Patient-Doctor Relationships Flashcards
Why consider patient-doctor relationships?
- Successful clinical encounters > Drs clinical knowledge + technical skills
- Qualitative + subjective nature of relationship important
- There are a range of relationships
- Its not all plain sailing
What roles do we expect patients to play in the clinical encounter?
To be truthful/open/honest
Patients expect to be listened to
Co-operation
What roles do we expect doctors to play in the clinical encounter?
Know their limitations
Make diagnoses
Be empathetic
Knowledgeable
How has social relationships in the clinical encounter changed in the last 2 decades?
More openness/honesty
Patients get more choice + control
Less hierarchy/paternalism
What are the expectations about patients + doctors?
Patients + Drs have social roles which define expectations + obligations of each participant. It is shaped by culture but expectation about roles change over time so patient-Dr relationships are constantly changing.
What are the 3 main ideal types of patient-doctor relationship?
- Paternalistic (doctor-led)
- Shared (partnership)
- Informed (patient-led)
Outline the paternalistic model in a step-by-step fashion.
- Dr makes a systematic enquiry asking specific questions
- Patient is passive + answers
- Information flow = largely from Dr -> patient (minimal info given)
- Dr makes decision about what is best for patient (underlying assumption that Dr is best placed to make this decision)
- Expectation that patient will agree as ‘Dr knows best’ + show compliance
= power with doctor
Is the paternalistic model appropriate in any situations? When?
It is appropriate if:
- Patient is too ill to be involved in consultation
- If the patient lacks capacity
- If the patient expresses a preference for this model but this would require explicit discussion (even though it could be argued that a form of partnership exists here)
When is the paternalistic model unlikely to be a good model to use?
It is unlikely to occur if Dr adopts paternalistic model at the outset
Explain the shared model.
2-way exchange of info between patient + Dr at all stages:
Both participants are seen as bringing expertise; Dr brings medical expertise about diseases/treatments + patient brings personal expertise (have some knowledge about disease/treatment) - both seen as having some limitation to knowledge
Patient + Dr reach decision together about best course of action/treatment; each reveal treatment preference + come to agreement/decision on proceedings so depends on building a consensus on appropriate treatment
= partnership
What is the challenge for doctors in the shared model?
Must create an environment in which patients feel able to express treatment preferences
If there is disagreement, process becomes one of negotiation
Describe the informed model.
Dr communicates all relevant info + treatment options including risks + benefits to patient - sufficient info for patient to make informed treatment decision (information giving is Drs key contribution)
Patient is active + expects to make the decision so decision making is the SOLE PREROGATIVE of patient = power with patient
How common is the informed model in the UK?
Seen much less often than others; maybe be seen in some areas of private practice or in cosmetic surgery (could perhaps come more common in the future)
,More common in countries with private insurance systems
What is the current thinking of doctor-patient relationships?
Shared model advocated:
- ‘Partnership’ idea evident in policy + professional discourses
- Shared decision making is seen as key element of person-centred care
BUT need a ‘repertoire of Dr-patient relationships’ (one shoe doesn’t fit all) as nature of relationship may change within/across consultations - need to be guided by patient preference + clinical condition
How does ethics link in with the patient-doctor relationship?
- All 3 models underpinned by ethical principles but can be used inappropriately
- Shared decision making process most important rather than shared decision as outcome
- Key ethical value = respect for persons
