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Patient doctor relationship Slide 1 Patient doctor relationship Slide 2 Patient doctor relationship Slide 3 Patient doctor relationship Slide 4 Patient doctor relationship Slide 5 Patient doctor relationship Slide 6 Patient doctor relationship Slide 7 Patient doctor relationship Slide 8 Patient doctor relationship Slide 9 Patient doctor relationship Slide 10 Patient doctor relationship Slide 11 Patient doctor relationship Slide 12 Patient doctor relationship Slide 13 Patient doctor relationship Slide 14 Patient doctor relationship Slide 15 Patient doctor relationship Slide 16 Patient doctor relationship Slide 17 Patient doctor relationship Slide 18 Patient doctor relationship Slide 19 Patient doctor relationship Slide 20 Patient doctor relationship Slide 21 Patient doctor relationship Slide 22 Patient doctor relationship Slide 23 Patient doctor relationship Slide 24 Patient doctor relationship Slide 25 Patient doctor relationship Slide 26 Patient doctor relationship Slide 27 Patient doctor relationship Slide 28 Patient doctor relationship Slide 29 Patient doctor relationship Slide 30 Patient doctor relationship Slide 31 Patient doctor relationship Slide 32 Patient doctor relationship Slide 33 Patient doctor relationship Slide 34 Patient doctor relationship Slide 35 Patient doctor relationship Slide 36
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Patient doctor relationship

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Dr KSR Prasad guest lecture for Clinical Induction of BAMS students at MGACHRC, Wardha

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Patient doctor relationship

  1. 1. Patient - Doctor relationship Dr KSR Prasad Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda
  2. 2. Introduction • Doctor – Patient relationships express the values of medical profession • The relationship should not be the fish & fisherman • It should be always like fish and water Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 01
  3. 3. Parsons’ “ Ideal Doctor”  Apply a high degree of – skill and knowledge  Act for the good of the patient  Remain objective and emotionally detached  Respect the position of privilege Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 02
  4. 4. Doctor’s role • Health care providers • Technical consultant • To convince the necessity of medical services • A tendency for the “consumer to be right” Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 03
  5. 5. Doctor Competencies • Patient Care • Medical Knowledge • Practice-Based Learning (EBM) and Improvement • Interpersonal Skills • Communication Skills • Professionalism • Systems-Based Practice Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 04
  6. 6. Patient’s role • Health shoppers Indications of consumer behavior • Cost-consciousness • Information seeking • Exercising independent judgment • Consumer knowledge Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 05
  7. 7. Parsons’ “Ideal Patient” Permitted to: Give up – • some activities • responsibilities • Regarded as being in need of care In Return : Must want to get better quickly Seek help from and cooperate with a doctor Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 06
  8. 8. Consumerism • The patients’ challenge to unilateral decision making by physicians in reaching closure on diagnoses and working out treatment plans • Reversing the very basic nature of the power relationship Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 07
  9. 9. Conflict of Interest • Interests of patient Vs society • Interests of patient Vs other patients • Problems of confidentiality Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 08
  10. 10. The Physician Charter Principles include: • Patient welfare • Patient autonomy Commitments include: • Honesty with patients • Patient confidentiality • Maintaining appropriate relationships with patients Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 09
  11. 11. • - in Physician-Patient Communication 1. Build the doctor-patient relationship 2. Open the discussion 3. Gather information 4. Understand the patient’s perspective 5. Share information 6. Reach agreement on problems and plans 7. Provide closure Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 10 Seven Essential Elements
  12. 12. Etiquette Based Medicine Checklist for first meeting with a hospitalized patient: • Ask permission to enter the room /interrogation ; wait for an answer • Introduce yourself, showing ID badge • Shake hands /greeting (wear gloves if needed) • Sit down, Smile if appropriate (relax your self and make patient relaxed) • Briefly explain your role on the team • Ask the patient how he/she is feeling about being in the hospital & about the treatments Kahn MW, N Eng J Med, 2008 Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 11
  13. 13. Length of Consultation • Makes patient centred consultation styles more difficult. Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 12 Average 8 minutes
  14. 14. Consultation Styles It’s serious isn’t it doctor? Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda • Sustained physician- patient partnerships with bonds of trust and knowledge of patients were correlates of three outcomes of care – Adherence – Satisfaction – Improved health status 13
  15. 15. Doctor-Patient Relationship Linked to Outcomes of Care Safran DG et al, J of Fam Practice, 1998 Rate from 0 to 100… 1. Communication 2. Compassion 3. Respectfulness 4. Responsibility SCALE 100-Best Possible 90-Excellent 80-Very Good 70-Good 60-Above Average 50-Average 40-Below Average 30-Poor 20-Very Poor 10-Terrible 0-Worst Possible Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 14 Evaluation key (to be rated by patient) Communication: • How well this doctor communicate with you and your family • Did doctor answer your questions? Compassion: • Was the doctor is sensitive to you and your family needs? Respectfulness: • Did the doctor ask and respect your choices about your care Responsibility: • Did you feel the doctor acted appropriative on your behalf?
  16. 16. Doctor-patient relationship in the past • Paternalism – Because physicians in the past are people who have higher social status – “doctor” is seen as a sacred occupation which saves people’s lives • The advices given by doctors are seen as paramount mandate Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 15
  17. 17. Doctor-patient relationship at present • Consumerism and mutuality • Patients nowadays have higher education and better economic status • The concept of patient’s autonomy • The ability to question doctors Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 16
  18. 18. Patient influences on consultation • The patient’s ability to exercise and control depends on a number of factors: – Social – Educational level – Sex – Membership of an ethnic minority Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 17
  19. 19. Patient controlled consultation “You’re paid to do what I tell you!!” Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 18
  20. 20. Patients beliefs and expectations Influenced by: 1. Previous experience, 2. literature, 3. the media; 4. Family and friends; 5. Cultural influences; 6. Social significance. These beliefs influence outcomes Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 19
  21. 21. Prototypes of doctor-patient relationship Physician control (Low) Physician control (High) Patient control (Low) Default Paternalism Patient control (High) Consumerism Mutuality Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 20
  22. 22. Ethical models at a glance –Paternalistic model –Informative model –Interpretive model –Deliberative model Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 21
  23. 23. Paternalistic model • Principle – The doctor should make all the decisions for a patient. • Assumptions – People are not always rational/mature. – Experts know better about the needs of patients. – Qualified doctors have good will. • Sources – Hippocratic Oath; Plato. • Problems – Are the needs of patients objective? – How can we be sure that doctors have good will? • Objection and modification – John Stuart Mill’s liberal principle Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 22
  24. 24. The Paternalistic Approach “If I’ve told you once I told you 1,000 times, stop smoking!!” Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 23
  25. 25. Informative model • Principle – The doctor should provide all the relevant information for the patient to make a decision, and provide the selected intervention on this basis. • Assumptions – A fact/value division of labor yields the best medical result. – What is good for a patient depends on what his/her personal values. – Consumerism. • Problems – What if the patient is unconscious, incompetent, and making choices totally unacceptable by our ethical standards? Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 24
  26. 26. The interpretive model • Principle – The doctor should help the patient to articulate his/her values through interpretation, and provide intervention which is truly wanted. • Assumptions – Patients have unconscious and inconsistent desires. – Their conscious decisions may not reflect their deepest values. • Sources – Sigmund Freud; hermeneutics. • Limitation – All that a doctor can do is to help the patient see his/her own desires/values more clearly, but not to criticize them. Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 25
  27. 27. The deliberative model • Principle – The doctor should help the patient to deliberate well through dialogue and discussion, and – so develop values which are objective and truly worthy. • Assumptions – The objectivity of values. – The patient’s good life consists not in the satisfaction of desires, but maturity and rationality. • Source – Aristotelian ethics • Problems – Is the model different from the paternalistic model? – What is the difference between dialogue and persuasion? Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 26
  28. 28. Mutuality • The optimal doctor-patient relationship model • This model views neither the patient nor the physician as standing aside • Each of participants brings strengths and resources to the relationship • Based on the communication between doctors and patients Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 27
  29. 29. Mutuality - Patient’s role • Patients need to define their problems in an open and full manner • The patient’s right to seek care elsewhere when demands are not satisfactorily met Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 28
  30. 30. Mutuality - Doctor’s role • Physicians need to work with the patient to articulate the problem and refine the request • The physician’s right to withdraw services formally from a patient if he or she feels it is impossible to satisfy the patient’s demand Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 29
  31. 31. Mutuality - Advantages • Patients can fully understand what problem they are coping with through physicians’ help • Physicians can entirely know patient’s value • Decisions can easily be made from a mutual and collaborative relationship Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 30
  32. 32. Mutuality - Disadvantages • Physicians do not know what certain degree should they reach in communication • If the communication is fake, - – both physicians and patients do not have mutual understanding, – making decision is overwhelming to a patient Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 31
  33. 33. Mutuality - Discussion • Is the patient capable of making the important therapeutic decision even though they have good communication of the physician? Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 32
  34. 34. Do – Don’ts • Do not toss the treatments for a patient • Make always reliable advises and practices • Assuring the patient is first choice of – placebo treatment – But it should never be false assurance • Authentic tested managements (EBM) are advised Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 33
  35. 35. Conclusion • Relationship between patients and doctors are often unstated, and thy are dynamic • As conditions change, the kind of relationship that works best for a patient may change • Doctors and patients should choose a “relationship fit” Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 34
  36. 36. Thank you • Dr KSR Prasad Patient - Doctor relationship Dr. K. Shiva Rama Prasad, see the ppt at http://www.slideshare.net/technoayurveda 35
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Dr KSR Prasad guest lecture for Clinical Induction of BAMS students at MGACHRC, Wardha

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