Doctor–patient relationship - Wikipedia
American Society of Law, Medicine & Ethics · Impact Factor The Impact of Web on the Doctor-Patient Relationship. Show all authors. Bernard Lo. The breakdown of conducive doctor–patient relationships, due to any reason . when I was privileged to deliver a talk on “Ethics of medical practice: at the third AnnPediatrCard_pdf – accessed 09 June the ethics of such a relationship between a doctor and former patient. in the original doctor–patient relationship and the ethical implications that arise from .. rhein-main-verzeichnis.info%20on%20sexual%rhein-main-verzeichnis.info
The onus of responsibility for this last task falls on the person who has the most power in the relationship which, as I will argue, is always the doctor. To explain why this is always the case, even with former patients, it is useful to consider the sources of medical power in light of a framework suggested by family practitioner and ethicist, Howard Brody.
New Code of Ethics for doctors | Australian Medical Association
In his book The Healer's Power, 20 Brody outlines three sources of medical power: Aesculapian, Charismatic and Social. It has also been suggested that another source of power —Hierarchical power, the power inherent by one's position in a medical hierarchy e.
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Although it does not involve the sexualization of the doctor—patient relationship, it clearly illustrates the importance of recognizing all four types of power, and, in particular, the prominence of Hierarchical power: A consultant specialist was admitted to hospital with a severe multi-system disease causing severe renal impairment. After 6 weeks in hospital, on the day of his planned discharge, he was accidentally given another patient's medication.
Instead of receiving his azathioprine and corticosteroids, he was given a high dose of frusemide and captopril. Simply by the sheer nature of taking on the role of patient, regardless of any other type of power, there is always an unequal power differential between the doctor and patient. This applies in both general practice and hospital-based medicine, although it may be accentuated by the latter's institutional culture.
However, there is also the question of whether this type of power would be accentuated further in a fee-for-service situation, as exists in general practice in Australasia, as opposed to free public hospital treatment.
This differential is exacerbated further by any imbalances arising from the other three sources of power. Charismatic power may not always be less on the patient's side depending on the personalities of patient and doctor.
Equally, Social power may vary in doctor— patient relationships depending on the social status of the individuals. This may also relate to the gender roles of the patient and doctor.
New Code of Ethics for doctors
The large majority of cases of sexualization occur between female patients and male doctors. Therefore, the onus of responsibility for controlling the power imbalance in an ethically correct manner is always on the doctor. However, what is the relevance of this analysis to relationships with former, not current patients? Several points can be made. Information gained in such a power imbalance can be artificially intimate—one does not normally begin to discuss details of sexual function within a few minutes of meeting a stranger, for example, but this frequently happens in general practice consultations.
Secondly, given the strength of Hierarchical power in determining one's overall power in the doctor—patient relationship as illustrated by the case historyit is hard to see how a relationship of equals could develop from such unequal beginnings.
Autonomous choice and consent How should a claim be judged that a former patient gave his or her free consent before entering into the relationship? The validity of consent of a former patient, as opposed to a current one, is a little more debated, but evidence is against that being a former patient materially alters the situation.
Transferences can persist indefinitely and with it the perpetuation of the potential or real incompetence of the patient to recognize these feelings for their true nature and the same for doctors with respect to counter-transference: Zelas is a little less prohibitive. Meaningful consent to a sexualized relationship cannot be given in a situation of unequal power: Traditional teaching of informed consent emphasizes the importance of autonomous choice, i.
Leaving aside the provision of information presumably such information should include a review of the current known research in this area, although this apparently rarely, if ever, happens 12this discussion will concentrate on coercion and impaired capacity. Coercion can arise from imposed restraints on any or all of three types of autonomy: However, an alternative definition of autonomy which centres upon the importance of one's social relationships demonstrates a more subtle source of coercion.
From both these arguments, then, it can be seen that attention to relationship is particularly important when considering general practice ethics. It could be argued, therefore, that general practice has a particular duty of fostering the autonomy of the patient and that a GP's actions should be evaluated in the light of this duty.
Sexual misconduct with a former patient does not, by any established evidence, foster patient autonomy, and a doctor participating in such a relationship is thus breaching this duty.
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.
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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.Debate "Deteriorating Doctor Patient Relationship; Is it due to fall in Ethics"
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. 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 A good bedside manner is typically one that reassures and comforts the patient while remaining honest about a diagnosis.
Vocal tones, body languageopenness, presence, honesty, and concealment of attitude may all affect bedside manner. Poor bedside manner leaves the patient feeling unsatisfied, worried, frightened, or alone. Bedside manner becomes difficult when a healthcare professional must explain an unfavorable diagnosis to the patient, while keeping the patient from being alarmed.