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The Doctor-Patient Relationship

From Sociology as applied to Medicine

Mutiara Budi Azhar

Faculty of Medicine, Sriwijaya University

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Doctor Patient Contacts

500,000 GP consultations every working day

The nature of the relationship determines

the success or otherwise of the contact

Central to this is the exchange ofinformation

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Communication and Diagnosis

Patients who feel at ease and who are

encouraged to talk freely are more likely todisclose the real reason for consulting

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Communication and Treatment

Advice reassurance and support from the

doctor can have a significant effect on

recovery

The placebo effect!!!

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Consultation Styles

Its serious isnt it

doctor?

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Parsons Ideal Patient

Permitted to:

Give up some activities and responsibilities

Regarded as being in need of care

In Return:

Must want to get better quicklySeek help from and cooperate with a doctor

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Parsons Ideal Doctor

Apply a high degree of skill and knowledge

Act for the good of the patient

Remain objective and emotionallydetached

Respect the position of privilege

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Conflict of Interest

Interests of patient v society

Interests of patient v other patients

Problems of confidentiality

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Types of D-P Relationship

Physician control

Patient Control Low High

Low Default Paternalist

High Consumerist Mutuality

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Paternalism

The traditional D-P relationship

Doctor Takes on role of parent

Patient submissiveShift towards Mutuality

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Patient controlled consultation

Youre paid to do

what I tell you!!

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Patients beliefs and expectations

Influenced by:

Previous experience, literature, the media;

Family and friends; Cultural influences;Social significance.

These beliefs influence outcomes

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The doctors consulting style

Doctor centred consultation style:

Paternalistic-doctor is the expert and patient

expected to cooperate

Tightly controlled interviewing style aimed at

reaching an organic diagnosis.

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The Paternalistic Approach

If Ive told you once I told you1,000 times, stop smoking!!

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The Doctors consultation style

Patient Centred consultation style:

Less authoritarian - encourages patient to

their own feelings and concerns Open questioning, interested in psycho-

social aspect of illness

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Patient centred clinical interview

Doctor-history examination investigation

results in a differential diagnosis

Patient-ideas expectations feelings

results in an understanding of patients

beliefs

Integration

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Length of Consultation

Average 8 minutes

Makes patient centredconsultation styles

more difficult.

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Patient influences on consultation

The patients ability to exercise and control

depends on a number of factors:

Social and educational level Sex

Membership of an ethnic minority

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Summary

An integrated approach to information

gathering.

Seeking to identify physical psychological and

social factors

Is likely to produce a better outcome.