Doctor–patient relationship - Wikipedia
The doctor-patient relationship has undergone a transition throughout the ages. the patient's eyes” [McWhinney I. The need for a transformed clinical method. Editor's note: Dr. Pellegrini presented the John J. Conley Ethics and Philosophy Lecture at Clinical Congress in Washington, DC. Effective doctor-patient communication is a central clinical function in building a therapeutic doctor-patient relationship, which is the heart and art of medicine.
In fact, most empirical studies examining the effect of the patient-clinician relationship on medical outcomes have been observational in nature  and therefore cannot assess causality. Nevertheless, these observational studies do suggest that relationship factors may hold important potential to affect health outcomes.
The patient-clinician relationship has both emotional and informational components — what Di Blasi and colleagues have termed emotional care and cognitive care . Emotional care includes mutual trust, empathy, respect, genuineness, acceptance and warmth . Cognitive care includes information gathering, sharing medical information, patient education, and expectation management.
Initially, our primary aim was to investigate the emotional component of the patient-clinician relationship. However, most studies of the patient-clinician relationship include both cognitive and emotional care, and consequently, we expanded our focus to include these studies also. We note, however, that studies that do not separately measure emotional care while investigating communication interventions leave unclear which factor — emotional care or cognitive care — is responsible for any beneficial effects.
We also note that the boundary between cognitive care such as communications training and emotional care that enhances the patient-clinician relationship is unclear.
For example, communications interventions often train clinicians to ask more open-ended questions, to resist interrupting patients, to identify and respond to patient expectations and fears, and to check patients' understanding of the diagnosis and recommended treatment.
While these techniques are intended to improve the quality of information exchange, they are also likely to produce richer interpersonal interactions.
Indeed, any intervention designed to improve communication — if effectively employed — is also likely to improve the quality of the interpersonal relationship.
Previous reviews have attempted to estimate the magnitude of the effect of relational factors on health outcomes and to discern the relative impact of discrete interventions and contextual factors . Since the last review was published almost a decade ago, and in response to enormous changes in conceptual thinking about how best to restructure the delivery of healthcare services, we undertook an updated systematic review and meta-analysis examining whether the patient-clinician relationship has a beneficial effect on healthcare outcomes.
In contrast to previous reviews, we included in our review only randomized controlled trials RCTs that had either objective or validated subjective medical outcomes; and we excluded studies that only examined intermediate outcomes such as patient satisfaction or comprehension of medical advice. Therefore, the current review focuses on the most rigorous sources of evidence to determine whether the relationship between patient and clinician can produce improvements in health.
We report here on the thirteen studies that met our selection criteria for study design and methods.
The exact electronic search strategy and a full description are provided in File S1. Briefly, the electronic search strategy required that articles: 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.
Doctor-Patient Communication: A Review
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.
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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.
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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