The Doctor-Patient Relationship Flashcards
An encounter between two persons: doctor and patient
Doctor-Patient relationship
Specific roles and motivations of the doctor
Expert in medicine motivated by the desire to help
Specific roles and motivations of the patient
health seeker motivated by the desire and hope for assistance and relief of pain
Elements of the Doctor Patient relationship
Reality Based Elements
Fantasy Based Elements
Aim is for patient’s wellbeing or health maintenance
Working/Therapeutic Alliance
Derived from the patient’s pattern of learned interpersonal behavior
Transference
Characteristics of the doctor
Medical knowledge Understanding of patient situation or value systems Self awareness Communication skills interview techniques
Characteristics of the patient
Gender Age Individual history Unique Personality Genetic make up life experiences Roles in social group belonging to a community
Gathering patient data, evaluating the content and process
Clinical Interview
Sets the stage for identifying relevant problems in the context of an empathic working alliance with a patient
Clinical interview
Spontaneous, conscious feeling of harmonious responsiveness that promotes the development of a therapeutic relationship
Rapport
Implies an understanding and trust between the doctor and the patient
Rapport
Commitment between the doctor and the patient to explore the patient’s problems, to establish mutual trust and to cooperate with each other to achieve realistic goal of a cure or the alleviation of symptoms
Therapeutic or Working Alliance
Process of displaying attitudes and feelings originally experienced in relationships with persons from the past
Transference
Part of the clinical interview that contains the patient’s stories
content
Part of the clinical interview that contains the patient’s non-verbal
process
Specific cognitive processes, ways of thinking, that the mind employs to avoid painful experience
Defense mechanism
Models of Doctor Patient Relationship
Paternalistic
Informative
Interpretive
Deliberative
Model of PDR wherein the patient is expected to comply with the doctor’s instructions without question
Paternalistic
Model of PDR that is appropriate for when doctors need to take control, such as during an emergency situation
Paternalistic model
Model of PDR wherein all available data are given but the choice of treatment is left to the patient
Informative model
Model of PDR that is appropriate for a one time consultation
Informative model
Model of PDR wherein the doctor presents and discusses alternatives with the patient’s participation
Interpretive model
Model of PDR that is appropriate for treating people with chronic diseases
Interpretive model
Model of PDR wherein the doctor presents information and actively advocates a particular cause of action
Deliberative model
Model of PDR that is appropriate in modifying behavior
Deliberative model
Philosophy and process of care that integrates the specialized knowledge of multiple disciplines
Multidisciplinary approach
Major premises for the multidisciplinary approach
Complexity of care needs the expertise of multiple disciplines
Process of care can be facilitated through the involvement of multiple disciplines
Members of the health care team
physicians nurses rehabilitation experts/therapists social workers counselors
Key elements of the multidisciplinary approach
Shared purpose and goal
Roles and responsibilities are clear
Members make appropriate contributions
Team members cooperate and coordinate activities
Members trust one another through an on-going relationship
Questions to keep in mind to determine patient personality types
What did you notice about the way in which this patient was talking?
What kind of questions was he or she asking?
What criteria was he or she using for deciding on treatment?
How quickly did they want to make their decision?
Behavioral clues for Extroverts
Rapid speech
Thinks out loud
Interrupts
Loud volume of voice
Behavioral clues for Introverts
Pauses when giving information
Appears to think things through
More quiet volume of voice
Shorter sentences
Behavioral clues for Sensing
Asks for step by step
Asks about the present
What and How
Precise descriptions
Behavioral clues for Intuition
Asks for purpose
Asks for current and long term
Why
General terms and possibilities
Behavioral clues for Thinking
Testing
Weighs evidence
Not easily impressed
Check logic
Behavioral clues for Feeling
Harmony
Value
Asks about others
Behavioral clues for Judging
Impatient
Enjoy getting things done
Behavioral clues for Perceiving
Space
Exploratory
Last minute
Process
Extravert doctor Introvert patient
slow down pace and give time for the patient to reflect
Introvert doctor Extravert patient
show more energy and give space for the person to talk
Intuition doctor sensing patient
Give detailed information in a stepwise fashion and practical examples
Sensing doctor intuition patient
big picture first
Thinking doctor feeling patient
Take interest in the patient as an individual
Feeling doctor thinking patient
Keep to objective facts and logical information
Judging doctor perceiving patient
provide space for the patient to explore and clarify the options
Perceiving doctor Judging patient
agree an agenda for action including dates for appointments
