Physicuan Patient Relationship

Question 1

What is the importance of a Physician Patient Relationship?

Answer 1

The interaction of the researcher with the participants may have produced a positive change in mood…Future studies should be designed to…determine whether (acupuncture) alone can lead to reduced waist circumference or if improvement in mood must be in combination with (acupuncture) to initiate waist circumference reduction.

Question 2

What is IFC?

Answer 2

IFC = Interferential Current Therapy (electrical stimulation of muscle motor nerves)

Question 3

What is treatment relationship?

Answer 3

Physician duties are owed only if in a treatment relationship

• Existence of relationship creates these duties

• How do we determine whether a relationship exists?
• Bilateral contract: Patient requests assistance and physician agrees

Question 4

What is reciprocal autonomy?

Answer 4

Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction.

Question 5

What are the rights and responsibilities of the physician. Once a relationship is formed?

Answer 5

• standard of care
• confidentiality
• non-abandonment
• informed consent

Question 6

What are the rights and responsibilities of the Physician?

Answer 6

• Informthepatient:
– Nature of the disorder
– Available treatments (including recommendation)
– Probable course if untreated

• Listentopatient’sconcerns,addressthemobjectively,andrespect his/her decisions
• Mayrefusetreatmentthatconflictswithhis/hermoralorethical principles but must respect the patient’s wishes and make appropriate referrals

Question 7

What are the rights and responsibilities of patients?

Answer 7

PatientsBillofRights(1972)
– Right to receive complete information
– Right to refuse treatment
– Right to know about a hospital’s financial conflicts of interest

• PatientSelf-DeterminationAct(1991)
– Patients must be given written information about their health care decision making rights and the institutional policy on advance directives

Question 8

What are the 3 main goals of Doctor-Patient communication ?

Answer 8

3 main goals of doctor-patient communication:

1. Create a good interpersonal relationship
2. Facilitate exchange of information
3. Include patients in decision making

Overall goal: Build trust so the patient will work with the physician

Question 9

What are the correlations of good doctor-patient communication?

Answer 9

Informed patients have greater sense of well-being and control

Associated with:
– greater ability to tolerate pain
– faster recovery from illness
– enhanced psychological adjustment to illness
– decreased length of hospital stay

Question 10

What are the benefits of good-doctor patient communication?

Answer 10

• Benefitsofgooddoctor-patientcommunication
– Helps patients regulate their emotions
– Facilitates comprehension of medical information
– Allows for better identification of patients’ needs, perceptions and expectations
– Increases the likelihood of patients being satisfied with their care, sharing pertinent information, and adhering to the treatment plan

• Patients’ agreement with doctor about the nature of the treatment and need for follow-up is strongly associated with their recovery

Question 11

How does Doctor-Patient Communication correlate to other factors (surveys)?

Answer 11

• Surveys: Patients want better communication with their doctors

• Doctors overestimate their communication ability
– 75% of orthopedic surgeons surveyed believed that they communicated satisfactorily with their patients (Tongue et al., 2005)
– 21% of the patients reported satisfactory communication with their doctors (Tongue et al., 2005)

• Better communication = lowered risk of malpractice suit

Question 12

What is doctor patient communication?

Answer 12

Relationship to Malpractice Claims Among Primary Care Physicians and Surgeons (Dr. Wendy Levinson): The doctors who had never been sued:
• Spent 3+minutes longer with each patient than those who had been sued (18.3 vs. 15)
• More likely to make“orienting” comments(e.g.,“FirstI’llexamine you, and then we will talk the problem over” or “I will leave time for your questions.”)
• More likely to engage inactive listening(e.g.,“Goon,tellmemore about that.”)
• More likely to laugh and be funny during the visit

Question 13

What are the methods to improve patient communication?

Answer 13

Open/receptive body language
– Sit facing the patient
– Maintain appropriate eye contact – Use a pleasant, encouraging tone

Empathy
– Take time to understand their home life, socioeconomic situation, culture
– Show interest, encouragement, warmth, courteousness, and respect

Question 14

How to communicate information to patients?

Answer 14

• Tell adults the complete truth about diagnosis and prognosis
• Use vocabulary words the patient will understand
• Speak to adult patients directly, not through relatives or staff
• Do not discuss patient care with friends/family members without the patient’s permission
• Before beginning a procedure, explain it to patient
• Do not offer premature reassurance
• Do not attempt to “scare patients into treatment”
• Do not order a course of action; provide info and let the patient decide

Question 15

What are the barriers to effective communication?

Answer 15

Past relationship schemas (beliefs, expectations, perceptions) influencing how we form current relationships

Transference
– Relationship schemas that the patient experiences – Can be positive or negative

Counter transference
– Relationship schemas that the physician experiences – Can be positive or negative

Question 16

What are the barriers of effective communication?

Answer 16

Positive Transference
– E.g., The patient likes her physician because the physician reminds her of her grandfather whom she respected and admired

Negative Transference
– E.g., The patient dislikes her physician because the physician reminds her of an uncle who sexually abused her

Positive Countertransference
– E.g., The physician likes her patient because the patient reminds her of her best friend from high school whom she admires and respects

Negative Countertransference
– E.g., The physician dislikes her patient because the patient reminds her of an ex-husband who abused her

Question 17

How can objectification/dehumanization for barriers to effective communication?

Answer 17

• Objectification/Dehumanization
– Using the patient as a teaching tool in a teaching hospital in direct
view of patient
– Discussing case with colleagues in listening range of the patient
• Do not define the patient by his/her disease:

“Patient with Alzheimer’s disease”
vs. “Alzheimer’s patient”

Question 18

How can sensory and cognitive impairment become a barrier to effective communication?

Answer 18

Sensory Impairment
– Be prepared to utilize a sign language interpreter or written materials

Cognitive Impairment
– Provide written instructions for memory impaired patients
– Determine patient competency to understand and comply with treatment recommendations, refer for evaluation if needed

Question 19

What are possible language and cultural differences?

Answer 19

• Language and Cultural Differences
– Enlist interpreters, translators
– Be receptive to cultural beliefs, explanations, and prohibitions

Question 20

How should doctors address non-conforming gender identities?

Answer 20

• Insensitivity to non-conforming gender identity and sexual orientation
– Be open, ask questions, and educate yourself

Question 21

What are the race effects of effective communication?

Answer 21

Race Effects
– Racial disparities in treatment and minority distrust of healthcare
professionals

Question 22

What are the barriers to treatment adherence?

Answer 22

• Poor relationship with physician
– Perception of the physician as cold and unapproachable
– Anger at the physician
– Anger at the practice due to poor overall experience

• Believing that the financial and time costs of care outweigh the benefits
• Symptom resolution (i.e., seizures stop; BP normalizes)
• Complex treatment schedule

Question 23

What are the fears of treatment adherence?

Answer 23

• Fears
– Loss of bodily integrity from medication side effects
– Dependency on others
– Loss of masculinity (explains why someone may play through an injury)
– Loss of work time, fear of losing their livelihood

Question 24

How can denial/avoidance prevent treatment?

Answer 24

Refusal to admit being ill or to acknowledge severity

Question 25

How can medical treatment adherence be improved?

Answer 25

• Medications
– Discussion of patient fears and avoidance strategies
– Higher doses, shorter treatment course
– Assess adherence at every clinical encounter with check-ins between if needed

• Behavioral Interventions
– Enlist caregivers, family members
– Diaries, logs, and workbooks

Question 26

What is a sick role?

Answer 26

Individual who has fallen ill adheres to a patterned social role of being sick

• Being sick is not just a ‘fact’ or ‘condition’; Customary rights and obligations based on social norms.
• Three rights of a sick person and two obligations…

Question 27

What are the rights and obligations of a sick role?

Answer 27

• Rights:
– Exempt from normal social roles
– Not responsible for his/her condition
– To be taken care of

• Obligations:
– Should try to get well in order to return to social role(s)
– Should seek technically competent help and cooperate with the medical professional

Question 28

What are the indications of the sick role?

Answer 28

Important to recognize when a patient is stuck in a sick role
• Indications:
– Symptoms might not respond to treatment
– Symptoms might extend beyond normal course
– Evidence the patient does not want to return to societal role – Symptoms of mental illness

Question 29

Why is PPR important?

Answer 29

• A positive physician-patient relationship (PPR) is important for the patient’s health and overall wellbeing
• Duties are owed to the patient once a treatment relationship is established
• Doctor-patient communication is key to the PPR
• Do not blame the patient for failure to adhere to treatment or for difficult behavior – work to overcome barriers to treatment
• Do not abandon the patient
• Patient autonomy - follow the patient’s wishes or advance directives as closely as possible