An analytic review of the doctor-patient relationship part I (original) (raw)
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Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i
The present paper revisits the ethical models of patient--physician relationship from the perspective of patient autonomy and values. It seems that the four traditional models of physician--patient relationship proposed by Emanuel & Emanuel in 1992 closely link patient values and patient autonomy. On the other hand, their reinterpretation provided by Agarwal & Murinson twenty years later emphasizes the independent expression of values and autonomy in individual patients. Additionally, patient education has been assumed to join patient values and patient autonomy. Moreover, several authors have noted that, over the past few decades, patient autonomy has gradually replaced the paternalistic approach based on the premise that the physician knows what is best for the patient. Neither the paternalistic model of physician-patient relationship, nor the informative model is considered to be satisfactory, as the paternalistic model excludes patient values from decision making, while the info...
Emerging ethical perspective in physician-patient relationship
Journal of Clinical and Diagnostic Research
Traditional health systems, with patients as passive recipients of care, have proven unsuccessful in stemming the most irresistible and exponential growth of the epidemic we now face. There is considerable healing power in a good Physician-patient relationship. In the field of healthcare, patient empowerment has been acknowledged as an alternative to compliance in order to guide the provider-patient relationship. It will help patients' confusion, fear and doubt slowly transform into clarity, relief and assurance. With the positive role of physicians, patients will definitely be relieved of hopelessness, have higher satisfaction, better adherence and improved health. There is no doubt that this small gesture by physicians will be a precious gift to humanity.
Frontiers in Public Health
Background: The aim of this scoping review is to explore whether or not person-centered care (PCC), in its quest to deliver high quality and safe health care, has a relational-ethics perspective. To do so, we first need to relate the extant literature pertaining to PCC and relational ethics. To this extent, the specific features that define PCC and relational ethics were identified. PCC dimensions include: patient and provider concordance, improved health outcomes, improved patient safety, individual expectations, patients' integration within the environment, patient as a person, patient as an active part of society, dialogue and interaction, sharing experience, and documentation of patient's (person's) narrative. Relational ethics framework includes the following actions: mutual respect, engagement, embodied knowledge, environment, and uncertainty. Methods: Data were retrieved through multiple keywords search on PubMed, Medline, and Scopus. Inclusion/exclusion criteria were set, and these were based on year of publication (2008-2018), language, paper focus, research method and document types. A total of 23 articles (N = 23) were selected and reviewed. Content analysis was conducted in order to identify and compare the main features of PCC and relational ethics. Results: The most important relational ethics action referred to in conjunction with PCC features is environment (referred to as person's integration within a social environment/community). This is followed by mutual respect, engagement and embodied knowledge. These were the salient relational ethics actions both directly and indirectly linked to PCC. Uncertainty was the less recurrent relational ethical action mentioned. Conclusions: This paper revealed that while PCC features embrace most of the relational ethics approaches, these are not exploited in their entirety and therefore PCC emerges as a unique ethical stance in healthcare. PCC's ethical approach goes beyond what is explained within provider-patient relational ethics and emphasizes that the patient is an active person and a partner in care with capabilities and resources. Tomaselli et al. Person-Centered Care and Relational Ethics This distinction enables us to explain the paradigm shift from "patient-centered" to "person-centered" care. The healthcare provider partnership and co-creation of the healthcare plan contributes to the delivery of high quality, safe and cost-contained healthcare.
Ethics of the Dialectic Dichotomy in Physician-Patient Relationships
Turkish Journal of Bioethics, 2021
Communication is the cornerstone of the physician-patient relationship. However, a difference in medical knowledge may create a communicative gap, negatively affecting the patient experience. Rather than bridging the difference in knowledge, physicians who overutilize technical medical language can further damage the relationship. To prevent this, Voice can be analyzed through an ethical lens as it relates to patient autonomy and patient understanding, as comprehension is required for the patient to give informed consent. Research suggests that improved communication and empathy radically increases patient satisfaction. This end is achieved by incorporating not only the Voice of Medicine but also the Voice of the Lifeworld. The former employs scientific jargon and technical-speak while the latter incorporates the patient's lived experiences into the medical dialogue. The Voice of the Lifeworld is a valuable tool that contextualizes disease and dissolves communication barriers. Physicians must appreciate patient perspectives to establish trust and pursue meaningful relationships. The use of either Voice is situation-specific and should be balanced according to the patient's context; failure to do so will result in patient dissatisfaction. With this framework as a foundation, physicians can further optimize interactions with their patients by matching Voice not only to the medical context, but further extending Voice into a more personal context. Attachment theory provides a second lens that predicts how one may respond to medical professionals attempting to build trusting relationships. Depending on the attachment style, patients may be easier to comfort and build rapport with. Altering the communication mix according to Voice and attachment style will offer a truly personalized healthcare experience to each patient. Future studies should test this framework and attempt to determine attachment style quickly and methodically, so trust can be built early in the relationship. The outcome of this proposed process suggests that revised medical training be implemented to satisfy patients' Lifeworld Voice and to increase clarity within the physician-patient relationship to promote ethical communication.
Health Policy, Patient-Centered Care and Clinical Ethics
Rationale, aims and objectives Patient-centred care has been a central part of US and UK health policy for over a decade, but, despite its importance, the policy literature often fails to provide an adequate theoretical justification for why and how we should value it. This omission is problematic because it renders the status, content and appropriate evaluation of patient-centredness unclear. In this paper we aim to examine two different accounts of patient-centred care. Method We draw upon methods of conceptual and ethical analysis. Results We argue that neither of the two accounts of patient-centred care identified appropriately grounds patient-centredness because neither of them takes into account the inherently moral nature of terms such as 'respect' and 'dignity', terms that are central to discussions of patient-centred care. Conclusions We suggest that clinical ethics can help to provide a theoretical justification for patient-centred care, and that clinical ethical practices can further patient-centred initiatives through ethics consultation, education and policy development and review. The principles underpinning the Darzi report are also reflected in the government's recent White Paper for the future of the NHS, Equity and Excellence: Liberating the NHS. Here, emphasis is placed on the value of patient experience and shared decision making .
Doctor-patient relationship: from medical paternalism to enhanced autonomy
Singapore medical journal, 2002
For centuries, physicians have been allowed to interfere and overrule patient's preferences with the aim of securing patient benefit or preventing harm. With the radical rise in emphasis on individual control and freedom, medical paternalism no longer receives unquestioned acceptance by society as the dominant mode for decision-making in health care. But neither is a decision-making approach based on absolute patient autonomy a satisfactory one. A more ethical and effective approach is to enhance a patient's autonomy by advocating a medical beneficence that incorporates patients' values and perspectives. This can be achieved through a model for shared decision making, acknowledging that though the final choices reside ultimately in patients, only through physician beneficence can the patient be empowered to make meaningful decisions that serve them best. For such a model to function effectively, the restoration of trust in doctor-patient relationship and the adoption of ...
A conceptual model of physician-patient relationships: a qualitative study
In any clinical encounter, an effective physician-patient relationship is necessary for achieving the desired outcome. This outcome is successful treatment, and therefore, the relationship should be a healing one. In addition, in the Islamic view, the physician is a manifestation of God's healing attribute, which is usually undermined in everyday therapeutic communications. Yet there are few empirical data about this experience and how it occurs in the clinical context. This study was conducted to develop a model of physician-patient relationship, with the healing process at its core. Our goal was to explain the nature and characteristics of this encounter. In Islamic teachings, healing is defined as " cure " when possible and if not, reducing pain and suffering and ultimately finding a meaning in the illness experience. This study was a qualitative inquiry. Data were collected through 17 open-ended, semi-structured interviews with physicians who had an effective relationship with their patients. The participants' experiences and their perception regarding the relationship were subjected to grounded theory content analysis. For establishing the trustworthiness of the data collection and analysis we used triangulation, peer review, and member checking. The findings showed that the components of the patient-physician healing relationship could be categorized in the four key processes of valuing the patient as a person, effective management of power imbalance, commitment, and the physician's competence and character. This leads to forming the three necessary relational elements of trust, peace and hope, and being acknowledged. Their importance has been better demonstrated in a relationship which incorporates the spiritual aspects of patient care and also physician's satisfaction. The physician-patient relationship has a central role in patient outcome. This relationship has an understandable structure and its components may have an effective impact on promoting the patient's experience of the health system.
IRA-International Journal of Management & Social Sciences (ISSN 2455-2267), 2016
Recent development in the organization of healthcare has impacted on physician and patient relationship. The physician-patient relationship is becoming more and more a universalistic concern. Since Hippocrates, the physician-patient relationship remains the corner stone of medical practice. A number of disciplines have questioned the interaction between physician and patient (from pure sciences and clinical sciences to social sciences). This paper uses a de-centered comparative method to examine how different theoretical approaches shape the understanding of doctor-patient interaction and health regulation implications. In particular, the article looks at two theoretical models: health economics and medical socio-anthropology. The findings show that the difference between the two approaches is based upon the background of each discipline. Nevertheless, there are some similarities. The paper concludes that no theoretical approach is totally privileged to understand the interaction.
Physician-Patient Relationship: The Present Situation and Our Responsibilities
Bangladesh Medical Journal, 2014
The "doctor-patient" relationship (DPR) or the "physician-patient" relationship (PPR) has long been recognized as a complex, multifaceted, and complicated balance of engagement between the care-seeker and the care-giver. The physician-patient relationship is central to the practice of healthcare and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease. The doctor-patient relationship forms one of the foundations of contemporary medical ethics. In the present moment doctor-patient relationship (DPR) or physician-patient relationship (PPR) is one of the major issues in health-care throughout the world. The most common complains about the physicians of Bangladesh is their attitude towards the patients. The patients must have confidence in the competence of doctors and should feel that they can confide in him or her. For physicians, the establishment of a good relationship with the patients is also important. In develope...
Patient- or person-centred practice in medicine? - A review of concepts
African journal of primary health care & family medicine, 2017
Person-centred practice in medicine may provide solutions to several pressing problems in health care, including the cost of services, poor outcomes in chronic care and the rise in litigation. It is also an ethical imperative in itself. However, patient- or person-centred care is not well researched partly because of a lack of conceptual and definitional clarity. The aim of this review was to analyse essential elements, ethical principles, logic and the practical application of person-centred practice described in clinician- and researcher-defined conceptual frameworks, terms and practices. A search of review articles on patient- and person-centred care or medicine was conducted using Medline and Google Scholar. Secondary searches were conducted using references and citations from selected articles. Five conceptual frameworks were identified in terms of their practical application of the ethical principles of beneficence, autonomy and justice. They converge around a few central idea...