Relationships Between Patients and Professionals Flashcards
What is the patient-professional relationship?
A very important component of the experience of illness
Has become increasingly central to improving the delivery of health care
Not just of sociological interest - also raises professional, legal and ethical concerns.
What are the 4 major sociological approaches to relationships between patients and professionals?
- Functionalism (emphasises consensus and reciprocity)
- Conflict theory (emphasises conflict)
- Interpretivism/Interactionism (emphasises the
meanings that people ascribe to social situations) - Patient-centred/Partnership models (emphasis
partnership)
Describe the functionalist approach to relationships between patients and professionals
Interested in how a relationship (doctor and patient) characterised by asymmetry could function so well
Patient is vulnerable; doctor is powerful - many taboos have to be broken for relationship to work
Trust has be based on abstract codes of conduct
Medicine restores people to good health and by so doing restores equilibrium
What is the sick role according to the functionalist approach to relationships between patients and professionals?
Falling ill is a socio-cultural experience
Although they may possess some knowledge of their condition, on the whole lay people don’t have the technical competence to remedy their situation
The sick person is placed in a state of helplessness
What are the rights and duties of the sick role according to the functionalist approach to relationships between patients and professionals?
On falling ill the sick person enters a social role which is circumscribed by specific rights and duties:
- Being ill presents itself as a legitimate reason to be
freed of social responsibilities and obligations
- The sick person is placed in a situation of dependence:
their new social status demands the attention of
medical care
- The sick person should want to get well and abuse
their legitimised exemption from normal responsibilities
- The sick person is expected to seek out the requisite
technical help in the role of the physician and
cooperate with them in the healing process
What is the doctor’s role according to the functionalist approach to relationships between patients and professionals?
Doctor’s role as tending to sickness in society
Characterized by certain norms and expectations (that we normally associate with professions)
- Doctors should use skills for the benefit of patients; act
for the welfare of patients rather than their own self-
interests; be objective and non-discriminatory
- Doctors granted intimate access to patients; autonomy;
status; financial reward
What are some of the criticisms of the functionalist approach to relationships between patients and professionals?
Sick role not well thought out; some patients cannot get better (chronic illness); legitimate and illegitimate occupants of the sick role?
Assumes patients are incompetent and must have a passive role
Assumes rationality and beneficence of medicine
Doesn’t explain why things go wrong
Describe the conflict approaches to relationships between patients and professionals, and Eliot Freidson’s connection.
By 1960s and 1970s more critical views of medical profession were emerging
Eliot Freidson rejected notions of legitimate authority and trust and replaced them with medical dominance and supressed conflict
Eliot Freidson:
- The doctor’s control is not the product of professional
values or technical expertise alone
- The doctor holds bureaucratic power - ‘gatekeeper’
- Doctors have a monopoly on defining health and illness
which they can exploit
- The patient has little choice but to submit to the
institutionalises dominance of the doctor
Describe conflict theory and “medicalization” in regards to relationships between patients and professionals.
Lay ideas are marginalised and discounted
Medicine colonises areas previously in control of lay public, and can pathologies aspects of social life
Cultural iatrogenesis (Ivan Illich) - people become dependent on medicine, lose self-reliance and become sick
Idea that “medicalization” of childbirth has resulted in loss of control for women
What are some of the criticisms of the conflict approaches to relationships between patients and professionals
Is portrayal of patients and doctors as inevitably ion conflict accurate?
Patients are not always passive - can exert control through e.g. non-adherence, use of complementary therapies
Patients may appear deferential in consultation but assert themselves outside of this
Patients can seek to ‘medicalise’ issues, too
Describe the Interpretive/interactionist approaches to relationships between patients and professionals.
Focus on the meanings that both parties give to the encounter
Interested in patterns - how does order emerge through interaction
Informal, unwritten rules govern almost every aspect of social life - may be much more important than formal rules
Describe the patient-centred models in regards to relationships between patients and professionals.
Aspiration that patient-professional relationship could be less hierarchical and more cooperative if patients’ views were taken more seriously
A shift away from traditional ‘professional-centred’ model toward a ‘patient-centred’ model
Emphasis on more egalitarian relationship: professional and patient as equals
Underpins many recent policy initiatives
Tell me about a patient-centred consultation.
Explores the patient’s main reasons for the visit, their concerns and need for information;
Seeks an intergrated understanding of the patient’s world - that is, their whole person, emotional needs and life issues
Finds common ground on what the problem is and mutually agrees on management
Enhances prevention and health promotion
Enhances the continuing relationship between patient and doctor
Tell me about shared decision-making.
Both the doctor and patient involved in the treatment decision-making process
Both the doctor and the patient share information with each other
Both the doctor and the patient take steps to participate in the decision making process by expressing treatment preferences
A treatment decision is made and both the doctor and the patient agree on the treatment
What can patients contribute to healthcare in terms of their consultation and relationship with doctors.
Their concerns and priorities in relation to presenting problems
Their personal perceptions of costs and benefits of alternative interventions to improve the problem
Complex judgements about the severity of their health problems and unwillingness to undergo risk, discomfort, or other potential costs
Trade-off issues of survival at cost of quality of life
