Doctor–patient relationship
The doctor–patient relationship is a central part of health care and the practice of medicine. A doctor–patient relationship is formed when a doctor attends to a patient's medical needs and is usually through consent. This relationship is built on trust, respect, communication, and a common understanding of both the doctor and patients' sides. The trust aspect of this relationship goes is mutual: the doctor trusts the patient to reveal any information that may be relevant to the case, and in turn, the patient trusts the doctor to respect their privacy and not disclose this information to outside parties.
A ceremonial dynamic of the doctor–patient relationship is that the doctor is encouraged by the Hippocratic Oath to follow certain ethical guidelines. Additionally, the healthiness of a doctor–patient relationship is essential to keep the quality of the patient's healthcare high as well as to ensure that the doctor is functioning at their optimum. In more recent times, healthcare has become more patient-centered and this has brought a new dynamic to this ancient relationship.
Importance
A patient must have confidence in the competence of their physician and must feel that they can confide in them. For most physicians, the establishment of good a rapport with a patient is important. Some medical specialties, such as psychiatry and family medicine, emphasize the physician–patient relationship more than others, such as pathology or radiology, which have very little contact with patients.The quality of the patient–physician relationship is important to both parties. The doctor and patient's values and perspectives about disease, life, and time available play a role in building up this relationship. A strong relationship between the doctor and patient may lead to frequent, freely-offered quality information about the patient's disease and as a result, better healthcare for the patient and their family. Enhancing both the accuracy of the diagnosis and the patient's knowledge about the disease contributes to a good relationship between the doctor and the patient. In a poor doctor–patient relationship, the physician's ability to make a full assessment may be compromised and the patient may be more likely to distrust the diagnosis and proposed treatment. The downstream effects of this mistrust may include decreased patient adherence to the physician's medical advice, which could result in poorer health outcomes for the patient. In these circumstances, and also in cases where there is genuine divergence of medical opinions, a second opinion from another physician may be sought, or the patient may choose to go to another physician that they trust more. Additionally, the benefits of any placebo effect are also based upon the patient's subjective assessment of the physician's credibility and skills.
Michael and Enid Balint together pioneered the study of the physician patient relationship in the UK. Michael Balint's "The Doctor, His Patient and the Illness" outlined several case histories in detail and became a seminal text. Their work is continued by the Balint Society, The International Balint Federation and other national Balint societies in other countries. It is one of the most influential works on the topic of doctor–patient relationships. In addition, a Canadian physician known as Sir William Osler was known as one of the "Big Four" professors at the time that the Johns Hopkins Hospital was first founded. At the Johns Hopkins Hospital, Osler had invented the world's first medical residency system. In terms of efficacy, the doctor–patient relationship seems to have a "small, but statistically significant impact on healthcare outcomes". However, due to a relatively small sample size and a minimally effective test, researchers concluded additional research on this topic is necessary. Recognizing that patients receive the best care when they work in partnership with doctors, the UK General Medical Council issued guidance for both of doctors named "Ethical guidance for doctors", as well as for patients "What to expect from your doctor" in April 2013.
Evolution
The doctor-patient relationship has changed drastically over the course of history. Originally called a “priest-supplicant relationship” in Ancient Egypt, as doctors were then known as “magicians and priest”. Then, during the Greek enlightenment there was also evidence of this relationship being present. During this time the Greeks had made some break throughs in medicine and had further developed their own version of a doctor patient relationship. They established what was known as the “Hippocratic Oath”. This was a code that would say how a doctor should act towards their patients. This code made it where the health of the patient was put before their “class or status”. This was the turning point for how doctor and patient relationships would be like. These events helped to shape how the doctor and patient relationships would be viewed in the future.The doctor's patient relationship was pervious mentioned throughout history but in the past patients were all taken care of the same way and they had only a few guidelines that involved things such as age and the allergies.Going into 1700 there were very few doctors, and their patients were mostly people from the upper class, but this all changed in the 18th century. During this time the first few hospitals, and doctors, began to get to know the patient by gathering more information on their patients and the symptoms instead of just assumptions. This is because of medical advancements that doctors need to know more about the patients, so they then are able to pinpoint the exact cause of how or what they are feeling. These critical moments in history help to improve the overall health of the patients but also improve the relationship between doctors and Patients.
Aspects of relationship
Informed consent
The default medical practice for showing respect to patients and their families is for the doctor to be truthful in informing the patient of their health and to be direct in asking for the patient's consent before giving treatment. Historically in many cultures there has been a shift from paternalism, the view that the "doctor always knows best", to the idea that patients must have a choice in the provision of their care and be given the right to provide informed consent to medical procedures. There can be issues with how to handle informed consent in a doctor–patient relationship; for instance, with patients who do not want to know the truth about their condition. Furthermore, there are ethical concerns regarding the use of placebo. Does giving a sugar pill lead to an undermining of trust between doctor and patient? Is deceiving a patient for his or her own good compatible with a respectful and consent-based doctor–patient relationship? These types of questions come up frequently in the healthcare system and the answers to all of these questions are usually far from clear but should be informed by medical ethics.Shared decision making
Shared decision-making involves both the doctor and patient being involved in decisions about treatment. There are varied perspective on what shared decision making involves, but the most commonly used definition involves the sharing of information by both parties, both parties taking steps to build consensus, and reaching an agreement about treatment.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. An alternative practice, 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 considered grossly unethical and against the idea of personal autonomy and freedom.
The spectrum of a physician's inclusion of a patient into treatment decisions is well represented in Ulrich Beck's World at Risk. At one end of this spectrum is Beck's Negotiated Approach to risk communication, in which the communicator maintains an open dialogue with the patient and settles on a compromise on which both patient and physician agree. 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. At the opposite end of this spectrum is the Technocratic Approach to risk communication, in which the physician exerts authoritarian control over the patient's treatment and pushes the patient to accept the treatment plan with which they are presented in a paternalistic manner. 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.