Week 4: Doctor patient relationship

Question 1

What is meant by the doctor -patient relationship?

Answer 1

Different ways in which healthcare professionals and lay people interact during a medical consultation.
Includes the context of the consultation and the communication styles, which all influence on the type of relationship and clinical outcomes.

Question 2

Why is the doctor patient relationship important to health?

Answer 2

INfluences adherence to treatment
Influence patient confidence and satisfaction
Influence help seeking behaviour

Question 3

What are the three different medical cosmologies?
What is proposed to be the future fourth?

Answer 3

Bedside medicine
Hospital medicine
Labratory medicine
Thought to be shifting back to at home bedside medicine due to technology.

Question 4

What are the key features of bedside medicine?

Answer 4

Individualised
Paternalistic
At home - limited treatment options available, often unable to identify the cause, many illnesses were treated in the same way.
Very little focus on population level health

Question 5

What are the key features of hospital medicine?

Answer 5

Started to identify patterns in illnesses
Collected resources and knowledge into one area.
Medical language developed - doctor sense of success changed to how they were viewed by peers rather than patients.
Increased focus on physical examination and autopsy

Question 6

What are the key features of laboratory medicine?

Answer 6

Considered a consumerist culture - tend to test for everything to be safe
Patients come with higher expectations, doctor should always be able to find a diagnosis or a solution
Rapid speed medicine

Question 7

What are the social factors that influence the consultation?

Answer 7

Patient characteristics
Docor characteristics
Culture clashes between different social worlds/viewd
Rise of complementary and alternative medicines
Changing policy and organisations context and priorities

Question 8

How do patient characteristics influcne the outcome of a consultation?

Answer 8

Increasing patient knowledge - preset expectations or concerns
Gender, socioeconomic, education, ethnicity and race - influence expectations, opinions and potentially willingness to engage in certain treatments, stimga around certain conditions
Language barriers or communication difficulties

Question 9

How do doctor characteristics influence the outcome of a consultation?

Answer 9

Speciality - medical v lay language
Gender
Models of health and illness
Change how to patient interprets the doctor and what the patient thinks the doctor thinks of them

Question 10

How does the rise of complimentary and alternative medicine influence the outcome of a consultation?

Answer 10

Declining status and trust in medical professionals
Concerns over conflicting advice from non-qualified health professionals.

Question 11

How does changing policy and organisation context and priorities alter the outcome of a consultation?

Answer 11

Doctor willingness to prescribe medication or tests
Patients have increased choice and consumerism in health care
Patient responsibility over health, self management - some people feel like that have been neglected by health professionals

Question 12

What are the four main components that underpin the doctor-patient relationship from the patient persepctive?

Answer 12

Knowledge - familiarity between the doctor and patient, sense of understanding and in same cases predicting how the other will react,
Trust - both ways, in doctor and in healthcare system
Loyalty - forgiveness in care potentially lapsed.
Regard - mutual liking between doctor and patient

All are reciprocal, what x thinks about y, and what x thinks y thinks about x, and the same thing but for y.

Question 13

What is meant by the interpersonal relationship?
Why is it important to the doctor patient relationship?

Answer 13

Unspoken exchanges between the doctor and the patient including body language, tone of voice,
This is the relationship that flows alongside the formal consultation

Can be used to prevent patient confusion, disengagement or disappointment. Should be used to a therapeutic advantage.

Question 14

What do Bruch and Bond suggest about the importance of empathy in a doctor patient interaction?

Answer 14

Empathy goes beyond demonstrating an understanding of a patient to being able t o predict what they might do.
This can help strengthen the relationship by preventing the patient from being in upsetting or angry setting.
However, must be careful not to make assumptions on the patient, should be given all the options available.

Question 15

Why is understand the internal frame of reference important in the doctor-patient relationship?

Answer 15

Understand your own internal frame of reference - acknowledge and avoid stigma and unconcsicous bias

Recognise and try to adapt to the patients internal frame or reference (rather than your own) - this will make it easier to emphasise with the patient and suggest options that will best suit them and behave in a way that will match their expectations.

Try to understand what the patient expects from you and the consultatio

Question 16

What factors underpin the manner and style of communication in the doctor patient relationship?

Answer 16

Who makes decisions
Level of patient involvement
Use od medical jargon
Socio-emotional utterances - small talk, showing concern, humour or reassourance. (recognising and responding to patient emotions)

Question 17

How does communication affect health outcomes?

Answer 17

Directly - survial, remission, suffering, emotional wellbeing, pain, functional ability and vitality
Indirectly - has a proximal affect on patient understanding, satisfaction and agreement, sense of trust, motivation and rapport.
This has a knowck on effect on access to care, commitment and trust to care which then influences health outcomes

Question 18

How does power and access to information alter the doctor-patient relationship over time?

Answer 18

Past - large differentiation between the patient and the doctor knowledge. Aided paternalistic relationship

Now - patients have equal access to information, different abilities to utilise and understand information, can be form of conflict, particularly if not clear about prior knowledge and expectations.
Doctors need to be transparent about what they do and do not know.

Question 19

What are the five different models of doctor-patient interactions?
How do they vary by the level of doctor and patient control?

Answer 19

Paternalistic - high doctor and low patient
Mutualistic - high doctor and high patient
Default - low patient and low doctor, poor engagement
Consumerist - low doctor and high patient
Conflict - middle patient and middle doctor, no body really gets what they want.

Question 20

What are the key features of the paternalistic doctor-patient relationship?

Answer 20

Father like - with high control from doctor and little input from the patient
Doctor - centred = makes all the decisions and directs the consultation
Follows biomedical model of disease - doctor is expert and disease is a biological phenomenon with an identifiable cause

Question 21

What are the criticism of the paternalistic doctor-patient relationship?

Answer 21

• patinet seen as a passive recipient of care
• overlooks patient knowledge and experience
• low patient satisfaction and high level of complaints
• low adhrence, information enxhcnage and poor therapeutic relationship
• conflict is the patient tries gain more power
  + appropriate in emergency scenarios and some patient may prefer this

Question 22

What are the key features of the mutualistic doctor-patient relationship?

Answer 22

High doctor and patient control
Mutual resepct
Doctor acknowledges the patient beliefs, knowledge and experiences
Patient centered
Shared decision making

Question 23

What is meant be patient centered care?

Answer 23

Individual as an equal partner in care
- follows the biopsychosocial model of health and illness
- patient as a person - personal meaning of illness
- doctor as a person - awareness of influence of personal qualities and subjectivity
- shared power and responsibility
- therapeutic alliance

Question 24

How are people involved in the their own care?

Answer 24

Increasing patient awareness and control over their care schemes
Patients given the opportunity yo make informed decisions alongside their health care professional, consider their needs and preferences
NHs is committed to this:
- giving power to people to manage their own health conditions and decisions
- supporting people to improve their health and give them the best opportunity to lead the life they want to live.

Question 25

What are the key ideas of shared decision making?

Answer 25

Sharing of information, uncertainties, options and outcomes between the patient and the dcotros
Creates a shared knowledge, view and experience to make decisions
- patient shares preferences, goals and values
- clinician brings information about condition and treatment
- health care professionals work together with a patient
- ensures understanding and risks of different treatment option
- ensures patients are more involved in their own care

Question 26

What are the benefits of patient centered medicine?

Answer 26

More information may be disclosed
Better handling of ticket of entry consultations
More likely to have better clarification, satisfaction and understanding
Fewer repeat consultations
Allows patient to choose degree of engagement in decision making
NICE patient decision aids

Question 27

Do patient want to be involved in decision making?
What factors affect this?

Answer 27

24% - doctor make decision 50% - doctor work together with the patient, 25% patient make decision
Most patients want information even if they do not want to be directly involved.

Depends on patient state of health and complexity of health needs
Harder to engage in shared decision making when patient is facing shocking, serious or life threatening diagnosis.

Question 28

What are the kye feature of a consumerist doctor patient relationship?

Answer 28

High patient control and low doctor control
Greater levels of patient choice
Patient is more active and demanding
Patients seen as consumers of health care services both nationally and internationally and are becoming more involved in the design, provision and policy making in services.
Key facilitator is the internet.
Rise of health tourism

Question 29

What are the key ideas of a conflict doctor patient relationship?

Answer 29

Disagreement and difference in perspectives
Often from different social worlds.
Patient wants more information than the doctor can give
Different expectations about behaviour and treatment
May be due to double blinding - receives two contradictory sources of information either different health care services or online v in person

Question 30

What are the key ways conflict in the doctor-patient relationship presents?

Answer 30

Conlfict can be latent - potential
Conflict can be real - observed
Patients often choose negotiation rather than full out conflict.

Question 31

What are the key features of the default doctor patient relationship?

Answer 31

Patient has low control and the doctor has low control - lack of engagement on both sides
Often doctors trys to engage patient but this is unsuccessful.
Common when an interpreter or carers is involved.