Podcast
Questions and Answers
In the 18th century, what was a characteristic of bedside medicine?
In the 18th century, what was a characteristic of bedside medicine?
What was a consequence of the growth of hospital-based care in the 19th century?
What was a consequence of the growth of hospital-based care in the 19th century?
What is a key feature of patient-centered care that emerged in the 1970s?
What is a key feature of patient-centered care that emerged in the 1970s?
How did the shift to hospital-based care in the 19th century affect the doctor-patient relationship?
How did the shift to hospital-based care in the 19th century affect the doctor-patient relationship?
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What was the primary focus of bedside medicine in the 18th century?
What was the primary focus of bedside medicine in the 18th century?
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What was a historical evolution in the doctor-patient relationship in the UK/West?
What was a historical evolution in the doctor-patient relationship in the UK/West?
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What concept is used to describe medical consultations according to Strong (1988)?
What concept is used to describe medical consultations according to Strong (1988)?
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What influences the particular nature of a ceremonial order in medical consultations?
What influences the particular nature of a ceremonial order in medical consultations?
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What is a characteristic of a 'private format' in medical consultations?
What is a characteristic of a 'private format' in medical consultations?
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What is associated with the 'bureaucratic format' in medical consultations?
What is associated with the 'bureaucratic format' in medical consultations?
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What is the context of the 'private format' in medical consultations?
What is the context of the 'private format' in medical consultations?
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What is implied by the concept of the 'expert patient'?
What is implied by the concept of the 'expert patient'?
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What is the relationship between ceremonial orders and macro structures?
What is the relationship between ceremonial orders and macro structures?
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What is the concept that describes the tacit or implicit rules that structure and regulate interaction in medical consultations?
What is the concept that describes the tacit or implicit rules that structure and regulate interaction in medical consultations?
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What is the primary characteristic of the 'paternalism' model in a doctor-patient relationship?
What is the primary characteristic of the 'paternalism' model in a doctor-patient relationship?
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Which model of doctor-patient relationship is most likely to involve the patient in decision making and recognizing their personal experience?
Which model of doctor-patient relationship is most likely to involve the patient in decision making and recognizing their personal experience?
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In which model of doctor-patient relationship is the patient most likely to be seen as an object with a disease?
In which model of doctor-patient relationship is the patient most likely to be seen as an object with a disease?
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What is the main difference between the 'paternalism' and 'doctor as agent' models of doctor-patient relationship?
What is the main difference between the 'paternalism' and 'doctor as agent' models of doctor-patient relationship?
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In which scenario is the 'paternalism' model of doctor-patient relationship most useful?
In which scenario is the 'paternalism' model of doctor-patient relationship most useful?
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What is the primary goal of the 'consumerism' model of doctor-patient relationship?
What is the primary goal of the 'consumerism' model of doctor-patient relationship?
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Which model of doctor-patient relationship is most likely to involve a biomedical focus?
Which model of doctor-patient relationship is most likely to involve a biomedical focus?
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In which model of doctor-patient relationship is the patient most likely to be seen as an individual with biopsychosocial needs?
In which model of doctor-patient relationship is the patient most likely to be seen as an individual with biopsychosocial needs?
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What is the underlying assumption of the 'logic of care' approach in healthcare?
What is the underlying assumption of the 'logic of care' approach in healthcare?
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What is the primary goal of the 'war on drugs' discourse in the context of healthcare?
What is the primary goal of the 'war on drugs' discourse in the context of healthcare?
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What is the primary critique of the 'choice' paradigm in healthcare?
What is the primary critique of the 'choice' paradigm in healthcare?
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According to the content, what is the primary goal of opioid substitution therapy in the context of healthcare?
According to the content, what is the primary goal of opioid substitution therapy in the context of healthcare?
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What is the primary difference between the 'paternalism' and 'mutuality' approaches to doctor-patient relationships?
What is the primary difference between the 'paternalism' and 'mutuality' approaches to doctor-patient relationships?
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What is the primary influence on how doctor-patient relationships are organized, according to the content?
What is the primary influence on how doctor-patient relationships are organized, according to the content?
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Study Notes
Doctor-Patient Relationships
- Historical evolution of patient and professional relationships in the UK/West:
- 18th century: Bedside medicine (person-oriented, reliant on patient reporting of experience, personal rapport, and relationships)
- 19th century: Hospital and laboratory medicine (pathology reduced reliance on patient experience, growth of hospital as a focus for care, distance between patient and doctor)
- 1970s: Patient centred care (biopsychosocial perspective, relationship as a therapeutic alliance)
Models of Doctor-Patient Relationships
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- Paternalism: high doctor control, low patient control, biomedical disease model, closed questions, doctor chooses treatment
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- Doctor as agent: high doctor control, low patient control, decision making stays with the doctor, informed by knowledge of patients' preferences and life world
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- Consumer: low doctor control, high patient control, information flow from doctor to patient, patient makes informed decisions
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- Partnership: high doctor and high patient control, recognising patient experience, sharing control and decision making, addressing biopsychosocial needs
Patient and Doctor Relationships in their Social Context
- General practice: minor courtesies and macro structures (e.g. policy, resources, culture) shape conduct in a consultation
- Ceremonial orders: tacit or implicit rules that structure and regulate interaction in a consultation, linked to macro structures
- Different rules of interaction depending on the context:
- Private formats (typical in fee-paying healthcare, USA): polite conduct, doctor's reliance on patient for salary, patients allowed to criticise other doctors
- Bureaucratic format (typical of the NHS, UK): doctor controls the encounter more, no effort to explain or demonstrate expertise, patients not entitled to question a doctor's skill or 'shop around'
Empowerment and Choice in Healthcare
- 'Choice' as a celebrated ideal (Western norms of autonomy, individualism) but 'choice' is not how care happens: patients are active, but in interaction with providers, decisions made over time through social networks and interactions
- Logic of care: care as emergent, dynamic, attentive, involving experimentation
- Opioid Substitution Therapy: health care as discipline, seeking 'moral' discipline in people dependent on heroin, daily attendance and not using other drugs as a way to control and shape behaviour
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Description
Explore the changing dynamics of doctor-patient relationships in the UK/West from the 18th century to the 1970s. Learn about the shift from bedside medicine to patient-centered care.
