Patient-doctor relationships

Question 1

What are the three main types of patient-doctor relationship?

Answer 1

Paternalistic- Dr led
Shared- Partnership
Informed- Patient led

Question 2

In a paternalistic model what are the patient and drs roles?

Answer 2

The Dr has the knowledge and makes a systematic enquiry: asks specific questions and makes the decision

The pt is passive and answers the questions minimal information given and the pt will agree with the Dr

Question 3

When is a paternalistic model appropriate?

Answer 3

When the pt is too ill and cannot be involved.
When the pt lacks capacity.
If the pt expressed a preference for this model.

Question 4

In a shared partnership model what does the patient and the Dr bring?

Answer 4

Doctors bring medical expertise about diseases and treatments.
Patients bring personal expertise (but have some knowledge about their condition and treatment)
Each participant seen as having some limitations to their knowledge

Question 5

How in a shared partnership does the Dr and patient come to a conclusion?

Answer 5

Each reveal treatment preferences

Come to an agreement and decision on how to proceed

Question 6

What are the challenges of the shared model?

Answer 6

Challenge for doctors is to create an environment in which patient feels able to express treatment preferences
If disagreement, process becomes one of negotiation.

Question 7

What occurs in the informed model of a dr-pt relationship?

Answer 7

Doctor communicates all relevant information and treatment options, and the risk and benefits, to patient.

Doctor communicates sufficient information for patient to make an informed treatment decision - information giving is doctor’s key contribution

Patient is active and expects to make the decision

Question 8

When is an informed relationship appropriate?

Answer 8

In cosmetic surgery

Question 9

What is the most ideal model and why?

Answer 9

Shared model advocated:
‘Partnership’ idea evident in policy and professional discourses
Shared decision making is seen key element of person-centred care

Question 10

What does the shared model need to be guided by?

Answer 10

Patient preferences and clinical condition

Question 11

What does increased engagement lead to in the pateint-doctor relationship?

Answer 11

Better outcomes

Question 12

What are the GMC duties of a doctor?

Answer 12

Work in partnership with patients
Listen to, and respond to, their concerns and preferences
Give patients the information they want or need in a way they can understand
Respect patients’ right to reach decisions with you about their treatment and care
Support patients in caring for themselves to improve and maintain their health

Question 13

How do we involve and engage patients in a consultation?

Answer 13

With Ideas, Concerns and Expectations (ICE)

Question 14

What is the ethical principal of the paternalistic model and what are the concerns of this?

Answer 14

Beneficence
Acting in the patients best interests
How do we know what is in a person’s best interests?

Question 15

What is the ethical principal of the informed model and what are the concerns of this?

Answer 15

Autonomy

However we need to facilitate this and make sure the patient is ready for the responsibility

Question 16

How does shared decision making alleviate the concerns with the other two models?

Answer 16

Facilitates autonomy

Shares responsibility

Question 17

How have the three models changed overtime?

Answer 17

We used to be more of a paternalistic model, currently working on shared. Could become informed.

Question 18

What are the challenges in shared decision making?

Answer 18

Patient access to information
Patient ability to process complex information
Communication difficulties

Question 19

What does making the care of your patient your first concern require?

Answer 19

Developing a relationship with your patient
Making decisions in the best interests of your patient from their perspective
Requires respecting their preferences/values (including their preference for model of decision making)
All requiring dialogue

Question 20

What can we as physicians gain from using ICE?

Answer 20

We are able to identify the patients agendain addition to our own
Patients feel cared about and listened to
Patients feeling you are addressing their problem

Question 21

Name 4 positive outcomes for patients from shared decision making?

Answer 21

Increased patient satisfaction resulting from
Feeling more engaged with decisions
Feeling that have made a better decision
Reduced anxiety
Improved adherence with medication/Self management of conditions

Question 22

How are pt-dr relationships effected by social forces?

Answer 22

European society, and north American society are becoming less hierarchical towards authority.
More openness and public engagement are regarded as important social values.
As result, many people in society are more critical and questioning and expect choice and a more personalised service. For many people these expectations extend to the kind of relationship they want with their doctor