The Doctor–Patient Relationship
unethical, the ethics of such a relationship between a doctor and former patient . In this review of the current evidence, based on major articles listed in. Doctor-patient relationships are strengthened by the practice of medical ethics, which can help you create better communication and health care decisions. An article published in the Canadian Medical Association Journal on the The ethics of physician-patient relationships is not a clear-cut issue;.
This scuffle forces us to ask, what should be the ideal physician-patient relationship? The relationship between a doctor and patient is the basis of successful clinical medicine.
Emerging Ethical Perspective in Physician-Patient Relationship
This relationship is important for improving patient health [ 12 ]. Such concept of beneficence allowed this authoritarian model to flourish with patients being passive recipients of the medical care. But, now there is need of the practice of mutual acceptable physician-patient relationship model in clinical set up. We can briefly outline the four models of the physician- patient interaction [ 45 ].
Then the physician presents the patient with selected information that encourages the patient to support the intervention the physician considers best. Finally, it is believed that the patient would be grateful for decisions made by the physician even if he or she would not agree to them at the time.
Hence, the physician can determine what is in the patient's best interest with limited patient participation.
The patient is informed about disease state, the nature of possible diagnostic and therapeutic interventions, the nature and probability of risks and benefits associated with the interventions, and any uncertainties of knowledge. Here, Physicians have an important responsibility of providing truthful information, be competent in their area of expertise and consult others when they lack knowledge and skills. In this model the physician does not dictate to the patient; it is the patient who decides which values and course of action best fit who he or she is.
In addition to supplying relevant information, helping elucidate values and suggesting what medical interventions realize these values the physician has a responsibility of engaging the patient in a joint process of understanding.
The Deliberative Model In this model, Physician provides information on patient's clinical situation and helps elucidate the types of values personified in the available options.
The physician suggests why certain health-related values are more worthy and should be aspired to. Here, physician and patient take into consideration what kind of health-related values the patient could and ultimately should pursue. In the deliberative model, the physician acts as a teacher or friend, engaging the patient in dialogue on what course of action would be best.
Not only does the physician indicate what the patient could do, but, knows the patient and wishes what is best and indicates that the patient must do-what decision regarding medical therapy would be worthy Essential Elements for a Better Doctor- Patient Relationship [ 67 ] The essential ingredients of a good doctor-patient relationship are communication, respect, confidentiality, professional honesty and trust. Effective communication has always been important in doctor-patient relationship.
Patients today are considered as health consumers and want to be active participants in decisions about their health [ 8 ]. Doctors, who educate patients, encourage patients to talk, laugh and use humours tend to have less formal complaints than those who do not do these things [ 9 ].
For a better communication the physician should sit down and attend to patient with comfort, establish eye contact, listen without interrupting, show attention with nonverbal signs such as nodding and gestures, acknowledge and legitimize feelings, and explain and reassure during examination. Good communication habits must have the following routines: Physician should avoid sceptical talks, false hopes, hopeless outlook and losing temper while communicating with patients.
The doctor-patient relationship: toward a conceptual re-examination
In a study conducted by Jenkins et al. Confidentiality And Privacy follow when a doctor respects the patients. Professional Honesty is about the doctor knowing the limits of own competence and when to refer the patient to other doctor or paramedic. There is nothing shameful about not knowing the solution to a medical problem and it is really dangerous to fake competence or pretend to know all. Trust is essential between doctor and patient. The best protection for doctor and patient is healthy professional boundaries.
Ways of maintaining professional boundaries include: Their trust emerged as a key theme related to patient—doctor relationships. The positive relationship between a doctor and patient are productive to both - the doctor and the patient. Benefits to doctors include higher doctor satisfaction [ 13 ] better use of time and fewer complaints from the patients [ 14 ] whereas benefits to patients include higher patient satisfaction [ 15 ] better patient adherence [ 16 ] and improved patient health.
This is what most people consider to be the essential task of medicine to help patients get healthier. Thus physicians have a duty to safeguard the health of the people and minimize the ravages of disease. Their knowledge and conscience must be directed to welfare of the patients. Implications for Teaching Doctor-Patient Relationship The modern societal values do not support or nurture relationships.
In medicine, individual achievements and technological solutions are being valued above community and wisdom. Contemporary medicine today faces a great challenge of retaining its humanity. Now-a-days we are producing more doctors but unfortunately with less values of humanity. This can be achieved by education which can counter the imbalance and model the middle way.
Firstly, teaching the science of medicine separate from art of medicine and disease as separate from the person must be resisted. They can do blood and urine tests in the hospital. The doctor recommends that if these tests do not show anything Asha should have a an MRI, however this test will have to be done at a private hospital as the public hospital does not have an MRI. She adds that although the MRI can be helpful it is not necessarily definitive. Asha will have to stay at the hospital under observation while the tests are done.
The family will have to pay for the tests at the public hospital because they are carried out by a private pathologist and family members will need to stay with Asha to look after her personal care, feed her, transport her within the hospital as needed and to obtain drugs if they are prescribed.
The family asks how much these tests will cost. Asha is alert but does not contribute to the discussion between the doctor and her family. The family decides they will pay for the blood and urine tests. They can manage this. If further tests are needed they will have to sell their meagre belongings including the jewellery Asha received on her marriage and probably take out a loan from someone that has engaged them as tailors.
This will probably also mean that the seven year old will have to stop going to school for the time-being. The doctor, who always tries to do the best for her patients, was not overly concerned that Asha did not express her preference.
She understands that when families arrive with a patient in this condition, they have already decided that this is their only hope. On the other hand, she wonders whether it was judicious to mention the MRI. And what will happen if the family is unable to afford the costs of these tests or potential treatment — even if it is only aspirin.
The Doctor–Patient Relationship
What if they decide to take out a loan, which they find they cannot repay. The diagnostic process will have been wasted and the family will be very much worse off than it was before agreeing to the tests. She has had one family where the breadwinner committed suicide because he could no longer meet the costs of a catastrophic health event affecting a family member or support his family. But, as a doctor, what can she do? Clinicians working in resource poor health systems with patients who are poor, or even middle class, inevitably deal with situations that are not contemplated in standard texts on medical ethics.
Autonomy and respect for it emerges from centuries of Western philosophy as a central value. The four principles cited earlier arise from a watershed moment for bioethics, at least in the West.
Transferring these principles from research to clinical practice was largely consistent with the direction of social movements seeking to make the consumer the key unit of concern in service delivery, rather than privileging paternalistic professional opinions.
This approach is now reinforced by domestic case and statute law in many countries and in international human rights law. The simple proposition that an adult ought to be able to make their own choices does not appear terribly controversial and this writer believes the proposition has value. Difficulty arises however, when ethical challenges are not readily resolved by resorting to autonomy as the solution. In other words, normative bioethical analysis contemplates a patient consulting a doctor and the patient being the sole unit of concern.
There are versions of autonomy that recognize, to different degrees, that patients are social beings who may be subject to many influences. An organization's accountability to its member population and to individual members has a series of inherent conflicts. Is the organization's primary accountability to its owners, to employer purchasers, to its population of members, or to individual, sick members? If these constituents somehow share the accountability, how are conflicting interests resolved or balanced?
For example, the use of the primary care clinician to coordinate or restrain access to other services involves the primary care clinician in accountability for resource use as well as for care of individual patients.
- Are Physician-Patient Relationships Ethical? Ethicists Say No, But Some Docs Disagree
- The doctor-patient relationship: toward a conceptual re-examination
- Making Ethical Rules for the Doctor-Patient Relationship
Although unrestricted advocacy for all patients is never really achievable, the proper balance and the principles of balancing between accountability to individual patients, a population of patients, or an organization need to be made explicit and to be negotiated in new ways.
All mechanisms for paying physicians, including fee-for-service reimbursement, create financial incentives to practice medicine in certain ways. We still lack a calculus to minimize or even describe in fine detail how such conflicts affect our ability to justify trusting relationships.Ethics - Doctor Patient Relationship - Right to Refuse
Even-handed social attention seems appropriate to all the different mechanisms of payment. Balanced assessment of how the details of remuneration systems influence doctor's willingness to act on behalf of patients will best protect both the health of the public and the health of doctor—patient relationships. This is a priority for a new form of empirical, ethical research.
Patients correctly wonder if doctors are caring for them, the plan, or their own jobs or incomes the latter is equally problematic in fee-for-service care.
This ambiguity erodes trust, promotes adversarial relationships, and inhibits patient—centered care. The recent controversy over gag rules has only confirmed this set of fears in the mind of the public which is now seeking regulation of the managed care industry through the political process. As illustrated in Figure 1the interests of patients, plans, and doctors can overlap to a greater or lesser extent. Professional ethics dictate that physicians attempt, as individuals and as a profession, to ensure that their interests and those of their patients are congruent in clinical practice.
Plan interests, however, can pull physicians away from this goal, as the organization's values and their implementation inevitably influence attitudes, behavior, and experiences. Alternatively, plans could promote patient-centered care by trying to maximize the extent to which patient, doctor, and plan interests overlap.
For example, promoting continuity, communication, and prevention can further all three interests so long as value and not cost alone is seen as the plan's product. Similarly, resource stewardship can be honestly promoted as a way to ensure that quality care is available for future patients.