Doctor–patient relationship - Wikipedia
Mar 24, In medical school, physicians probably learned communication skills such as interviewing (getting information from patients on the reasons for. Three dimensions of the doctor–patient relationship, that is, physician patient lower trust in the physician (50%) as compared to male patients (75%) (OR = , significant, and more interesting than psychological and sociocultural issues'. Doctor-patient relationships are strengthened by the practice of medical ethics, LINK 2: Code of Medical Ethics Opinions: Special issues in patient-physician.
After 6 weeks in hospital, on the day of his planned discharge, he was accidentally given another patient's medication. Instead of receiving his azathioprine and corticosteroids, he was given a high dose of frusemide and captopril. Simply by the sheer nature of taking on the role of patient, regardless of any other type of power, there is always an unequal power differential between the doctor and patient. This applies in both general practice and hospital-based medicine, although it may be accentuated by the latter's institutional culture.
However, there is also the question of whether this type of power would be accentuated further in a fee-for-service situation, as exists in general practice in Australasia, as opposed to free public hospital treatment. This differential is exacerbated further by any imbalances arising from the other three sources of power. Charismatic power may not always be less on the patient's side depending on the personalities of patient and doctor.
Equally, Social power may vary in doctor— patient relationships depending on the social status of the individuals.
This may also relate to the gender roles of the patient and doctor. The large majority of cases of sexualization occur between female patients and male doctors. Therefore, the onus of responsibility for controlling the power imbalance in an ethically correct manner is always on the doctor. However, what is the relevance of this analysis to relationships with former, not current patients? Several points can be made. Information gained in such a power imbalance can be artificially intimate—one does not normally begin to discuss details of sexual function within a few minutes of meeting a stranger, for example, but this frequently happens in general practice consultations.
Secondly, given the strength of Hierarchical power in determining one's overall power in the doctor—patient relationship as illustrated by the case historyit is hard to see how a relationship of equals could develop from such unequal beginnings. Autonomous choice and consent How should a claim be judged that a former patient gave his or her free consent before entering into the relationship? The validity of consent of a former patient, as opposed to a current one, is a little more debated, but evidence is against that being a former patient materially alters the situation.
Transferences can persist indefinitely and with it the perpetuation of the potential or real incompetence of the patient to recognize these feelings for their true nature and the same for doctors with respect to counter-transference: Zelas is a little less prohibitive.
Meaningful consent to a sexualized relationship cannot be given in a situation of unequal power: Traditional teaching of informed consent emphasizes the importance of autonomous choice, i.
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Leaving aside the provision of information presumably such information should include a review of the current known research in this area, although this apparently rarely, if ever, happens 12this discussion will concentrate on coercion and impaired capacity.
Coercion can arise from imposed restraints on any or all of three types of autonomy: However, an alternative definition of autonomy which centres upon the importance of one's social relationships demonstrates a more subtle source of coercion.
From both these arguments, then, it can be seen that attention to relationship is particularly important when considering general practice ethics. It could be argued, therefore, that general practice has a particular duty of fostering the autonomy of the patient and that a GP's actions should be evaluated in the light of this duty. Sexual misconduct with a former patient does not, by any established evidence, foster patient autonomy, and a doctor participating in such a relationship is thus breaching this duty.
Conclusion It would be the minority of consultations, especially in general practice, where the above conditions of persistent transference and power imbalance did not exist.
Certainly the onus of proof, in any disciplinary hearing, would lie with the doctor to demonstrate how these ethical issues were of minimal impact in the subsequent sexualized relationship. Only in situations where there was a minimal potential for transference—counter-transference to arise, together with an unusual equality of power, could the former patient be in a position to exercise true autonomy and choice when entering into a sexualized relationship with the doctor.
In general, the criteria by which the New Zealand Medical Council will judge the ethical acceptability of sexual relationships with former patients 7 appear to be necessary, but not sufficient. They have correctly identified several situations where the likelihood of significant and persistent transference—counter-transference, and the perpetuation of a significant power imbalance in the relationship, is very high.
However, other situations may well occur which fall beyond these criteria but nevertheless have a similar degree of transference—counter-transference and residual power imbalance so that a sexualized relationship is equally as abusive as the listed criteria.
It is these underlying factors, rather than any more superficial descriptors, by which the ethical acceptability should be judged. Adherence management coaching becomes necessary to provide positive reinforcement of unpleasant options.
For example, according to a Scottish study,  patients want to be addressed by their first name more often than is currently the case.
Fixing the Doctor-Patient Relationship
In this study, most of the patients either liked or did not mind being called by their first names. Only 77 individuals disliked being called by their first name, most of whom were aged over Generally, the doctor—patient relationship is facilitated by continuity of care in regard to attending personnel.
Special strategies of integrated care may be required where multiple health care providers are involved, including horizontal integration linking similar levels of care, e. In most scenarios, a doctor will walk into the room in which the patient is being held and will ask a variety of questions involving the patient's history, examination, and diagnosis.
This can go a long way into impacting the future of the relationship throughout the patient's care. All speech acts between individuals seek to accomplish the same goal, sharing and exchanging information and meeting each participants conversational goals.
A question that comes to mind considering this is if interruptions hinder or improve the condition of the patient. Constant interruptions from the patient whilst the doctor is discussing treatment options and diagnoses can be detrimental or lead to less effective efforts in patient treatment. This is extremely important to take note of as it is something that can be addressed in quite a simple manner.
This research conducted on doctor-patient interruptions also indicates that males are much more likely to interject out of turn in a conversation then women. These may provide psychological support for the patient, but in some cases it may compromise the doctor—patient confidentiality and inhibit the patient from disclosing uncomfortable or intimate subjects.
When visiting a health provider about sexual issues, having both partners of a couple present is often necessary, and is typically a good thing, but may also prevent the disclosure of certain subjects, and, according to one report, increases the stress level. Family members, in addition to the patient needing treatment may disagree on the treatment needing to be done. This can lead to tension and discomfort for the patient and the doctor, putting further strain on the relationship. Bedside manner[ edit ] The medical doctor, with a nurse by his side, is performing a blood test at a hospital in A good bedside manner is typically one that reassures and comforts the patient while remaining honest about a diagnosis.
Vocal tones, body languageopenness, presence, honesty, and concealment of attitude may all affect bedside manner. Poor bedside manner leaves the patient feeling unsatisfied, worried, frightened, or alone. Bedside manner becomes difficult when a healthcare professional must explain an unfavorable diagnosis to the patient, while keeping the patient from being alarmed.
Rita Charon launched the narrative medicine movement in with an article in the Journal of the American Medical Association. In the article she claimed that better understanding the patient's narrative could lead to better medical care. First, patients want their providers to provide reassurance. Third, patients want to see their lab results and for the doctor to explain what they mean. Fourth, patients simply do not want to feel judged by their providers. And fifth, patients want to be participants in medical decision-making; they want providers to ask them what they want.
Please help improve this article by adding citations to reliable sources. July Learn how and when to remove this template message Dr. Gregory House of the show House has an acerbic, insensitive bedside manner. However, this is an extension of his normal personality.
Impact of the Doctor-Patient Relationship
In Grey's AnatomyDr. George O'Malley 's ability to care for Dr. Bailey's baby by saying "it speaks to a good bedside manner. In LostHurley tells Jack Shephard that his bedside manner "sucks". Later in the episode, Jack is told by his father to put more hope into his sayings, which he does when operating on his future wife.
The comments continue in other episodes of the series with Benjamin Linus sarcastically telling Jack that his "bedside manner leaves something to be desired" after Jack gives him a harsh negative diagnosis.Men and the doctor-patient relationship
In CloserLarry, the physician tells Anna when they first meet that he is famed for his bedside manner.