Patient and the Doctor Patient Relationships

Question 1

Definition of compliance

Answer 1

Extent to which the patient’s behaviour matches prescribers recommendations
Implies lack of patient involvement

Question 2

Definition of adherence

Answer 2

Extent to which patient’s behaviour matches agreed prescriber recommendations
Implies patient involvement

Question 3

Definition of concordance

Answer 3

Negotiation between equals
Respect for patient’s agenda and creation of openness in the relationship
No concealment

Question 4

What are the patient rights and obligations according to Parson’s Sick Role

Answer 4

Rights

• Stop/reduce normal activities and responsibilities
• Regarded as someone in need of care

Obligations

• Seek and submit to medical help
• Want to get better ASAP

Question 5

What are the doctor rights and obligations according to Parson’s Sick Role

Answer 5

Rights

• Examine physically, ask sensitive questions
• Autonomy and authority in practice

Obligations

• Act in patient’s best interests
• Act objectively, guided by professional practice

Question 6

Describe the 5 step pathway in a traditional consultation for acute conditions

Why is this not always used

Answer 6

Dr asks mainly closed questions
Ascertain symptoms
Identify pathologies, processes and disease
Prescribe treatment
Patient accepts advice and acts on it

Does not apply to chronic conditions
Patients aren’t always the passive recipients of care

Question 7

What are the 4 degrees of control in the Doctor Patient Relationship according to Steward and Roter

Answer 7

Default
-low patient and doctor control

Paternalistic
-low patient, high doctor control

Consumeristic
-high patient, low doctor control

Mutualistic
-high patient and doctor control

Question 8

What are the 4 factors that can influence the type of doctor patient relationship

Answer 8

Drs clinical orientation and consulting style
-disease or patient centered?

Time available

Patient characteristics and behaviours
-info rich?

Structural context

Question 9

What are the main stigmas of illness in doctors

Answer 9

Inappropriate for doctors
Stigma of some illnesses and pressure to work and not take sick leave
Tend to treat themselves, delay help seeking

Question 10

Why is mutual participation becoming more important

Answer 10

Changes in society

• access to info online
• changing relationships with professionals

Changing views of medicine

• psychosocial causes and impacts
• more emphasis on patient as person and illness in social content

Increased prevalence of chronic diseases

• treatments that help symptom management
• ageing population

Question 11

What is a patient centered consultation

Answer 11

Doctor involved in full range of problems that patients bring
Patients are experts in their illness and know what’s in their best interets
Power is shared

Question 12

Why is patient involvement important

Answer 12

Patients have increased medical knowledge
Social values endorse autonomy and responsibility
Increased prevalence of chronic illness needing patient self management
Choices in situations of medical uncertainty (risk/blame)

Question 13

What are the factors that lead to patient involvement

Answer 13

Associated with

• <60 years, female
• higher SE
• type of problem (higher for psychological illness)
• simpler treatment choices

Question 14

What are the effects of participation, pros and cons

Answer 14

Can be associated with

• improved self esteem
• reduced depression
• increased adherence

-patient anxiety

Question 15

How would you promote shared decisions making

Answer 15

Specialist training programmes
Patient centered written info/videos
Decision aids

Question 16

What is the difference between compliance, adherence and concordance

Answer 16

Compliance

• extent to which the patient’s behaviour matches the prescribers recommendations
• implies lack of patient involvement

Adherence

• extent to which patient’s behaviour matches agreed prescriber recommendations
• implies patient involvement

Concordance

• negotiation between equals
• respect for patient’s agenda and creation of openness in the relationship
• no concealment

Question 17

How does concordance affect patient choice and doctor’s recommendations

Answer 17

Patient gas right to decide not to take meds (as long as patient has capacity to choose)

Drs do not have to provide treatments that aren’t in the patients best interests but must explain their

• reasons
• other options
• second opinion

Question 18

What are the problems with concordance and prescribing

Answer 18

Would this be ethical with serious infectious/mental ilnesses

More suited to chronic than acute illnesses