Patient Dr relationships

Question 1

What is the Paternal model? advantages and critiques?

Answer 1

Paternal model

Doctor makes a systematic enquiry and patient
• Patient is passive : answers doctor’s questions and is passive recipient of information ( often little info given)
• Doctor makes decision about what is best for the patient, not knowing them very well
• Patient expected to obey

Critique :
• Doctor might not know what is right for the patient, even if they are using gold standard to treat them
• Power dynamic might mean that patient will not follow instructions
• As patient is passive recipient, they might not vocalise something they do not understand about the trt, thus compliance decreases

Advantages:
• Patient might be too overwhelmed to decide and deal, or might not care enough.. which is fine.
• Some cases patient might want paternal care, however it needs to be explicitly stated how much they
want to be involved in their care, so then it is still shared decision making.

Ethical principle :
beneficence (doing good)
Acting in a patient’s best interests

But this only works if you know what their best interests are… requires information sharing.

Question 2

What are the 2 parts of the shared model?

What are it’s challenges?

Answer 2

Shared model
2 way exchange of information btw dr and patient at all stages.
Patient might prefer this model when they are less stressed, have more cogniive reserve and capacity

Both seen as bringing expertise :
• Doctor brings medical knowledge and potential trt algorithms
• Patient brings knowledge of their own values, tendencies and weaknesses and strengths
• Each has limitations to knowledge

Both make a decision together about the right course of trt
Each reveal trt preferences and come to a decision about how to proceed

Challenges:

• for Dr to create the right environment for patient to feel comfortable to express thier desires.
• patient need to have access to information ( onus on dr to provide info, patient needs to access info from other sources as well - some patients might be better at this than others)
• some patients might have challenges processing complex information and have communication difficulties ( according to the principle of justice, shared decision making should be made accessible to everyone)

Ethical principle :
Respect for autonomy
Shares responsibility
Acknowledging there is a relationship btw doctor and patient

Question 3

Talk about the informed model and its advantages and disadv.

Answer 3

Informed model (consumerist/privatised model- not common in the UK)

Doctor communicates all relevant information to the patient and patient makes their own decision about trt

Need to present information that is based on patients values and preferences, requires a dialogue

Advantages:

• Patient holds the most power, self determination and they are empowered to make their own decisions
• Patients with a lot of good health information can use it to make their own decision about their health

Disadvantages:

• Doctor needs to provide sufficient information to the patient to make a decision, and when there are unknown unknowns, the patient might end up making a decision they did not intend too.
• Depending on patient background knowledge, may require a lot of time thet dr might not have given increased service demands
• Requires patient to take responsibility for thier actions something goes wrong with treatment, may cause psychological harm

How information is presented may influence how the decision is made,

Potential for paternal manipulation

Question 4

What are the key ethical principles underlying paternal model? critique?

Answer 4

beneficence (doing good)
Acting in a patient’s best interests

But this only works if you know what their best interests are… requires information sharing.

Question 5

Informed model ethical principle

Answer 5

Respect for autonomy

Question 6

eth model underlying shred

Answer 6

respect for autonomy

Question 7

Describe shared decision making in the context of a clinical consultation

Answer 7

by using ICE ( and structured interviews that incorportate patient views)

You are engaging the patient in the consultation and thus indirectly telling them that thier opinion is valued . This empowers them and makes them feel that they play an active role in thier treatment.

We can identify and address their agenda in addition to our own.. then alter trt plan accordingly

Patients feel cared about and listened to

Patients feeling you are addressing their problem

Consequences:

These all lead to better outcomes in treatment.

Reduced axiety

increased trust in medial profession

I - involving them in the care ( increased eng. leads to better outcomes)

C- Figuring out what they value, will help us when deciding between trt plans to increase concordance

E - To make them feel like thier problem is really being adressed.. increased conc. with trt.

Question 8

how are doctor-patient relationships affected by social forces
and change over time?

Answer 8

Society has expectations of the social roles that both doctors and patients play.

These social roles change over time, in the last couple decades these relationships have now become a bit less hierarchical, less deferential to authority, people expect more openness and engagement.
The population is more critical, questioning, wanting more choice in all aspects of their lives and a more personalised service.
These are expected to be brought forward in medical practice.

Question 9

Which model is advocated in the UK?

Answer 9

Shared decision making