Doctor Patient Relationship

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Doctor Patient Relationship

In the context of fast growing health care sector,the doctorpatient relationship holds a major key(point) for the effective practise and delivery
of high quality health care services.According to Hippocrates its more important to
know the patient who has the disease than the disease the patient has.A recent
study shows that its the physicians approach to the doctor patient
relationship,which gets reflected in the patients final health.
Tracing back to history,it can be seen that the doctor patient
relationship has evolved much.By historical context,the doctor patient relationship
depends upon the medical situation and the social scene. The medical situation
reflects the technical(technological) skills,self-reflection and the communication
between the patient and doctor(during a particular period or era).The social scene
refers to the socio-political atmosphere during the same period.Accordingly some
phases in the historical evolution of doctor patient relationship are,namely,
(1)Ancient Egypt(around 4000-1000B.C)
(2)Greek Enlightenment(600100B.C) (3)Medieval Europe & The Inquisition(1200-1600A.D) (4)The
French Revolution(late 18th century) (5)Central Europe(late 19th century)
(6)The Contemporary American Scene(Post World War II). Ancient practises
revolved upon the magical remedies(miracles) offered by priests incorporating with
religious beliefs,which by passage of time,evolved into an empirico-rational
approach,further evolved with the advancement of science and technology.This
evolution has also led to reasonable improvements in doctor patient relationship,to
an extent.It helped to minimise the inequality(where the physicians had the sole
right and power making the patients inferior,as during ancient times) and laid a new
foundation in medical ethics.
Though the present scenario sounds good,still improvements
are to be made in the doctor patient relationship.Based on this view, four models of
doctor patient relationship was suggested*,namely, The Paternalistic Model,The
Informative Model,The Interpretive Model & The Deliberative Model.The Paternalistic
Model is more like a parental model where the patient has only a limited
participation(with regards to communication,decision making,medical interventions)
but the emphasis is still on the health and well being of the patient using the skills
of physician.In informative model,the physician provide the patient with all relevant
information regarding the disease state and all available interventions.The
Interpretive Model is similar to Informative model but the physicians obligations
also require(include) engaging the patient in a joint process of understanding.
In the Deliberative Model,the physician acts as a teacher or a
friend,which involves the equal participation of the patient to choose the best
course of action.Here the conception of patient autonomy is moral self

development.Though the aforesaid 4 models help better the doctor patient


relationship in different scenarios,the Deliberative model seems more ideal owing to
the moral self development and caring attitude.
Medical Ethics is an important factor in a doctor patient
relationship.Thus the main principles of medical ethics include respect for patient
autonomy,beneficence, nonmalficence, justice.Other important aspects of medical
ethics include informed consent(like deliberative model) where the patient is
informed about the benefits and risks in their choice of treatment, confidentiality,
truthfulness and honesty. The bonding(relation) between a patient and doctor starts
from the time an appointment is made by the former for a consultation.So apart
from providing the best health care practises various other factors are also
involved.The first and foremost thing is effective communication and giving duo
respect to the patient.From a doctors point of view active listening and showing
empathy are important.The non verbal communication like gestures,frequent eye
contacts also add to the trust and secure feeling of the patient.Educating the
patient(like informed consent) also plays a major role wherein a patient is made
aware of his present condition,possible or available interventions,the
consequences(if any),the life style he has to follow etc(without exxagerations).So a
doctor helps the patient improve his/her confidence and self esteem.
Today,there are several (medical) ethical dilemmas and other
factors that hinder an effective doctor patient relationship.The very recent such a
dilemma in news was about Ebola drugs,a not much scientifically tested drug
called ZMapp was given to the patients(2 nos.).Though there were reports of
improvement in (health of) those patients(given the drug),wide spread use of such
untested drugs might pose a problem in near future as not enough informations or
data is present(since untested) regarding the effectiveness and risk it possess.The
vested interest of other drug manufacturers may also pose a threat.The basic
medical ethic principles are often violated or diluted.The cultural difference also
contibute to ethical issues.The rural area is very much confined to cultural and
geographical conflicts.Shortage of health care services,long distance travels,lack of
transpotation,limited economic resources like income and insurance often hinder
the rural public from availing effective health care facilities.The self-reliance or selfcare attitudes to public health,community values about an illness,lack of knowledge
regarding the importance of treatment reflects the non acceptance of health care
providers by rural community.The interdependent and overlapping relationships
between the (small) communities of rural area may lead to stigma.In rural and
frontier communities,the clinicians often(routinely) interact with patients in nonmedical roles. In such situations, ethics conflicts pertaining to principles of
autonomy, ethical use of power, confidentiality, and right to treatment may arise.
Providing care for those at the end of life can be one of the most challenging yet
rewarding tasks in health care. End-of-life care decisions are challenging, because
emotions and ethics are attached to actions that can lead to the hastening or

perceived hastening of death.This may even lead to double effect-a good one as
well as a bad one.Coming to the urban area which has better health care
facilities,the biasing based on socio-economic factors are prevelant.The
privatization and vested interest(of drug manufacturers) are the main attributes to
economic biasing.The conflict of interest in referral system(a patient being referred
to a particular lab solely for financial gain,a patient referring another person to a
not so efficient physician),sexual relationships also violates the ethic principles of
health care sector.
There might be many rules and regulations to keep up the
ethics but effective implementation of the same has to be enforced or enacted
upon.The patients quality of care,professional excellence and health care
Organisations financial ability should be focussed upon.Effective policies should be
developed about the basic principles like informed consent,confidentiality and
privacy.Some informative discussions about the confidentiality and privacy with the
rural public will also be beneficial.Strenghtening the Ethics Committee and widening
its response will provide more strict supervision of patients right.By identifying the
ethical issues,analysing it,incorporating the existing knowledge to form effective
strategies and implementing it,the doctor patient relationship can be improved
thereby ensuring better health care services and contributing to overall societal
development.

N.B
*(3rd para,4 models):By E.J Emmanuel & Linda Emmanuel,JAMA(The Journal of
American Medical Association) dated April22,1992
1st para: a small intro abt the topic.
2nd para: the evolution in the historical context.Being a time-framed essay,i limited
the historical context to few sentences(just summarising it).Its taken from a
research paper(7-8pages) ,the doctor patient relationship and its historical context.
3rd para:the contemporary scene and a 4 model suggestion to improve the present
scenario.
4th para: abt the deliberative model(best suitable as suggested by the authors).
5th para: Abt Medical Ethics.You might be able to add more points(hope u had such
a subject in academics) and can even add a deatiled explanation on those basic 4
principles,I think.
6th para: A generic dilemma,then focussing on a particular area(rural).If uve some
live examples or case studies to add up,it wud be more beneficial,I think.

7th para: Conclusion.


Please note that in certain (research)papers and articles,the four models(3 rd para) of
the doctor patient model are generalised into 3,namely,Activity-Passivity
model,Guidance-Cooperation Model &Mutual participation model.
#Neither an expert writer,nor a doctor:there might be imperfections and less
resourceful informations ,kindly excuse
:P ;-)
Courtsey:To all the people out there
who have added their valuable information via internet sources.

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