Midterm - models of care Flashcards
What is autonomy?
the principle that ensures that patients are afforded the chance to make informed, un-coerced decisions
What is beneficence?
The principle that obligates doctors to do everything they can that would benefit or help the patient
What is non-maleficence?
the principle of “primum non nocere” (first, do no harm) which obligates doctors to do as little harm as possible
What is justice?
the principle of fairness. In health care Justice normally refers to distributive justice, which is fairness in distribution of resources
- Remember that fairness is NOT the same as “equality”. Insurance relies on the principle of justice to collect small amounts of money from many and pool it to pay for the expensive care of the few that get sick…
What is the paternalistic model?
The guardian
What is the informative model
Competent technical expert
What is the interpretive model?
Counselor or advisor
What is the deliberative model?
Coach or teacher
What is the paternalistic model? Informative? Interpretive? Deliberative?
Paternalistic = guardian Informative = competent technical expert Interpretive = counselor or advisor Deliberative = coach or teacher
N emergency situation would favor the _____ model
Paternalistic (Guardian)
A problem for which the management requires some intense and likely unpleasant therapy such as post-surgery rehabilitation otherwise a poor outcome can be expected would favor the ______ model
Informative (competent technical expert)
A short term condition (back injury) for which the patient has a role in the cure (exercises and stretches) would favor the ___________ model
Interpretive (counselor/advisor)
A long-term management problem such as diabetes would favor a ____________ model
Deliberative (coach or teacher)
It is generally accepted that commencement of the doctor patient relationship is established when
______________ has been offered
Informed Consent - in other words when a bona fide intent to treat is established
- In some jurisdictions, the establishment of the doctor/patient duties occurs prior- at first examination effort on the part of the doctor.
In casual, nonprofessional (social) situations, one can avoid the appearance of creating or promoting the engagement of a doctor patient relationship by:
(5)
- Avoiding in-depth inquiry to the nature of the patient’s problem
- Avoiding examination or any form of treatment (even as benign as a brief massage) outside an office or designated professional setting
- Avoiding recommending a specific therapy
- Avoiding promising anything to the patient
- Clarify in conversation that any ideas expressed are without the benefit of a complete evaluation, which is absolutely necessary before any sound advice could be offered
Obligations of a physician in the doctor/patient relationship: (7)
- Abiding the legal requirements of practice
- Within-scope competent practice
- Billing and communication that is ethical, legal and accurate
- Truthful and patient-centered advocacy
- Ethical care of the patient (abiding the boundaries)
- Protecting from unauthorized disclosure all protected health information
- To honor the Dr./Pt relationship until it is formally terminated through release from care, and to ensure that legally appropriate behavior survives the relationship
Recall that when conflicts in payment policies vs. best care approaches exist, the physician must behave thus (5)
- First duty is to patient
- Efficiency and best practices should prevail for the patient
- Advocate for the patient
- Do NOT violate the law or the contractual obligations of an insurance plan
- Do NOT falsify or “substitute” care or documentation to achieve both agendas
Patients want their doctor to: (5)
- Care about them as people
- Be competent
- Be effective
- Be efficient
- Be an advocate in “the system”
Elements of caring: (3)
- Empathy
- Arranging to meet healthcare needs
- Respect and non-judgment
Recall the elements of effective communication: (6)
- Active and engaged listening- not controlling or interrupting them
- Giving information in appropriate doses (inform as needed)
- Choosing words carefully and check for meaning
- Being direct and straightforward but not abrupt
- Being consistent in your verbal and nonverbal behaviors
- Exhibiting a soft but confident tone, slow pace, and comfortable appearance
Communication dynamics: What drives patient’s perceptions of your caring:
- Talking constitutes up to ___% of a Dr./Pt interaction but only ___% of the conveyance of humanistic qualities…
- ___% of humanistic quality is conveyed by “tone of voice”
- ___% is conveyed by visual perception of your body language
75%, 7%
22%
55%
- Empathy is driven by recognition and understanding of _____________.
- Not adopting or internalizing the perspective of the individual who is in need
- Maintaining an __________ state of awareness
- Understanding of circumstances, emotions and behaviors without losing __________ ability to evaluate and contextualize the patient’s feelings
- Being able to interact in a way that honors the moment- by- moment experience of the patient (being sensitive) but not be compelled to act based on that awareness (remaining
___________)
Another’s viewpoint
Objective
Objective
Objective
Empathy skills- the doctor should demonstrate: (4)
- Reflection/ give a name to the emotion
- Validation of the patient’s feelings and experience
- Respect the importance these feelings and expressions have to the patient
- Offer your partnership/ support to ensure they understand they can count on you
Remember that several things mimic empathy, but are NOT empathy: (3)
- Sympathy- feeling the emotions of the patient and internalizing them- losing objectivity and vesting part of your feelings in their feelings
- Identification- losing objectivity because of a significant trait or characteristic in common with the patient- example- ethnicity, gender, socio-economic status, religion, etc.
- Pity- insincere empathy- expression of empathy that is condescending, patronizing or otherwise lacking genuineness and honesty
