Experiences of a good doctor-patient relationship were associated with trust, This is especially the case for older people, who tend to have a. There is growing evidence that the outcomes of health care for seniors are dependent not only upon . The physician-patient relationship as a therapeutic agent. While not discounting the need to provide seniors with health In a paternalistic doctor–patient relationship, the doctor presents as a.
A patient female, 87 years old made such a comment: And then if I had any difficulties or questions, I … say: In the world of everyday matters affecting the patient, the interviewed patients almost exclusively wanted to make the decision alone: A clear reason for this was almost never provided. Most of the participants considered the rearrangement of their living environment to be a topic that did not fall within the scope of primary care.
Utilisation of Nursing Care Services Almost all patients wanted to make up their own mind in this decision-making scenario as well, even if they were forced into this decision by complex constraints.
This manifested itself specifically in the fear of not being able to cope with everyday life alone: At several points, the interviewees mentioned their concerns about losing their independence and thus not being able to make decisions themselves.
One patient female, 79 years old: This will be illustrated with one case example. In the fictitious decision-making scenarios different treatment options, taking an X-ray, intake of new medication, and utilisation of nursing care servicesit was the opinion of the patient female, 81 years old that the doctor should make the decision: This is because he must prescribe it and he suggests it. Thus, in some cases, older patients act more self-determinedly than they describe in hypothetical situations or than they would imagine themselves to.
Results Analysis Step 2: Patient Typology on Decision Making It became apparent that different patient types evolved not only because of the personal attitude towards participation but also in response to the relationship experienced in consultations and particularly in decision-making situations.
To illustrate the two derivations, two extreme examples are given. We had a good relationship. He once cleared my heel spur overnight. I phoned him and I was allowed to phone him anytime to say: First I had not believed that it worked. Trust evolved as a response to a good doctor-patient relationship, and it helped patients to be more relaxed with decisions and led to better adherence.
The patients often pointed out how doctors contribute to a good relationship: Hence it needs to be taken into account that the patient typology on decision making is often based on the two aspects, which are patients' personal attitudes and the context, in particular the experienced relationship with the doctor.
On the basis of the different dimensions self-determined decision making, adherence, trust, desire for informationeight different ideal types could be found with different degrees of preferences in the decision-making process: Overview of the patient types ideal typesclassified by the two main categories self-determination and adherence and the two additional categories trust and information-seeking behaviour.
Patients Make the Decisions Three ideal patient types can be defined for patients who would like to make the health care decisions themselves Figure 1.
Patient 26 reported that rheumatism had been misdiagnosed by a specialist.Doctor and Patient Relationship
For 14 years he took compromising medications. The advantages and disadvantages. At the same time, they actively inform themselves and discuss the matter critically with the doctors.
But then [I] have had dizziness, [I] measured the blood pressure … and it was low. I tell myself, I do not need to take the tablet against sugar. Then I stopped taking the tablet by myself. Patients in this group tend to feel that they are in a relationship of dependency on the doctor. Patient 13 recalled an incidence with a bleeding nipple.
After some tests her gynaecologist wanted to wait. She went for a second opinion and later returned postoperatively. When asked about shared decision making, she replied: The patient also actively opposes the medical advice and does not place trust in the doctor. It is me and of course the doctor, who decide. They want information from the doctor, but there is no active discussion or questioning of this information on the part of the patient. The patients place their trust in the doctor.
The Doctors Make the Decisions The following three ideal types of patients are of the opinion that the doctors should make the decisions. Patient 39 reflected on his information-seeking behaviour in connection with a prostate operation: No further information is desired by the patients. Most of the patients interviewed belong to the groups in which the doctor alone should make the medical decisions.
Complete trust is placed in him. Discussion In this study, patients were interviewed about their participation preferences in fictitious decision-making scenarios and their experiences in actual decision-making situations with their doctors. Overall, the results reinforce that, when asked about their preference for involvement, the group of older patients differs cf.
International Journal of Family Medicine
However, the results suggest that in tendency older patients are more likely to remain passive and let the doctor make the decisions. This tallies with an American study in which a typology is also developed Flynn et al. There the authors distinguish between autonomous patients and patients who would rather delegate the decision-making to the doctor.
A similar classification into passive and active patient behaviour in decision-making situations is found in Scheibler [ 28 ]. On the other hand, experiences of a good doctor-patient relationship facilitated a convinced doctor-trusting attitude. Our results clearly demonstrate that the desire for involvement in the decision-making process depends on the matter to be decided.
This is also described by Whitney et al. Our older patients show a lower involvement in medical decisions as compared to health-related everyday life decisions, which they tend to not share.
Planning and Companionship Can Help Seniors at the Doctor’s - Caregiver StressCaregiver Stress
A decision by the doctor that affects issues at home is connected to the risk of losing autonomy cf. It also seems unexpected since, according to patient opinion, the responsibility for such a decision lies on the patient. This is not the case with disease-related decisions. Our results reinforce those of an American study [ 30 ] which show that a forced involvement of the patient in disease-related decisions by the doctor can even lead to resistance on the part of the patient.
Our patient typology targets older patients and further differentiates existing typologies that represent all age groups. Beyond the distinction between active and passive patient types, our typology includes elements, such as adherence, trust, and information-seeking behaviour.
Using the developed classification grid in our study, we have found eight different patient types in relation to decision-making preferences and actual health care participation of older patients. It seems that little trust in doctors motivates patients to seek information outside the doctor-patient relationship and encourages opposition to medical advice.
Some of the patients state that they see themselves in a relationship of dependency on the doctor and have no alternative but to trust him, whereas others will happily and willingly trust their doctors cf.
Patients were chosen from nine practices, each recruiting four. Therefore results should not readily be generalized to practices in other regions. However, this study serves as a pilot into a differentiated ideal- patient typology. Statements concerning the frequency of these patient types in the elderly population cannot be made on the basis of the results of our study.
This is an area requiring further quantitative research. Time as an important factor in the often longitudinal decision-making processes has not been explored sufficiently here.
Age-Related Differences in Doctor-Patient Interaction and Patient Satisfaction
Further research is needed to determine its influence on decision-making types. However, we identified elements essential for decision-making process with older patients.
Firstly, self-determined patients tend to actively make health-related decisions.
We found that a motive can be either distrust in the context of bad experiences with doctors' decisions or a personal attitude independent of the specific doctor-patient relationship. Secondly, the less self-determined patients tend to rely on doctors making health-related decisions.
Trust evolves from experiences of a good doctor-patient relationship.
- Planning and Companionship Can Help Seniors at the Doctor’s
Our patients determined a relationship as positive, if they received personal attention and adequate information, truthfulness, empathy, and if they were able to look back at difficult situations that have been mastered together. Giving adequate information is of particular value not only for the doctor-patient relationship but also for decision-making situations [ 3435 ].
In practice information needs to be offered in such a way that patients can properly assess it and weigh it up. Social and structural factors need to be taken into account: Three barriers relevant to shared decision making were observed in this group of older patients: The second one is the assumption that for some older patients there is only a right decision and a wrong decision—weighing up and discussing different options represent a pattern of behaviour with which these older patients seem to be unfamiliar.
Finally, pending decisions in everyday life are not easily raised by the patient for fear of losing autonomy. It is apparent that, for one or more of the reasons mentioned previously, older patients sometimes neither desire nor regard shared decision making as possible. In this case, the doctor should be prepared to assess barriers, to reiterate information regarding alternatives, and to respect patient decisions even if the alternatives seem more promising.
This open-minded process enhances a trusting relationship, a requirement for such patient-centered care see [ 3637 ]. Successful communication continues to be the key to the realisation of a good doctor-patient relationship and to the design of medical care in line with patient needs [ 81438 ].
This requires extensive and practically oriented training for doctors. Get an examination the old-fashioned way. A thorough physical must include a thorough examination, no matter how uncomfortable, for early detection and prevention.
Find out about metabolic syndrome. Metabolic syndrome increases the risk of developing diabetes and cardiovascular disease and is easily diagnosed through a cholesterol or lipid profile, blood glucose sugarblood pressure readings and measurement of waist circumference. Metabolic syndrome is not routinely addressed by many doctors during a physical.
Take the initiative and ask if you should be assessed. Ask about screening for chronic diseases. Early detection leads to improved prognosis for many of the most common chronic diseases, such as heart disease, cancer and diabetes.
Talk to your doctor about a schedule of recommended preventive screenings.
Current Gerontology and Geriatrics Research
Tell your doctor about all the medicines you are already taking. This includes prescription medicines and the medicines you buy without a prescription, such as aspirin, laxatives, vitamin supplements, and home remedies. Tell your doctor what is important to you about your medicines. You may want a medicine with fewest side effects, or fewest doses to take each day. If you have trouble swallowing, you may want a liquid form of medicine.
You may care most about cost there may be a generic drug or another lower-cost medicine you can takeor you may want the medicine your doctor believes will work best.