Doctor- Patient Relationship and Modern Medicine
CommunicationCommunication between two people is most likely to be successful when two conditions are present: One person is not more powerful than the other Both people have the same objective.
Communication
The doctor is likely to be in a more powerful position than the patient; having professional knowledge social status, and gate keepers such as receptionists and secretaries. The patient is the supplicant, may have waited a long time for the appointment, may feel humiliated by embarrassing confessions or undress and may be heavily out-numbered e.g. during a ward round.Communication
The patient will be concerned mainly with their own symptoms; and their perspective will be colored by the material, cultural and inter-personal context in which their symptoms have developed. The doctor will be concerned with their whole work load i.e. the present patient plus all other patients waiting to be seen; and their perspective will be colored by their professional training and socialization.Communication
In consequence, successful communication during a consultation can be difficult to achieve. Doctors need to understand these problems, because successful communication can influence their clinical effectiveness.Clinical effectivenessThe quality of communication between a doctor and patient influences the exchange of information between them and the patient’s satisfaction with the doctor; both can affect the doctor’s clinical effectivenessInformation exchange
Accuracy and completeness of the diagnosis. Physiological response to therapy Practicality of the treatment regimePatient Satisfaction
Effectiveness of therapy, e.g. placebo effectCompliance with medical advice e.g.30% of prescribed drugs are either not taken or taken incorrectly, non compliance with preventive advice is higher still.Future illness behavior and the doctor’s effectiveness as medical educator
Balance of power
Historically power has shifted between doctor and patient; as medicine becomes more specialized, shift of power toward doctor. However medical paternalism clashes with patient autonomy, therefore the power shift back towards patient.Factor affecting the balance of power between doctor and patient
Patient clinical status Unconscious or anaesthetized. Acutely ill. Managing a chronic disease. Healthy patient requesting assistance Each has a corresponding appropriate DPR: Activity-passivity/ paternalistic. Guidance-co-operation. Mutual participation.Factor affecting the balance of power between doctor and patient
Setting of the consultation Number of staff present Whether patient undressed or in bed. Patient alone Depends whether GP, Hospital, surgeon etc. Symbols of authority-white coat, stethoscope etc.Factor affecting the balance of power between doctor and patient
Social distance between doctor and patient Doctors are members of social class and the majority of consultations are with working class patients. Inverse care law: the lower class you are, the less time you get with GPFactor affecting the balance of power between doctor and patient
National health services Fee-paying patients often feel more confident; and doctors may be more concerned to remain of service to these patients. Negotiation Doctors have tended to prefer guidance-co-operation Paternalistic style. High level of physician control Doctor- centered Patients prefer mutual participationBoth doctors and patients have strategies for shifting the balance of power in the direction they desire. The doctor can indicate lack of time and emphasize greater knowledge. The patient may display emotion e.g. sob or cry; and make unfavorable comparisons with other doctors.
The expert patient
Recognize, monitor and respond to symptoms Manage acute episodes and emergencies Use medications Adopt appropriate aspects of lifestyle including healthy diet, exercise and relaxation and not smoking Interact appropriately with health care providers seek information and using community resources, i.e. the internetCriticism on Modern Medicine:1. The Absence of the Democratic Ideal. 2. The Danger behind Professional Sector. 3. The Economic Hazard. 4. The Dominance Authority on the Patient's Life. 5. The Narrow Point of View. 6. The “Inverse Care Law”.
Medical Profession: Medical profession is one of the main characteristics of the modern medicine, and can be defined as: "a profession as being based on a body of specialized knowledge (the content) not easily acquired and that, in the hands of qualified practitioners, meets the need of clients". Medical profession is also culturally and socially oriented
Characteristics of Doctors in Modern Medicine: 1. Group of healers whose positions are upheld by law. 2. They enjoy higher social status in the community. 3. They have greater income. 4. They have more clearly defined rights and obligations. 5. They have the authority over their patients. 6. They can also "label" their patient.
A specialist is defined as: "one who learn more and more about less and less“.The danger here, “if he might know less and less about more and more”.
Hospital Sociology: - Hospitals are among the most complex organizations in modern society. - Hospitals are dynamic organization, change according to need. - In the past (before100 years ago), hospitals were a place of refuge for the sick and homeless rather than a place for effective medical treatment.
Problems of Modern Medicine: 1. The success paradox. 2. The tax of advance. 3. The side effects of modern medicine. 4. The weakness of the modern medicine. 5. The stiffness of modern doctors. 6. The information overload.