Topic 15: doctor patient relationships

Question 1

3 Types of practicing medicine

Answer 1

1) Bedside > laboratory medicine
2) Patient-centred medicine
3) Evidence-based medicine

Question 2

Describe bedside > laboratory medicine

Answer 2

• Early 19th century
• Focused on manifestation not hidden causes
• Diagnosis + treatment = subjective
• Overtime more patients hospitalized
• Emphasis on pathology + importance of lab tests

Question 3

Describe evidence-based medicine

Answer 3

• Clinical experience guided treatment = if drug worked in clinical = used again
• Recent shift = establish objective effectiveness of practice
• Evidence from research and trials not everyday practice

Question 4

Describe patient-centered medicine

Answer 4

• 1980s = combined biological + psychological + social perspective
• Patients provide info = for diagnosis
• Now = people have chronic diseases = patient centred approach appropriate = LT collab with doctors

Question 5

Describe the sick role of patients

Answer 5

OBLIGATIONS/EXPECTATIONS:
- Patients must want to get well as quickly as possible
- Should seek medical advice
RIGHTS:
- Allowed to withdraw from daily activities
- Regarded as unable to get better by own will

Question 6

Describe the sick role of doctors

Answer 6

OBLIGATIONS/EXPECTATIONS:
- Apply high degree of skills
- Act for good of patient + community
- Objective + emotionally attached
- Guided by rules of professional practice
RIGHTS:
- To examine patients physically
- Autonomy in medical practice
- Position of authority in relation to patient

Question 7

Describe conflict between 2 roles

Answer 7

• Different values
• Confidentiality breach by doctors
• Doctors not able to determine cause of symptoms = patients frustrated
• Doctors not able to coordinate effectively
• Ineffective communication

Question 8

4 Types of doctor-patient relationships

Answer 8

1) Paternalistic = high doctor control + low pateint control
2) Mutuality = equal control
3) Consumerist = low doctor control + high pateint control = private consultations
4) Default = low doctor + low patient control

Question 8

Describe the model of doctor-patient relationship

Answer 8

• Paternalistic + mutuality = most common
• Doctors/patients perceptions of roles = influential for relationship
• Patient expectation = younger + educated = expect more patient-centered consult
• Practices guided by guidelines

Question 9

3 Models of treatment decision making

Answer 9

1) Professional choice = doctor decides
2) Shared choice
3) Consumer choice = patient decided

Question 10

When do patients not prefer shared choice?

Answer 10

• When in crisis = make own decison
• Even if don’t want to participate in decision = want to be informed

Question 11

Basic communication skills for history taking

Answer 11

• Initiate consultations = intro + explain purpose of consult
• Consent + confidentiality
• Use closed + open questions
• Check patient’s perspective
• Empathize = RAV = recognize + accept + validate
• Signpost = prepare patient of area exploring next
• Check patient’s understanding = ask if they understand terms + clarity
• Summerise
• Close consultation

Question 12

Basic communication skills for information giving

Answer 12

• Avoid jargon
• Organize info
• Give info in small chunks
• Don’t scare = start with positive
• Check understanding