Physician-Patient Relationship Flashcards
Physician has the responsibility to inform patient of what?
- Probable course if untreated
2. Available and recommended treatments
What are some additional responsibilities of a physician in regards to patient care?
- Must respect patient’s decision
2. Act in best interest of patient
What should the physician tell the patient about drug side effects? Should they list every side effect??
- Common side effects
- Serious Side Effects
(hell no not every side effect)
What should a physician do if they are placed in a situation where the patients best interest is being challenged either due to patients beliefs or whatever reason?
Always…..Default in the best interest of the patient
aka wake your boss up and ask him if you dont know what to do
When may the physician refuse to perform certain treatments?
Physician May:
- Refuse to perform act that conflicts with personal, moral, or ethical principles
- Has responsibility to respect patient’s wishes and make a referral
Is it okay to date or get into a relationships with former or current patients?
once a patient always a patient
Soooooo hell no
According to the patients Bill of Rights of 1972, patient has the right to….?
- Receive complete information
- Refuse treatment unless deemed incompetent
- Know hospital’s possible financial conflicts of interest
Is forming a relationship with a patient illegal or unethical?
Unethical, not illegal
If you are a pediatrician, is the mother or father also your patient?
yes, mother or father are your patients as well
aka just dont fuck your patients parents
If patient refuses treatment, what must the physician do?
Have a psych consult (to make sure its not a psychological issue)
what does informed consent say?
patient has the right to:
- Refuse or accept medical care
- execute an advance directive concerning their care or designate a proxy
- Full, accurate and understandable explanations from physician
What are the limits of confidentiality?
Physician cannot share patient information without their consent unless:
- He/she is concerned patient will harm themselves or others
- Situations that involve mandatory reporting (child abuse, communicable disease)
What are the guidelines for protecting confidentiality?
- Conduct interview in private
- Tell patients with whom and under what circumstances information will be shared
- Teach or consult about patients in private
- Override confidentiality if safety of patient is a concern
If the police have a court order for records, can you talk about the patient?
No, they only have permission to take the records, not for you as the doctor to talk about it.
If a patient admits to being a serial killer in the past, can you report that?
No
If a patient rapes someone in the past can you report that?
NO
Crimes committed abroad or to kids, can you report those?
yes
As a doctor is it illegal to treat a family member?
Not illegal but it is unethical to treat family members.
Is it acceptable to break confidentiality if MD gets a subpoena?
yes
In regards to gifts, what are the limits???
Symbolic meaning not necessarily amount
just be realistic…dont accept gifts that are suggestive
In regards to physician patient relationship what is accurate empathy?
ability to transiently resonate with the emotional state of the patient.
to understand patient’s illness experiences from patient perspective
to communicate this understanding to patient
Have this understanding confirmed by patient
What are some factors that may lead to boundary crossing????
- Failure to be aware of TRANSFERENCE of patient towards physician. (aka something IN THE PATIENT that you as the physician triggered based on patient experiences and beliefs)…POSITIVE OR NEGATIVE
- Failure of physician to understand COUNTERTRANSFERENCE. (aka something IN THE PHYSICIAN that is triggered, can be NEGATIVE OR POSITIVE)
Can transference be negative and positive?
yes can be both
Can countertransference be positive or negative?
yes can be both
What are some Impediments to communication?
Sensory impairment
Language and cultural differences
Age effects
Gender Effects
What are the two main fears in patients?
- Losing bodily integrity
- Becoming dependent
- Becoming a burden
Influences to patient’s adherence to treatment recommendations, depend on patient’s belief that:
- Illness warrants treatment
- Treatment is effective
- Cost of treatment is reasonable given benefits
- Treatment is feasible
What is the formula for compliance?
compliance= adherence and concordance
What is adherence?
Complexity of regime
Persistence of symptoms
Frequency and quality of contact with physician
What are the factors that increase compliance?
- Good Physician-Patient relationship
- Feeling ill
- Limitation of usual activities
- Written instructions for taking medication
- Acute illness
- Simple treatment schedule
- Short time spent in the waiting room
- Recommending one change at a time
- Benefits of care outweigh costs
- Peer Support
What are the factors that decrease compliance?
- Poor Rapport
- Has few symptoms
- Little disruption of activities
- Verbal instructions
- Chronic illness
- Little peer support
- Complex treatment schedule
- Long time spent in waiting room
- Recommending multiple changes at the same time
- Believing costs outweigh benefits
There are six methods for supporting participatory decision making, what are they?
- Present options for how patient can participate in decision making
- Present options for how clinical details presented to the patient
- State info regarding clinical procedure in terms of absolute risk since relative risk reduction
- Carefully weigh order in which info is presented
- Carefully present time frame of treatment outcome
- In presenting outcome rates, use proportions rather than percentages
