Doctor-Patient Relationship PDF

Doctor-Patient Dr Ahmed Elsheshai Relationship MD MRCPsych A consensual relationship in which the patient knowingly seeks the physician’s assistance and in which the physician knowingly accepts the person as a patient.  Healt h va...

Doctor-Patient Dr Ahmed Elsheshai Relationship MD MRCPsych A consensual relationship in which the patient knowingly seeks the physician’s assistance and in which the physician knowingly accepts the person as a patient.  Healt h value s Matter in question Patie nt value s Fundamentals of DPR Communication Empathy Trust Informed consent Professional boundaries  Deliberati Paternal ve 4 Models of DPR Informati Interpreti ve ve  An The radical intervention will allow him to return to field in “internation 1 year therefore missing a al whole seasons with his team. footballer” The alternative will allow him who makes to return to the field in 3 around months, but he has to take $500K/week intensive physiotherapy and in around 3 years he , sustains a probably will need knee knee injury. replacement. Paternalistic model (Authoritarian) Physicians use their skills to determine the diagnosis, required investigations, and best treatment. Then they will present the patient with selected information that will encourage the patients to consent to the doctors opinion. This model assumes that the criteria for decision making is shared between patient and physician. i.e. no personal issues or choices.  Physician act as guardian At the extreme, the physician only informs the patient when the intervention will be initiated. Usually only advocated in emergency situations and where patients are incapacitated (e.g. disoriented or severely psychotic patients). Deliberative model (Authoritative) Physicians recommend the course they see best and discuss with the patient why this course should be taken. The physician here should stick ONLY to health related values. i.e. values that affect or are affected by the patient’s disease or treatment. The patient feels empowered and safe in choosing a path that adheres to their health as well as life values.  Physicians act as “teachers” At the extreme, Physicians may engage with patients in “deliberation” of all available courses of action. E.g. Jehovah’s witnesses refuse blood transfusions, Muslims refuse wine as sleep aid, vegans may insist on a special diet, and someone may just value their temporary well-being over an extended life of sickness in refusing chemotherapy. Informative model (Consumer) The physician informs the patient of his/her disease state, the nature of possible therapeautic and diagnostic interventions, the nature and probability of risks and benefits associated with each intervention, and any uncertainties of knowledge. The patient selects the medical intervention he/she wants and the physician then proceeds to execute them.  Physicians act as information vendors or technical expert. At the extreme, patients could come to know all medical information relevant to their disease and available interventions that best relaize their values. Especially valuable in chronic conditions requiring continuous care such as DM and RA, also in elective and aesthetic procedures. Interpretive model (Advocate) Here the physician tries to clarify the patient’s values, describe available intervention options in light of patient’s values, and help patients decide the best option that fits their values  Physician act as counselor At the extreme, the physician will form a full picture of the patient’s life as a narrative whole and from this specify the patient’s values and what is best done to help. Examples where this model is especially effective include lifestyle medicine, dietary medicine, sport medicine, and addiction medicine.  Paternalistic Deliberative Informative Interpretive Patient values Only concern is Open to Defined fixed and Require health, shared by development and known to the clarification and physician & revision patient. agreement patient Physician’s Patient well-being Persuading the Provide factual Clarify patient’s obligation independent of patient of the best information… personal values… their prefernece path… and implement and implement and implement their choice. patient’s choice. their choice. Autonomy Assenting to Developed through Control over Developed through objective health understanding of medical care understanding of values health values own values Physician role Guardian Teacher or friend Technical expert Counselor or advisor  Physicians who communicate well and treat patients with chronic illnesses fairly improve the patient’s ability to manage their disease independently with adherence to the advice of Impact of DPR doctors. For example, patients monitor their blood pressure and adhere to medical regimens as per the advice of the doctor to manage health disorders such as hypertension and diabetes.  An The radical intervention will “internation allow him to return to field in 1 year therefore missing a al whole seasons with his team. footballer” The alternative will allow him who makes to return to the field in 3 around months, but he has to take intensive physiotherapy and $500K/week in around 3 years he , sustains a probably will need knee knee injury. replacement.  Who would act in a paternalistic model? Who would act as a deliberative Brain-storm physician? Who would assume the informative model? Who may be the Interpretive doctor in this situation? Insuran Team ce doctor doctor Salah’s Private friend doctor Thank you