doctor patient relationship

what does doctor patient relationship refer to

• what can influence this

• the different ways HCP and lay ppl interact during a consultation

  • includes many factors like the context of consultation, communication styles that can influence type of relationship

how is the DP relationship changing over time: link to

• types of illnesses

• BSS model

• what type of approach

• culture

• acute infectious conditions to chronic illness

• biomedical context to biopsychosocial context

• symptom centred to patient centred approach

• cultural ignorance to cultural competence

name examples of communication issues in DP relationship

• who is making the decisions

• level of jargon used

• level of patient/family involvement

• breaking bad news

• managing difficult patients or situations

• dealing with non compliance

• language barriers

• cultural incompetence

what are the 5 types of DP relationships, BSS model

• P,M,D,C,C

• paternalistic

• mutualistic

• conflict

• default

• consumerist

paternalistic relationship

• what does this mean

• what type of communication style

• describe the control the doctor/patient has

• what type of centred approach is it

• disease is a biological problem with identifiable cause, doctor is expert and directs decision making

• prescriptive communication style, instructive (doctor knows best)

• low patient control, high doctor control

• doctor centred approach

name criticisms of the paternalistic style DP relationship

• effect on patient care

• when may it be appropriate

• what impact does it have on adherence

• overlooks patients own knowledge and experiences, poorer care

• in AnE

• lower adherence as they may not fully have agreed to this approach of care

conflict relationship

• what is this DP relationship characterised by

• what does ‘double bind‘ mean

• solutions to this

• characterised by a difference in perspectives due to different sociocultural worlds/expectations

• patients are expected to have enough knowledge to be able to judge when to seek care then give power to HCP

• sympathising, negotiation, understand what makes them resistant

default relationship

• describe the level of control the patient and doctors have

• what is there a lack of on both sides

• in what type of illnesses is this most prevelant in

• low patient and doctor control

• there is a lack of engagement on both sides and direction in consultation

• in long term conditions

consumerist relationship - informative

• describe the level of control doctors and patients have in this relationship

• what is there a greater level of in these types of consultations

• high patient control and low doctor control

• patients have a higher level of control of their health and greater participation in decision making

mutualistic relationship - negotiation

• what are the levels of control in this relationship

• what exists mutually

• what type of centred approach is this

• high doctor and patient control

• mutual respect as doctor acknowledges the patients beliefs/experiences as important

• shared decision making allows more patient centred consultation

give examples of how doctors decide/give information for each model

• paternalistic model

• deliberative model

• interpretative model

• informative model

• paternalistic model - doctor decides

• deliberative model - doctor tells their preferences

• interpretative model - doctor gives facts and helps patient find their preferences

• informative model - doctor gives facts

what must doctors do to have a good DP relationship

• take care of patient as main concern

• treat with patience, politeness

• respect patients dignity and privacy

• listen to patients views

• give understandable information to patients

• allow them to also be in charge of their care

• be honest and trustworthy

• do not prejudice

• respect confidentiality

patient centred care

• what is this

• what are the 5 dimensions of this approach

  • BSS

  • patients as person

  • doctor as person

  • sharing P/R

  • T alliance

• the patient is an equal partner in their care

  • biopsychosocial perspective

  • patient as person - understanding the personal meaning of the illness for them

  • doctor as person - awareness of the influence a doctor has

  • sharing power and responsibility

  • therapeutic alliance

what are benefits of patient centred medicine

• more information will be disclosed

• greater likelihood of clarification happening

• better concordance and adherence to treatment

• fewer re admissions

• increased satisfaction

what is the meaning model

• what sort of questions does this involve asking

• how does it state is the best way to treat patients

• what would you like for me to do today

• what do you think is causing the problem

• what is the best way so far for managing your problem

  • approach medical diagnosis and treatment through our relationship with patients rather than seeing the diagnosis/treatment separate from the patient

shared decision making SDM

• define

• it means patients and clinicians work together to make care decisions based on both clinical evidence and the patients values, beliefs and preferences

• its a collaborative process that involves clinicians expertise and patients experiences/preferences

how do you communicate risks, benefits and consequences

• using what type of figures

• using visuals

• options for what

• personalise

• using relevant information and figures like 1 in 100

• visual aids like charts, diagrams

• include the option to decline or continue treatment

• personalise information based on them

what should you bare in mind when discussing sensitive issues with patients

• ensuring confidentiality, dignity and privacy

• non judgement

• check readiness and ask for permission

• avoid jargon

• signpost

• offer choices

• be sensitive to cultures, gender, age

• document appropriately

can patients always be involved in SDM

• what may affect this 3

• state of their health

• complexity of the treatment

• cultural perceptions of medicine

SDM can be harder when the patient is faced with shocking or serious life-threatening diagnosis

barriers to shared decision making

• cultural barriers

• fear of legal implications

• lack of time, knowledge, understanding

• heirarchies

name some ways to improve DP relationship

• prepare with intention

• listen intently and completely

• agree on what matters most

• connect with the patients story

• explore emotional cues