-Cooperation Model (Typical Relationship)
Patient has feelings and is alarmed, hopes for treatment. Patient has increased involvement and doctor controls the communication but needs cooperation to occur. Doctor is less autocratic.
Szasz & Hollander Model
Mutual-Participation Model (Most Egalitarian)
5
Patient must be central player, both communicate the essential information, mutually satisfying relationship, not appropriate for children due to power differences
Veatch Model of the Phys-Pat Relationship (1972)
Moral Relationship between two parties (4 relationships)
• Engineering Model: Value free model, physician presents
all facts, patient no involvement in decision making
- Priestly Model: Physician quasi-religious figure, expert on all matters: Veatch disagrees with this model
- Collegial Model: Both are colleagues working on a common goal. Veatch sees this as unrealistic due to socio- demographic differences
- Contractual Model: Both have obligations and expectations for benefits in the relationship. Physician recognizes that the patient still has control over their destiny when decisions are made.
Outcome of the Relationship: Patient Satisfaction
Levels of Satisfaction
– Most people are satisfied with their primary care
– Most survey patients score very high
Outcome of the Relationship: Patient Satisfaction
Most patients distinguish b/w technical competence and socio-emotional aspects of their encounter
– Factors of Patient Satisfaction
– Patient background little to do with satisfaction
– Most can’t judge the technical competence of physicians
– Satisfaction influence by quality of communication
– Satisfaction affected by physicians who talk about psychosocial matters and their connection to health
Outcome of the Relationship: Patient Compliance
Definition
Compliance is the extent to which people follow medical regimens
