Questions and Answers
In the 18th century, what was a characteristic of bedside medicine?
Personal rapport and relationships between doctor and patient
What was a consequence of the growth of hospital-based care in the 19th century?
Distance between patient and doctor
What is a key feature of patient-centered care that emerged in the 1970s?
Biopsychosocial perspective on patient care
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?
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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)?
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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?
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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?
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What is implied by the concept of the 'expert patient'?
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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?
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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?
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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?
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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?
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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?
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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?
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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?
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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?
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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?
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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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