Patient doctor relationship

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Patient - Doctor relationship Dr KSR Prasad Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

description

Dr KSR Prasad guest lecture for Clinical Induction of BAMS students at MGACHRC, Wardha

Transcript of Patient doctor relationship

Page 1: Patient doctor relationship

Patient - Doctor relationship Dr KSR Prasad

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

Page 2: Patient doctor relationship

Introduction

• Doctor – Patient relationships express the values of medical profession

• The relationship should not be the fish & fisherman

• It should be always like fish and water

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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Parsons’ “ Ideal Doctor”

Apply a high degree of – skill and knowledge

Act for the good of the patient

Remain objective and emotionally detached

Respect the position of privilege

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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Doctor’s role

• Health care providers• Technical consultant• To convince the necessity of

medical services• A tendency for the“consumer to be right”

Patient - Doctor relationship

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Doctor Competencies

• Patient Care• Medical Knowledge• Practice-Based Learning (EBM) and

Improvement• Interpersonal Skills • Communication Skills• Professionalism• Systems-Based Practice

Patient - Doctor relationship

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Presenter
Presentation Notes
Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value
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Patient’s role• Health shoppers Indications

of consumer behavior• Cost-consciousness• Information seeking• Exercising independent

judgment• Consumer knowledge

Patient - Doctor relationship

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Parsons’ “Ideal Patient”Permitted to:Give up –• some activities • responsibilities• Regarded as being in need of care

In Return :Must want to get better quickly Seek help from and cooperate with a doctor

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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Consumerism

• The patients’ challenge to unilateral decision making by physicians in reaching closure on diagnoses and working out treatment plans

• Reversing the very basic nature of the power relationship

Patient - Doctor relationship

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Conflict of Interest

• Interests of patient Vs society• Interests of patient Vs other patients• Problems of confidentiality

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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The Physician Charter

Principles include:

• Patient welfare • Patient autonomy

Commitments include:

• Honesty with patients• Patient confidentiality• Maintaining appropriate

relationships with patients

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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• - in Physician-Patient Communication1. Build the doctor-patient relationship2. Open the discussion3. Gather information4. Understand the patient’s perspective5. Share information6. Reach agreement on problems and plans7. Provide closure

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

10Seven Essential Elements

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Etiquette Based MedicineChecklist for first meeting with a hospitalizedpatient:• Ask permission to enter the room /interrogation ;

wait for an answer• Introduce yourself, showing ID badge• Shake hands /greeting (wear gloves if needed)• Sit down, Smile if appropriate (relax your self and

make patient relaxed)• Briefly explain your role on the team• Ask the patient how he/she is feeling about being in

the hospital & about the treatments

Kahn MW, N Eng J Med, 2008

Patient - Doctor relationship

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Length of Consultation

• Makes patient centred consultation styles more difficult.

Patient - Doctor relationship

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Average 8 minutes

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Consultation Styles

It’s serious isn’t it doctor?

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

• Sustained physician-patient partnerships with bonds of trust and knowledge of patients were correlates of three outcomes of care– Adherence– Satisfaction– Improved health

status

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Doctor-Patient Relationship Linked to Outcomes of Care

Safran DG et al, J of Fam Practice, 1998

Rate from 0 to 100…

1. Communication

2. Compassion

3. Respectfulness

4. Responsibility

SCALE

100-Best Possible 90-Excellent 80-Very Good 70-Good 60-Above Average 50-Average 40-Below Average 30-Poor 20-Very Poor 10-Terrible 0-Worst Possible

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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(to be rated by patient)

Communication: • How well this doctor communicate with

you and your family• Did doctor answer your questions?Compassion: • Was the doctor is sensitive to you and

your family needs?Respectfulness:• Did the doctor ask and respect your

choices about your care Responsibility:• Did you feel the doctor acted

appropriative on your behalf?

Presenter
Presentation Notes
Physicians’ comprehensive (whole person) knowledge of patients and patients trust in their physician were the variables most strongly associated with adherence, and trust was the variable most strongly associated with patients’ satisfaction with their physician.
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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

Patient - Doctor relationship

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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

Patient - Doctor relationship

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Patient influences on consultation

• The patient’s ability to exercise and control depends on a number of factors:– Social – Educational level– Sex– Membership of an ethnic

minority

Patient - Doctor relationship

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Patient controlled consultation

“You’re paid to do what I tell you!!”

Patient - Doctor relationship

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Patients beliefs and expectationsInfluenced by:

1. Previous experience, 2. literature, 3. the media;4. Family and friends;5. Cultural influences;6. Social significance.

These beliefs influence outcomes

Patient - Doctor relationship

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Prototypes of doctor-patient relationship

Physician control (Low)

Physician control (High)

Patient control (Low) Default Paternalism

Patient control (High) Consumerism Mutuality

Patient - Doctor relationship

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Ethical models at a glance

–Paternalistic model–Informative model–Interpretive model–Deliberative model

Patient - Doctor relationship

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Paternalistic model• Principle

– The doctor should make all the decisions for a patient.• Assumptions

– People are not always rational/mature.– Experts know better about the needs of patients.– Qualified doctors have good will.

• Sources– Hippocratic Oath; Plato.

• Problems – Are the needs of patients objective? – How can we be sure that doctors have good will?

• Objection and modification– John Stuart Mill’s liberal principle

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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The Paternalistic Approach

“If I’ve told you once I told you 1,000 times, stop smoking!!”

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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Informative model• Principle

– The doctor should provide all the relevant information for the patient to make a decision, and provide the selected intervention on this basis.

• Assumptions – A fact/value division of labor yields the best medical result.– What is good for a patient depends on what his/her personal

values. – Consumerism.

• Problems – What if the patient is unconscious, incompetent, and making

choices totally unacceptable by our ethical standards?

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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The interpretive model• Principle

– The doctor should help the patient to articulate his/her values through interpretation, and provide intervention which is truly wanted.

• Assumptions – Patients have unconscious and inconsistent desires.– Their conscious decisions may not reflect their deepest

values. • Sources

– Sigmund Freud; hermeneutics.• Limitation

– All that a doctor can do is to help the patient see his/her own desires/values more clearly, but not to criticize them.

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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The deliberative model• Principle

– The doctor should help the patient to deliberate well through dialogue and discussion, and

– so develop values which are objective and truly worthy. • Assumptions

– The objectivity of values.– The patient’s good life consists not in the satisfaction of desires, but

maturity and rationality.• Source

– Aristotelian ethics• Problems

– Is the model different from the paternalistic model? – What is the difference between dialogue and persuasion?

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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Mutuality• The optimal doctor-patient relationship model• This model views neither the patient nor the

physician as standing aside• Each of participants brings strengths and

resources to the relationship• Based on the communication between doctors

and patients

Patient - Doctor relationship

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Mutuality - Patient’s role• 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

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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Mutuality - Doctor’s role• 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

Patient - Doctor relationship

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Mutuality - 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

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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Mutuality - 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

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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Mutuality - Discussion

• Is the patient capable of making the important therapeutic decision even though they have good communication of the physician?

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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Do – Don’ts • Do not toss the treatments for

a patient• Make always reliable advises

and practices• Assuring the patient is first

choice of – placebo treatment – But it should never be false

assurance • Authentic tested managements

(EBM) are advised

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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Conclusion• Relationship between patients

and doctors are often unstated, and thy are dynamic

• As conditions change, the kind of relationship that works best for a patient may change

• Doctors and patients should choose a “relationship fit”

Patient - Doctor relationship

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Thank you

• Dr KSR Prasad

Patient - Doctor relationship

Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda

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