The doctor-patient relationship: toward a conceptual re-examination
The physician-patient relationship involves both ethical and psychological aspects. More recent theories on medical relationships underline the importance of. from behavioural sciences, including medical sociology and psychology that This chapter reviews the literature on the theory of doctor-patient relationship. Mary Ainsworth, Attachment theory is an doctor–patient relationship is likely to be problematic.2 towards a theory of human relationships in medical practice.
Furthermore, there are ethical concerns regarding the use of placebo. Does giving a sugar pill lead to an undermining of trust between doctor and patient? Is deceiving a patient for his or her own good compatible with a respectful and consent-based doctor—patient relationship? 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 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.
[The doctor-patient relationship: new psychological models].
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. 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 Doctor-patient relationship, Philosophy, Psychology, Sociology, Orbital parameters Introduction The doctor-patient relationship plays an essential role in ordering the health care system and medical ethics, and since it is a form of communication, it necessitates ethical, philosophical, psychological, and sociological considerations.
The present paper aims to evaluate the essence of the doctor-patient relationship in order to re-examine its conceptual framework.
In the first part, the philosophical, psychological and sociological significance of this relationship is explored, and in the final section, the theoretical implications will be discussed. Simultaneous consideration of sociological, psychological and philosophical dimensions of the doctor-patient relationship can contribute to developing theoretical foundations and multidisciplinary bases for establishing practical ethical codes. The result will eventually be a more effective interaction between the two.
A The Philosophical Essence of the Doctor-Patient Relationship In investigating the philosophical essence of the doctor-patient relationship, three points should be taken into consideration. First, ethical demands in doctor-patient interactions must have distinct definitions and terms; second, the phenomenological ethical debates on this issue need to be explored; and third, modern topics in the philosophy of the relationship should be considered, and relationships with the others should be analyzed from different perspectives.
Ethical Demands Various organizations and professions differ in their attitudes towards ethical demands, recommendations, norms, values and judgments. The three components of inclusion, priority and severity are presented below as the criteria for judgment in ethical issues. The main questions to answer in regard to this component are: This important matter is embedded within the principles of beneficence and non-maleficence.
The component of priority relies on the answers to the following questions: Should we always take the ethical side and forget about our personal interests? Or personal interests could have priority over moral obligations?
The main questions here are: Can ethics press extreme and costly demands from us? Or are the obligations of morality lighter and easier in the way that most people could overcome? Based on the above-mentioned considerations and classifications, three macro-positions emerge in the ethical relationship, including: Maximal ethics include all the three components discussed above. In this type of ethics, ethical inclusion does not have any limits and covers all human actions.
Extremist moralities consider ethical inclusion to be an absolute matter that covers all life styles and signify that no human action should be outside of this infinite circle. Here what ethics demands from us are boundaries. In other words, moderate ethics often state that after performing our obligations and moral duties, in a relatively wild range of personal interests we can start selecting.
Thus, our actions are not always subject to moral judgment. This type of ethics is contradicted with maximal ethics. According to minimalists, the only forbidden action is intentional harassment.
Followers of minimal ethics believe in a wide range of choices and selection areas; they recognize only a limited range of constraints and are in favor of acting upon personal interests 3. It is a growing concern in medical ethics that the doctor-patient relationship is not approached in a sufficiently broad way and that this overly narrow medical perspective leaves doctors, nurses and other health care professionals badly equipped to deal with ethical dilemmas 4.
Phenomenology could broaden this perspective and serve as a strong basis to understand moral sensitivity. Two notions in phenomenology have a central role in understanding the concept of the doctor-patient relationship: Intentionality and first-person point of view One of the basic concepts of phenomenology is attainment of phenomenal intentionality, which occurs when a person recognizes earlier assumptions and adopts a perspective 5.
Some thinkers like Franz Brentano believe that intentionality and the phenomenological approach can be applied to the first-person point of view 6. For instance the first sighting of a beautiful landscape elevates us in a way that may not happen in later encounters. The reason is that later encounters are accompanied by presuppositions of the observer, who will be more used to the landscape. It seems that the phenomenological approach can be applied to the doctor-patient relationship.
Doctors must reexamine and restrict assumptions toward patients, and at the same time value intentionality in order not to fall into habits.
Moral Sensitivity Moral sensitivity may be enhanced in two ways. First, through reinforcing the phenomenological approach by renewing the first sight experience, that is, in each re-identification of the patient for instancepriorities should be observed. Second, since any situation could come to a fork and ethical conflicts may rise, the adverse impacts should be considered and every situation must be regarded from an ethical perspective.
Although at commencement moral sensitivity appears to overlap with maximal ethics, it is of particular importance especially in heterogeneous communications such as the doctor-patient relationship. It may be added that enhancing moral sensitivity even seems to be the target of the phenomenology of ethics in the doctor-patient relationship 7. B The Psychological Essence of The Doctor-Patient Relationship In terms of psychology, the doctor-patient relationship is imbalanced as the doctor has superiority over the patient.
- Doctor–patient relationship
- [The doctor-patient relationship: new psychological models].
- The doctor-patient relationship: toward a conceptual re-examination
Such imbalanced relationships may give rise to various patterns of communication behavior. Psychologists 8 have distinguished the following four communication behavior patterns based on components such as honesty, perspicuity, respect and inhibition: They are also afraid of being judged or offending others, so they are incapable of making eye contact while speaking.
Their voices are weak and unsteady, and they speak hesitantly. Submissive people avoid conflict rather than try to resolve it. They speak indirectly and in general terms because they cannot express themselves openly and may quickly feel depressed and vulnerable.
There was a problem providing the content you requested
People with this behavioral pattern admittedly let others abuse them and treat them disrespectfully. These patterns work both for doctors and patients. Accordingly, they try to deceive others and take advantage. Domineering persons do not have the perspicuity and honesty necessary for earning their wishes.
They express themselves in general terms and sometimes their voices shake. This behavioral pattern is often seen in doctors and sometimes among patients as well. Doctors who prefer patient satisfaction to authority thus create a false autonomy for the patients and will eventually be dominated by them, and patients with this behavioral pattern impair the healing process by inhibition and deception. Their difference is that a domineering person achieves this aim by secrecy and cheating, while an aggressive person follows it frankly and openly.
Unlike the domineering type, aggressive people are honest and straightforward; they are horrible listeners, always accuse others, get angry soon, get confused by criticism, and are usually grim in appearance. They have loud voices and look hostile, and in conflicts, they tend to destroy their opponents.
This pattern is seen among both physicians and patients. Impatient physicians that do not listen, shout all the time and sometimes make irreparable mistakes during the healing process, or patients with lower anger thresholds who create tension in medical environments belong in the category of aggressive people.
Assertive people respect themselves and others, and observe the authority of all sides. They are both honest and frank, and do not accuse themselves or others. Their approach to matters is problem-oriented, that is, when dealing with a problem, instead of accusing themselves and others, they think of a solution. They listen effectively and speak appropriately and understandably. During conflict they emphasize conversation.
Their arguments are clear, specified, objective, fair and respectful, and eventually they are the most successful communicators. Issues such as breaking bad news, wasted treatments and medical mistakes are easy and solvable with this type of behavioral pattern. While submissiveness, dominance and aggression lead to lose-lose situations in long term, assertiveness, is a helpful behavioral pattern and finally results in win-win solutions 9.
Based on the above-mentioned notions, the following practical hints should be outlined: An important topic in aesthetics and artistic criticism that is also related to ethics is psychic distance. In aesthetics, this refers to the distance that should exist between a work of art and the viewer, so that aesthetic entente is created and art is not confused with reality. Omitting the psychic distance and forming deep sympathy and psychological identification with the work of art obstructs artistic judgment and aesthetic approach.