doctor-patient relationship.pptx

AETCOM
Module 3

1. AETCOM Module 3

2. The Doctor-Patient Relationship

3. The Doctor-Patient Relationship

4. Objectives Understand why doctor-patient communication is key to a successful relationship Learn basic communication strategies for an improved doctor-patient experience

5. • • • Social roles of doctors and patients ( parson ’s model of the sick role and doctor ’s role T raditional doctor ‑ patient relationship Different types of doctor ‑ patient relationships Explain the concepts of shared decision making and concordance and their relevance to medical practice

6. • • • Introduction It is an emotional association (clinical encounter) between the doctor and a patient which arises when the doctor in a professional capacity interact with the patient The relationship begins when a person who is ill or believe that he is ill & consults a doctor. The success or otherwise depend on various factors including the nature of the relationship that exist between the doctor and the patient.

7. The History of the Doctor-Patient Relationship 20+ years ago... Over the last 20 years • • • • • • • Lower rates of education Less access to good medical care Doctors trusted completely Doctor gave advice/medication and patient would take it Patients ’ ideas, concerns & expectations not asked about Doctor treated- family cared Doctor Centred Approach • • • • • • Higher rates of education Medical advice on internet/libraries Better access and choice of good medical care High profile cases of doctors not acting professionally- general mistrust of doctors Broken families- doctors need to treat and care Patients want to make own decisions

8. • • • • Four types of doctor- patient relationship Paternalistic Mutual Consumerist Default

9. • • • • • • • Paternalistic relationship Traditionally characterized medical consultation Autocratic model It is assumed that Dr knows best High physician control and low patient control The doctor is dominant and takes on role of “parent ” Patient submissive Shift towards Mutuality

10. Communication in Paternalistic Between doctor and patient • • • Foundation for diagnosis and treatment (elicit & convey information) Relationship has a therapeutic effect placebo effect of drug Doctor-centered consultation (Paternalistic style)   ‘Closed’ nature questions e.g. “How long have you had the pain? & is it sharp or dull? ” Diseased centered model talk

11. Paternalistic Relationship If I ’ve told you once I told you 1,000 times, stop smoking!! ”

12. MUTUAL PARTICIPATION MODEL Regarded as optimal DPR 

13. MUTUAL PARTICIPATION MODEL Both parties share power and responsibility, exchange of ideas & sharing of belief systems, need each other and will work towards choices and actions satisfying to them both Open questioning, interested in psycho-social aspect of illness history & examination investigation results in a diagnosis Hence there is integration

14. COMMUNICATION Between doctor and patient • ‘ Patient-centered ’ approach (Mutuality)    Encourage & facilitate their patients to participate Use of ‘open ’ questions e.g. ‘tell me about your pain ’, ‘how do you feel? & ‘what do you think is the cause of the problem? ’ Active listening skills, requires more time (participative style) It ’s serious isn ’t it doctor?

15. • • Patient ’s role in mutual relationship Patients need to define their problems in an open and full manner The patient’s right to seek care elsewhere when demands are not satisfactorily met

16. • • Doctor ’s role in mutual relationship Physicians need to work with the patient to articulate the problem and refine the request The physician ’s right to withdraw services formally from a patient if he or she feels it is impossible to satisfy the patient ’s demand

17. • • • Advantages Patients can fully understand what problem they are coping with through physicians ’ help Physicians can entirely know patient’s value Decisions can easily be made from a mutual and collaborative relationship

18. • • Disadvantages Physicians do not know what certain degree should they reach in communication If the communication is fake, both physicians and patients do not have mutual understanding, making decision is overwhelming to a patient

19. • • consumerist relationship The patient takes the active role and the doctor plays passive role. Trying to satisfy the patient need in term of referral to the hospital, usage of medication and sick leave.

20. Consumerism Patient controlled consultation “You ’re paid to do what I tell you!! ”

21. • • • • • • • Relationship of default When patient and physician expectation are at odds Or when the need for change in the relationship cannot be negotiated The relationship may come to a dysfunction standstill Passive role by the patient and the doctor Lack of sufficient direction in consultation Ineffective in dealing with the illness. Commonly occur in managing chronic illness e.g. diabetes mellitus and hypertension,

22. • • • • Doctor-patient relationship in the past Paternalism Because physicians in the past are people who have higher social status “doctor ” is seen as a sacred occupation which saves people ’s lives The advices given by doctors are seen as paramount mandate

23. • • • • Doctor-patient relationship at present Consumerism and mutuality Patients nowadays have higher education and better economic status The concept of patient ’s autonomy The ability to question doctors

24. • • Social roles of doctors and patient Occupying social role which facilitate interaction as they define the expectations and obligations of each participant. Ensure that patients return to health and normal role performance as soon as possible.

25. PARSONS ’ MODEL OF SICK ROLE.

26. • • Parsons ’ model Parson saw the doctor and patient as fulfilling necessary functions in a well balanced and maintained social structure Sickness is considered to be a necessary, occasional respite, providing a brief exemption for patient from social responsibilities

27. • • Patient’s role When sick, a patient is allowed the privileges of convalescence-he or she is not held responsible for poor health and is excused from everyday responsibilities In order to enjoy these privileges, the patient must seek technically competent help and comply with medical advice →passive and dependent

28. • • Doctor ’s role Be guided by rules of professional practice Applying a high degree of skill and knowledge to the patients The doctor legitimates the patient ’s illness and determines the course of treatment. In doing so, the physician is compelled by professional ethics to act only in his or her sphere of expertise, to maintain an emotional detachment and distance from the patient, and to act in the patient ’s best interest →professionally dominant and autonomous

29. Parsons ’ “Ideal Patient” (Sick Role) Rights (Permitted) to:  Give up some activities and responsibilities  Regarded as being in need of care and unable to get well by his own decision & will Obligations (In Return) :  Must want to get better quickly  Seek professional medical advice and cooperate with the doctor. Parsons, 1951

30. Expectations Patient expects from doctor.... Why a patient goes to doctor.. • • • • • • • • • • • • • • • A cure Medication To be listened to Sympathy Advice- he understands The ‘answer’ A sick note What they want (agenda) Comfort A chat No harm Professionalism & Respect To be told what to do To feel better The truth • • • • • • • • They feel ill physically They feel ill mentally They are lonely They want time off work Need advise Don ’t know who to turn to Marital/family problems Legal reasons

31. Expectations Doctor expects from patient... • • • • • • • • Trust Compliance to treatment Agreement The truth Respect They want to get better To be listened to To obey the ‘Rules’!

32. If Expectations are not met... Patient may... Doctor may... • • • • • • • • • • Not take medication Not follow advice Choose another doctor Lose trust Complain Not come back Come back Become more ill/die Not tell doctor why they came Become Distressed/Sad/Angry • • • • • • • Become annoyed Become ‘stressed’ Not be thorough Dread seeing patient again Refuse to see patient again Refer pt to another doctor (Balint calls this ‘the collusion of anonymity’ ) Not listen

33. • • • • Problems with Parsons ’ model Address acute problems (ignores chronic dx: imagine a cancer patient on medical leave for 10 year!) Clinically oriented Centered on individuals Rights do not always apply

34. Communication Patient-Doctor communication is important Improved satisfaction Improved compliance Improved decision making Better health outcomes Decreased malpractice claims

35. Communication Information gathered must be: Objective Accurate Precise

36. Communication Who will you be communicating with? Patients Families Colleagues Other health professionals

37. Communication Skills Essential for diagnosing and treating illness Essential in establishing a meaningful patient-doctor relationship Facilitates educating and counseling patients

38. Patient Communication Patients who feel at ease are more likely to tell you their reason for coming to the doctor’s office Be yourself! Show true interest

39. The Physician’s Duties Respects the patient Ensures privacy and trust of confidential information Demonstrates genuine concern for patient’s health Limits distraction to provide patient undivided attention

40. Respect If appropriate shake hands Always address the patient as: Mr., Mrs., Ms, etc.

41. A model patient-doctor relationship Trust Compassion Open and honest communication Respect

42. Why is Doctor-Patient Communication Unique? Trust Patients on the first visit share their most personal information to someone they have never met before They look to you for guidance when making critical health care decisions Within minutes of meeting, patients are often required to disrobe for a physical examination and are placed in a vulnerable situation

43. Empathy To understand a person’s experience Different than sympathy Requires Active listening Interest in patient’s experience

44. Objectivity Removing your own beliefs and values Avoid judgmental attitudes IV Drug Abuse Education Socioeconomic status Language/Cultural differences Ageism

45. Active Listening Skills Respect the patient as a whole person, not a diseased body Use confirmatory statements: “Yes” “Tell me more about that” Allow the person to tell their whole story without unnecessary interruptions Don’t be afraid of silence

46. Body Language Examination room configuration Sitting/Standing Eye contact Note taking Posture Hurried speech

47. Body Language Patients notice more than you think 2/3 of communication is non-verbal Appropriate use of touch

48. Patient-Doctor Communication: Key Points Ask about expectations, feelings and concerns Show concern for comfort and modesty Give an opportunity to express feelings and concerns Encourage patients to ask questions

49. Communication skills can be developed with practice, patience and a willingness to learn .

50. • • • • • Influence of time Shortage of time is a major constraint – paternalistic approach Less attention paid to social and psychological aspect Unnecessary prescription issued Increase in the number of visits Thus more time required for participative patient centered consultation, listen to patient ’s worries and concern

51. The importance of a good PATIENT DOCTOR RELATIONSHIP lies in the : • Confidence • Trust • Knowledge • Shared knowledge about diseases and how they are related

52. The success of a good Doctor Patient Relationship is related to • Amount of Information • Quality of Information • Accuracy of Diagnosis • Effective Treatment • Compliance

53. IN SUMMARY Relationships based on openness, trust and good communication will enable you to work in partnership with your patients to address their individual needs. To fulfil your role in the doctor-patient partnership you must: a. be polite, considerate and honest b. treat patients with dignity c. treat each patient as an individual d. respect patients' privacy and right to confidentiality e. support patients in caring for themselves to improve and maintain their health f. encourage patients who have knowledge about their condition to use this when they are making decisions about their care.

54. HOW TO FIND OUT IF IT WAS A GOOD DOCTOR PATIENT RELATIONSHIP •PATIENT SATISFACTION • CONTINUITY • GOOD OUTCOMES