DR PT Relat Flashcards
What is a DR PT relationship
refers to the way in which HCPs and LAy people intteract during a medical consultation
many factors such as the context and communication style of the the consultation influence the type of relationship
What things can affect the social context of consultation?
patient characterisitics (e.g knowledge, use of internet, pt gender SES education)
dr characterisitics (speiciality, gender)
culture clashes (dr vs pt health beliefs, biomedical vs. bps models)
Rise of CAM (trust in medical profession?)
Draw out the Models of DR Pt relationship (russell 2009)
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Describe Paternalistic relationship:
Father like
Instructive/Prescriptive
(Patient control low, Dr Control hi)
DR centred, responsible for decision making
Dr is the ‘expert’ follow biomedical model of disease
What are criticisms of paternalistic Dr pat relationship?
Patient is expected to be the passive recipient of care
May be appropriate in certain clinical contexts e.g. A&E and for some patients (differences between patients)
Overlooks the patient’s own knowledge and experiences
Can result in low patient satisfaction and complaints
May impact on adherence, disclosing of key information, understanding of information and on the therapeutic relationship
May lead to conflict if patient tries to take more control
What is conflict relationship?
Relationship characterised by conflict
Disagreement and difference in perspectives
Doctors and patients come from different social worlds
Patients want more information than the doctor is willing to give
Different expectations
What is Mutualistic relationship?
Patient and doctor control = high
Involves mutual respect where patient plays a more active role
Doctor acknowledges the patient’s beliefs, knowledge and experiences as important
The consultation is more patient-centred
Shared decision-making: both parties involved in decision-making
Follows a Biopsychsocial model.
What is pt centred care?
“The individual as an equal partner in their care (RCN”)
Five dimensions:
Biopsychosocial perspective
‘Patient-as-person’: understanding the personal meaning of the illness for each patient
‘Doctor-as-person’: awareness of the influence of the personal qualities and subjectivity of the doctor
Sharing power and responsibility
The therapeutic alliance
What is shared decision making?
Patients contribute their preferences, goals and values (which only they know about)
The clinician brings information about the condition and treatment options
Reflects a major shift in ideas about how patients should be involved in healthcare
What are the benefits of pt centred medicine?
More may be disclosed
Better handling of ‘ticket of entry’ consultations
Greater likelihood of clarification being sought
Better concordance, and therefore adherence to treatment
Fewer repeat consultations
Increased satisfaction
What is a default relationship?
Patient control = low
Doctor control = low
Lack of engagement on both sides e.g. doctor’s attempts to involve the patient in the consultation are unsuccessful
What is a consumerist relationship?
Patient control = high
Doctor control = low
Greater levels of patient choice
Patients becoming more active and demanding e.g. internet
Patients as consumers of health and health care
Increased choice, participation in decision-making – policy, design and provision of services
Nationally and internationally e.g. health tourism
Discuss two reasons why the nature of the doctor-patient relationship changed towards the end of the last century.
What are the main models of the doctor-patient relationship and how do they differ from one another?
What are some criticisms of the paternalistic style of doctor-patient relationship?
