It is often said that relationships between patients and doctors have changed dramatically over the last 50 years. In the s it would have been rare for a. The relationship between patients and doctors is at the core of medical ethics, serving as an anchor for many of the most important debates in the field. Over the . The doctor-patient relationship has undergone a transition throughout the ages. Prior to the last two decades, the relationship was predominantly between a.
Your doctor should take your complete history, ask you plenty of questions, and encourage you to talk openly and honestly about your situation. He should take his time, listening attentively to your concerns.
Most doctors are pressed for time today for a variety of reasons, but a doctor who rushes through your visit not only risks making uninformed decisions about your care and treatment, he or she also misses an opportunity to establish a meaningful relationship with you.
Doctor–patient relationship - Wikipedia
If you feel rushed, unheard, dismissed, confused, or unsure during your visit, calmly let your doctor know. Remember that your doctor is a trained professional who needs to know the whole picture in order to accurately diagnose and treat your condition.
Also, keep in mind that healthcare providers are only human—being rude or aggressive toward doctors, nurses, and other healthcare personnel is not only distracting and stressful for these caregivers, it can also lead to medical mistakes. As difficult as your situation may be, the age-old expression applies: This is called shared decision making.
If you feel like your doctor is pushing you into accepting a specific treatment plan, this is a warning sign. When it comes to decisions large and small about your healthcare, your doctor should be your partner in the decision-making process.
Yet, delivering such news can and should be done honestly and with empathy. A doctor who is cold, arrogant, impatient, rushed, or who otherwise demonstrates a poor bedside manner can quickly lose your trust and leave you feeling unsure, anxious, frightened, angry, and alone.
Perhaps he or she is very direct, talks faster than you can follow, or has a demeanor that makes you anxious or uncomfortable. Use your first visit as a test.
For example, a doctor may strongly encourage the use of a particular medication that has side effects a patient considers unacceptable. Or, because of religious beliefs, a patient may refuse a blood transfusion that could improve or prolong their life. As a patient, your doctor is ethically obligated to consider your wishes about your healthcare.
One or two lawsuits may not be cause for panic, but, if the physician or hospital has a history of lawsuits, this is a problem sign. Board certification through the American Board of Physician Specialties ABPS means the physician has earned a four-year medical degree from a qualified medical school, is licensed to practice medicine by a state medical board, has completed an accredited residency program of at least years, has passed exams administered by the ABPS, and participates in continuing education.
In particular, ask about drug reps and medical device manufacturers—who often influence doctors and physician practices to use particular drugs, often by wooing them with catered lunches and other perks.
If your doctor sends you home with a bag of drug samples, this is a telling sign.
Shared decision making
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.
The Importance of Healthy Doctor-Patient Relationships
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.
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.
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. 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.
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- The Importance of Healthy Doctor-Patient Relationships
- Doctor–patient relationship
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: