Dr. Patient Relations

(Dr. Cherian, 31 Aug 2000, by  Brian Buschman)

 

Return to Semester Three Goodies

Return to The Unofficial Ross Page

 

Doctor/Patient Relationship Models

• Active-Passive role is a model in which a patient is like a child and the doc the adult that makes the decisions for the child.  This is the ideal relationship for surgical procedures or care of an incompetent patient.
• Teacher-Student model is when the doctor educates the patient as to good health practice and how they should work to overcome the disease and prevent future illness.
• Mutual-Particiation model is where both the doctor and the patient work together to determine the best treatment.  It is used in care of chronic conditions where the patient must be agreeable to the ongoing treatment.
• Friendship model is not acceptable in current medical practice.  It involves the doctor becoming emotionally connected with the patient which can cloud the patient’s judgment and cause the doctor to make poor medical decisions.

Conceptual Models

• The Bio-Psycho-Social Model describes a patient’s view of disease based on what they actually have, what they psychologically think about it and how it effects their social interactions.
• The free association modem involves expression of whatever comes to mind when ask open ended questions.  It is used to gather information about how a patient really feels about something.
• Problem-oriented model involves focusing on the problem and not on the surface symptoms.

Illness Behavior

When you get sick you behavior follows a series of stages:

1)      You get sick

2)      You assume the sick person role.  That is unless you have a lack of knowledge of the sickness or are in denial.

3)      You contact medical care if possible.

4)      You enter the dependant patient role during treatment.

5)      You enter the recovery role and loose the sick person role as you return to normal.

Rights/Responsibilities of the Sick

A sick person has the right to:

1)      Be held blameless for the illness.

2)      Be excused from certain obligations of normal life.

3)      Be treated based

 

The patient has the responsibilities to:

1)      Be expected to want help.

2)      Seek competent help.

3)      Comply with medical advice.

4)      Report changes to the attending physician.

Factors Affecting Illness Behavior

A patient’s behavior may be modified based on a number of factors including:

1)      Economic

2)      Cultural

3)      Religious

4)      Past personal experiences

5)      The patient’s personality

Personal Meaning of Illness

Many people have a different view of the sick state.  They may see it as:

1)      A challenge to overcome.

2)      A weakness that they can’t help.

3)      They may feel attacked.

4)      Some people feel punished by God.

5)      May enjoy relief of social demands or collection of disability pay.

6)      May cause suicide.

Coping

People deal with disease in a number of pays including:

1)      They try to minimize the feeling and just hold it inside.

2)      Others exaggerate the situation.

3)      Tackling is seen in some people when they deal with the sickness off and on.

4)      Ideally, the patient will accept the disease.

Responses to the Patient

Transference is what the patient feels for the doctor.  It may be positive or negative and is often based on past experiences

 

Counter transference is what the doctor feels for the patient.  It may be a sexual feeling towards the patient or patient’s parent (if peds).  It can cause improper diagnosis.

 

God complexes make the doctor feel invincible.

 

Doctors may feel defeated, epically if they work with AIDS or cancer patients regularly, because it may seem that nothing is working.

 

Doctors may loose confidence and run away.  They may hide in alcoholism or commit suicide.

The physician should:

1)      Have a good understanding of himself.  He needs to know who he is, what he values, what his strengths and weaknesses are and what is the depth of his knowledge basis.

2)      Respect the patient.

3)      Speak to the patient on their level.  Don’t be technical with the laymen or tower over a little kid.

4)      Be honest (within limits) with tough cases like cancer or adoption.

5)      Recognize the patient’s feelings.  If they are about to cry offer a tissue.

6)      When possible express understanding.

7)      Encourage them to express their feelings.

8)      Empathize with them.  Let them know you feel sorry for them.  Don’t sympathize with them.  The difference is that sympathy involves letting your feelings become involved.

9)      Acknowledge the patient so they know that you are listening and let them clarify.

10)  Show expertise.

11)  Allow patients to express their thoughts freely.  Don’t interrupt, cut them off or change the subject on them.

12)  Use your time effectively.  Don’t show up late and stay focused on the patient and their needs.

 

You should NOT:

1)      Don’t be defensive with the patient makes reference to you.

2)      Don’t sidestep issues lie a politician.

3)      Don’t minimize the problem.  Don’t send them away because you don’t see it as a problem.  Obviously they do if they came to your office.

4)      Don’t be judgmental.

5)      Don’t be authoritarian unless absolutely needed.

Compliance

Many factors lead to non-compliance including:

1)      Complex regimes.

2)      Too many required behavior changes at once.

3)      Perception of negative physician characteristics.

4)      Patients think the doc is unskilled or doesn’t care.

5)      They have too much or too little anxiety about the situation.

 

Compliance may be improved with:

1)      Explanations of the value of the TX.

2)      The doc accepts the patient’s belief system.

3)      Decreasing side effects.

4)      Patients have a say in the TX.

5)      Patients feel that they need the TX.

6)      The doc gives good feedback to the patient.

Special Issues

Fees – 1) You can only survive if you charge.

            2) You can only charge if the patient knew up front.

3) If you don’t charge the patient may feel that the treatment is no good.  That is if it’s “not worth charging for.”

 

Confidentiality – Keep all treatment and even the fact that they are your patient confidential without written permission from the patient or court order.

 

Missed appointments – Always ask for the reason.  There will be one.  Be sure to understand the reason before charging the missed appointment fee.

 

Continued care – You must continue care of the patient.  You cannon just dump the patient off on another doc.  If you have a reason to pass them off you must pass them into competent hands.

 

 

 

Return to Semester Three Goodies

Return to The Unofficial Ross Page