[The doctor-patient relationship in history].
The doctor-patient relationship in its historical context depends on the medical. (or psychiatric) situation and the social scene. By medical situation is meant. The idealized vision of the physician-patient relationship was characterized by Throughout history, physicians have been socially respected not only for their. An Sist Sanit Navar. ;29 Suppl [The doctor-patient relationship in history]. [Article in Spanish]. Lázaro J(1), Gracia D. Author information.
While males speak with a higher, stronger, tone of voice, dominating and competitive, interrupting others, communication from women is more emotional, subjective, and cordial, showing more commitment with the sentiments of others 17 ; additionally, the verbal conducts of women are reflected in the non-verbal communication. There is evidence revealing that female medical professionals for the most part express and interpret emotions through non-verbal clues, more precisely than males 14for example through a smile 18although there are exceptions.
But gender is not the only aspect influencing the physician-patient relationship. It is clear that technological progress in medicine and telecommunications have notably influenced said relationship; thus, for example, the use of computers in the medical consultation drastically changed the physician's communication and personal treatment toward the patient. Using computers in the practice of general medicine began in the United Kingdom inand by there were medical offices in the country with computers mediating in the medical practice Using computers facilitates patient registration, relocations, screenings, repetition of prescriptions, and notations related with each case, as well as decisions on support aids, quick and opportune preventive measures, use of treatment protocols registered in the healthcare system Additionally, in some countries, physicians can enter the diagnosis and the computer suggests different standardized prescriptions, in the presence of the patient; also, recording the medical information in electronic files offers greater space than the traditionally used paper files Besides, it is known that because of globalization of information, currently, patients are more informed each day about their health problems, which sometimes generates complications in the communication, given that having information available is not equal to having the criterion to understanding it, and the erroneous interpretations are numerous It has been postulated that there are five fundamental factors influencing the relationship, namely: For other authors, the factors influencing on the physician-patient relationship are the appearance of a new morbidity, with predominance of chronic disease over acute disease; the appearance of sequelae of previously incurable disease; the indubitable determination of the health condition as a function of socio-environmental conditions; and the globalization of information that has narrowed the asymmetry of knowledge between patients and physicians Physicians' employers, pharmaceutical companies, and insurance companies have entered the once private relationship: This relationship has become a simple encounter rather than a relationship Substituting the generic terms of physician and patient for healthcare provider and client 30reflects the growing impersonality of the encounter and reveals the commercialization of medicine The idealized vision of this relationship characterized by the patient's trust and the availability of the physician was a long-term relationship in which physicians were aware of everything related to their patients and their families and were part of the patient's community This conceptualization also received the cultural values, which physicians and patients contributed to the relationship and to the role played by the medical team and the patient's family In spite of the asymmetry in this relationship, the difference in the balance of power was not seen as an impediment in the quality of healthcare and the physician's authority was understood as a comprehensive part of the relationship, without considering that the physician could abuse of such But during the s, it was postulated that the relationship was beginning to change This metaphor was based on the palpable status gain by the patient, on the criticism against the power of physicians, which generated medical consumerism, where patients could challenge their physicians after acquiring the necessary knowledge to make decisions based on awareness concerning the therapeutic options Movements offrustrated consumers were organized, regarding patient care and the rights of patients and women's healthcare were enacted 42 The courts took sides in the physician-patient relationship, guaranteeing the recognition of the rights and emphasizing on the obligations of physicians of providing relevant information 39the decisions of physicians began being influenced by the reactions, needs, and desires of the patients 30 and decision making was no longer unilateral, profiling the embodiment of healthcare based on the conception of seeing the patient as a consumer After understanding healthcare as a commodity, healthcare could not break away from analysis of costs; thereby, needing executive experts in providing medical care.
As if this were not enough -within a commercial savings strategy- administrators also expect physicians to work as experts in areas where they are not, given that they must often assume the leading roles in healthcare providing institutions in specific areas of medicine without even being specialists.
All this gets complicated upon the possibility of the pharmaceutical companies selling medications to public without medical prescription, fusing self-diagnosis with self-medication as a base for self-care, without considering the physician in that process; something which is truly dangerous Finally, and with the passage of time, it opts for the welfare of the patients, this being a mutual relationship where both have benefited.
Mass information technologies have led to greater numbers of patients exercising self-diagnosis and to physicians being permanently questioned and even brought tojustice; this is detrimental for the trust physicians and patients once had on each other.
Technological progress serving medicine has generated a more efficient medical practice, when trying to overcome disease, but it makes physicians perform in routine manner. Management of medical services by third parties, pressure from the pharmaceutical industry and medical insurance companies lead to the work of the physician to being questioned, intervened, limited, and poorly paid; all this bringing as a consequence a medical exercise that is conditioned to mercantilist forces, excessive savings, and increased revenues and profits for healthcare administrators.
Because of the aforementioned, the physician-patient relationship has ruptured going on to be merely a moment in which physicians quickly gather and interpret data in impersonalized manner, without assigning the necessary importance to the humanist treatment and care patients should receive. None of the authors has conflicts of interest related to this study.
Evolution and changes in the physician-patient relationship
A history of medicine. Hippocrates and the Hippocratic Collection. La medicina en la Edad Media latina. Historia universal de la medicina. Szasz T, Hollender M. A contribution to the philosophy of medicine: The disappearance of the sick-man from medical cosmology, Doctors and their patients.
The doctor, his patient and the illness. Roter DL, Frankel R. Quantitative and qualitative approaches to the evaluation of the medical dialogue.
Doctor–patient relationship - Wikipedia
The impact of feminization on general practice. Women's priorities regarding physician behavior and their preference for a female physician.
Improving communication in medical visits. Physician gender effects in medical communication: Are there too many female medical graduates? Gender differences in interaction: Canary DJ, Dindia K, eds. Sex differences and similarities in communication.
Lawrence Erbaum Associates; How big are nonverbal sex differences? The case of smiling and sensitivity to nonverbal clues. The ABC of medical computing: Privacy, confidentiality and electronic medical records.
J Am Med Inform Assoc. Reiffen B, Sherman H. The use of computers in ambulatory care: The battle for hearts and minds: The end of the golden age of doctoring. Int J Health Serv. Bring the sociological back. Studies of the provider-patient relationship: Continuity and change in health and medicine. University of London; Shared decision making[ edit ] Health advocacy messages such as this one encourage patients to talk with their doctors about their healthcare.
Shared decision making Shared decision making is the idea that as a patient gives informed consent to treatment, that patient also is given an opportunity to choose among the treatment options provided by the physician that is responsible for their healthcare. This means the doctor does not recommend what the patient should do, rather the patient's autonomy is respected and they choose what medical treatment they want to have done.
A practice which is an alternative to this is for the doctor to make a person's health decisions without considering that person's treatment goals or having that person's input into the decision-making process is grossly unethical and against the idea of personal autonomy and freedom. A majority of physicians employ a variation of this communication model to some degree, as it is only with this technique that a doctor can maintain the open cooperation of his or her patient.
This communication model places the physician in a position of omniscience and omnipotence over the patient and leaves little room for patient contribution to a treatment plan. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed.
June Learn how and when to remove this template message The physician may be viewed as superior to the patient simply because physicians tend to use big words and concepts to put him or herself in a position above the patient.
- [The doctor-patient relationship in history].
- The evolution of the doctor-patient relationship.
- Doctor–patient relationship
The physician—patient relationship is also complicated by the patient's suffering patient derives from the Latin patior, "suffer" and limited ability to relieve it on his or her own, potentially resulting in a state of desperation and dependency on the physician.
A physician should be aware of these disparities in order to establish a good rapport and optimize communication with the patient. Additionally, having a clear perception of these disparities can go a long way to helping the patient in the future treatment. It may be further beneficial for the doctor—patient relationship to have a form of shared care with patient empowerment to take a major degree of responsibility for her or his care.
Those who go to a doctor typically do not know exact medical reasons of why they are there, which is why they go to a doctor in the first place. An in depth discussion of lab results and the certainty that the patient can understand them may lead to the patient feeling reassured, and with that may bring positive outcomes in the physician-patient relationship. Benefiting or pleasing[ edit ] A dilemma may arise in situations where determining the most efficient treatment, or encountering avoidance of treatment, creates a disagreement between the physician and the patient, for any number of reasons.
In such cases, the physician needs strategies for presenting unfavorable treatment options or unwelcome information in a way that minimizes strain on the doctor—patient relationship while benefiting the patient's overall physical health and best interests.
When the patient either can not or will not do what the physician knows is the correct course of treatment, the patient becomes non-adherent. Adherence management coaching becomes necessary to provide positive reinforcement of unpleasant options.
There was a problem providing the content you requested
For example, according to a Scottish study,  patients want to be addressed by their first name more often than is currently the case. 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.