Patient-Doctor Relationships

Question 1

What are the 3 different models of patient-doctor relationships?

Answer 1

Paternalistic
Shared
Informed

Question 2

Outline the Paternalistic model of patient-doctor relationships? What ethical values underlie it?

Answer 2

Dr makes systematic enquiry into patients history/symptoms
Patient is passive
Dr makes decision of treatment
Underlying assumption that Dr is best placed to make decision
Patient agrees as ‘Dr knows best’

Appropriate in emergency situations?

Ethical principle of beneficence as Dr believes making the best decision and acting in patients best interests but doesn’t respect autonomy

Question 3

Outline the Informed model of patient-doctor relationships - what ethical principle underlies it?

Answer 3

Dr communicates all relevant information and treatment options to patient, giving sufficient information for patient alone to make decision

Seen in cosmetic surgery or private healthcare

Respects principle of autonomy but potential psychological harm as patient will then feel responsible if choose treatment with bad outcome? And potential for manipulation by degree of information given

Question 4

Outline the shared model of patient-doctor relationships - what ethical principles underly it?

Answer 4

Both patient and Dr input information
Dr - medical knowledge
Patient - personal knowledge of their condition/treatment options that suit their lifestyle
Dr and patient both express treatment preferences and come to shared decision
Both have limitations to their knowledge

Facilitates autonomy and shares responsibility

Question 5

Shared decision making is the GMC advocated model - what are some positive outcomes of this type of relationship?

Answer 5

Patients seem more engaged
Increased engagement leads to better patient outcomes
More likely to adhere to medication
More likely to be open about feelings/symptoms/history meaning more efficient diagnosis
Reduced anxiety
Increased patient satisfaction
Improves self management of condition

Question 6

What are the GMC duties of a Dr with regards to patient-Dr relationships?

Answer 6

Work in partnerships
Listen to and respond to patient concerns and preferences
Give patients necessary and accurate information that they want or need, in a way they’re able to understand
Respect patients rights to reach decisions about their treatment/care
Support patients in caring for themselves to improve and maintain health

Question 7

What’s the importance of ICE?

Answer 7

Allows shared decision making by highlighting patients ideas, concerns and preferences = able to address these and improve patient satisfaction so they feel cared for and respected

Question 8

What questions could you ask for Ideas, Concerns and Expectations?

Answer 8

Ideas:
Have you any ideas what might be causing this?
Do you think this is the same as before?
Tell me what you think is the cause?
What do you think the problem might be?

Concerns:
Is there anything in particular that’s worrying you about this?
What’s your biggest concern about this?

Expectations:
Is there anything in particular that you were hoping I’d be able to do for you today?
What were you expecting me to do today about this?
When you came here today was there anything in particular you were hoping I could do?