The Doctor–Patient Relationship
Making Ethical Rules for the Doctor-Patient Relationship. Making . The sorts of ethical issues that emerge may be about patient competence, the sufficiency of. Oct 28, It forms the basis for the physician-patient relationship. In order for the (For further discussion of this issue, see Student Issues.) Many patients. In the context of the physician–patient relationship, a problems. Even if the business succeeds, the physician is no longer an impartial and objective person for.
Thus, a single organization may both provide and pay for care. Organizations as providers have duties such as competence, skill, and fidelity to sick members.
Organizations as payers have duties of stewardship and justice that can conflict with provider duties. Managed care organizations thus have conflicting roles and conflicting accountability.
An organization's accountability to its member population and to individual members has a series of inherent conflicts. Is the organization's primary accountability to its owners, to employer purchasers, to its population of members, or to individual, sick members?
Making Ethical Rules for the Doctor-Patient Relationship | Cancer Control
If these constituents somehow share the accountability, how are conflicting interests resolved or balanced? For example, the use of the primary care clinician to coordinate or restrain access to other services involves the primary care clinician in accountability for resource use as well as for care of individual patients.
Although unrestricted advocacy for all patients is never really achievable, the proper balance and the principles of balancing between accountability to individual patients, a population of patients, or an organization need to be made explicit and to be negotiated in new ways. All mechanisms for paying physicians, including fee-for-service reimbursement, create financial incentives to practice medicine in certain ways.
We still lack a calculus to minimize or even describe in fine detail how such conflicts affect our ability to justify trusting relationships. Even-handed social attention seems appropriate to all the different mechanisms of payment.
Balanced assessment of how the details of remuneration systems influence doctor's willingness to act on behalf of patients will best protect both the health of the public and the health of doctor—patient relationships. This is a priority for a new form of empirical, ethical research. Patients correctly wonder if doctors are caring for them, the plan, or their own jobs or incomes the latter is equally problematic in fee-for-service care.
This ambiguity erodes trust, promotes adversarial relationships, and inhibits patient—centered care. The recent controversy over gag rules has only confirmed this set of fears in the mind of the public which is now seeking regulation of the managed care industry through the political process.
As illustrated in Figure 1the interests of patients, plans, and doctors can overlap to a greater or lesser extent. Professional ethics dictate that physicians attempt, as individuals and as a profession, to ensure that their interests and those of their patients are congruent in clinical practice.
In this review of the current evidence, based on major articles listed in Medline and Bioethicsline in the past 15 years, the argument is made here that such relationships are almost always unethical due to the persistence of transference, the unequal power distribution in the original doctor—patient relationship and the ethical implications that arise from both these factors especially with respect to the patient's autonomy and ability to consent, even when a former patient.
Only in very particular circumstances could such relationships be ethically permissible. Sexualization of the doctor—patient relationship: Family Practice ; Introduction All codes of ethics set up by medical professional bodies prohibit sexual relationships between a doctor and a current patient.
Although this stance initially provoked a degree of controversy within the country, 2— 6 the deleterious effects of such relationships upon patients have become increasingly recognized and condemned by the medical community. However, some areas of debate do still remain. One such area is whether sexual relationships with former patients are ever ethically permissible and, if so, under what circumstances. First, the concepts of boundaries and transference are discussed and a profile of the medical practitioner at risk of offending is drawn.
Secondly, three aspects of the doctor—patient relationship are explored: Thirdly, a discussion of the role of autonomous choice and consent is presented. Boundaries and boundary violations Many boundaries exist in the doctor—patient relationship. These include boundaries of role, time, place and space, money, gifts and services, clothing, language and physical contact.
This does not mean that no such type of relationship may exist, but it has not been researched. This suggests that the overwhelming outcome for most, if not all, patients is negative.
However, the crossing of boundaries per se does not necessarily mean that an unethical act occurred: Nor do all boundary transgressions between doctor and patient ultimately lead to sexual misconduct. Clues as to what these other factors should be can be gleaned from examining the profiles of offending doctors. Profiles of doctors who violate boundaries A key factor in the identification of doctors at risk of violating boundaries is the enhanced vulnerability of a doctor to the transference—counter-transference dyad which occurs in varying degrees in every doctor—patient relationship.
Doctor–patient relationship - Wikipedia
Doctors can mistake the feelings of love that arise in a therapeutic relationship as being the same as love that arises elsewhere; it is not. Transferences per se, as with boundary crossings, also occur in normal love relationships, 12 and therefore are also a necessary but not sufficient condition for ethical unacceptability.
However, it is the existence and persistence of this type of transference, linked with the fiduciary relationship and unequal power structure, which makes most relationships with former patients ethically unacceptable see following sections.
In turn, to build such a relationship, the unequal power distribution between doctor and patient has to be acknowledged and contained in an ethically correct manner. Third, patients want to see their lab results and for the doctor to explain what they mean. Fourth, patients simply do not want to feel judged by their providers. And fifth, patients want to be participants in medical decision-making; they want providers to ask them what they want.
Please help improve this article by adding citations to reliable sources. July Learn how and when to remove this template message Dr. Gregory House of the show House has an acerbic, insensitive bedside manner. However, this is an extension of his normal personality. In Grey's AnatomyDr. George O'Malley 's ability to care for Dr. Bailey's baby by saying "it speaks to a good bedside manner. In LostHurley tells Jack Shephard that his bedside manner "sucks".
Later in the episode, Jack is told by his father to put more hope into his sayings, which he does when operating on his future wife. The comments continue in other episodes of the series with Benjamin Linus sarcastically telling Jack that his "bedside manner leaves something to be desired" after Jack gives him a harsh negative diagnosis. In CloserLarry, the physician tells Anna when they first meet that he is famed for his bedside manner.
In ScrubsJ. D is presented as an example of a physician with great bedside manner, while Elliot Reid is a physician with bad or non-existent bedside manner at first, until she evolves during her tenure at Sacred Heart. Cox is an interesting subversion, in that his manner is brash and undiplomatic while still inspiring patients to do their own best to aid in the healing process, akin to a drill sergeant.
This show also comically remarked that the most amount of time that a doctor needs to be in the presence of the patient before he finds out everything he needs to know is approximately 15 seconds. Voyagerthe Doctor often compliments himself on the charming bedside manner he developed with the help of Kes.
Hunnicuttand Sherman Potter all possess a caring and humorous bedside manner meant to help patients cope with traumatic injuries. Charles Winchester initially possesses no real bedside manner, acting with detached professionalism, until the rigors of his job help him develop a sense of compassion for his patients.
Frank Burns has a poor bedside manner, constantly minimizing the seriousness of his patients' injuries, accusing them of cowardice and goading them to return to the front lines. Patient behavior[ edit ] The behavior of the patient affects the doctor—patient relationship.
Rude or aggressive behavior from patients or their family members can also distract healthcare professionals and cause them to be less effective or to make mistakes during a medical procedure. When dealing with situations in any healthcare setting, there is stress on the medical staff to do their job effectively. Whilst many factors can affect how their job gets done, rude patients and unappealing attitudes can play a big role.