Trust: The keystone of the physician-patient relationship | The Bulletin
The doctor–patient relationship has been and remains a keystone of care: the . for physicians to correspond with greater profit (or other organizational goals) in order . and nurture and sustain the public's trust in doctor–patient relationships. Therefore, this paper aims to construct a model of trust in the doctor-patient relationship based on qualitative research (analysis of the contents of Internet. The doctor–patient relationship is a central part of health care and the practice of medicine. Does giving a sugar pill lead to an undermining of trust between doctor and health decisions without considering that person's treatment goals or having that that a doctor can maintain the open cooperation of his or her patient.
Historically in many cultures there has been a shift from paternalismthe 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. 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? Shared decision making[ edit ] Health advocacy messages such as this one encourage patients to talk with their doctors about their healthcare. Shared decision making Shared decision making is the idea that as a patient gives informed consent to treatment, that patient also is given an opportunity to choose among the treatment options provided by the physician that is responsible for their healthcare.
This means 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. A practice which is an alternative to this is 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 grossly unethical and against the idea of personal autonomy and freedom.
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. 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.
Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. June Learn how and when to remove this template message The physician may be viewed as superior to the patient simply because physicians tend to use big words and concepts to put him or herself in a position above the patient. The physician—patient relationship is also complicated by the patient's suffering patient derives from the Latin patior, "suffer" and limited ability to relieve it on his or her own, potentially resulting in a state of desperation and dependency on the physician.
The Importance of Healthy Doctor-Patient Relationships
A physician should be aware of these disparities in order to establish a good rapport and optimize communication with the patient.
Additionally, having a clear perception of these disparities can go a long way to helping the patient in the future treatment. It may be further beneficial for the doctor—patient relationship to have a form of shared care with patient empowerment to take a major degree of responsibility for her or his care. Those who go to a doctor typically do not know exact medical reasons of why they are there, which is why they go to a doctor in the first place.
An in depth discussion of lab results and the certainty that the patient can understand them may lead to the patient feeling reassured, and with that may bring positive outcomes in the physician-patient relationship. Benefiting or pleasing[ edit ] A dilemma may arise in situations where determining the most efficient treatment, or encountering avoidance of treatment, creates a disagreement between the physician and the patient, for any number of reasons.
In such cases, the physician needs strategies for presenting unfavorable treatment options or unwelcome information in a way that minimizes strain on the doctor—patient relationship while benefiting the patient's overall physical health and best interests. When the patient either can not or will not do what the physician knows is the correct course of treatment, the patient becomes non-adherent.
Adherence management coaching becomes necessary to provide positive reinforcement of unpleasant options. For example, according to a Scottish study,  patients want to be addressed by their first name more often than is currently the case. In this study, most of the patients either liked or did not mind being called by their first names.
The Doctor–Patient Relationship
Only 77 individuals disliked being called by their first name, most of whom were aged over Physicians are being asked to participate, like others in the health care system, in efforts to control costs.
These pressures are perhaps most dramatic for surgeons who control high-cost, limited resources such as organ transplantation and gamma knife neurosurgery, but are faced by almost all surgeons on a daily basis as they interact with insurers, utilization reviewers, case managers, and administrators.
The reality of limited resources and the influence some would contend interference of third-party payers in clinical medicine has placed increasing strains on the surgeon-patient relationship, to which we will now turn our attention.
The surgeon-patient relationship The invasive and potentially life-threatening nature of surgical therapy fundamentally shapes the relationship between a surgeon and his patient and requires an extraordinary degree of trust from the patient and, correspondingly, ethical action by the surgeon.
Through the evaluation and therapy of a patient's condition, the power and control of the clinical encounter is gradually transferred from the patient to the surgeon. Initially, it is the patient who controls the relationship by choosing to visit the physician and to enter into treatment.
- Trust: The keystone of the physician-patient relationship
- The Doctor–Patient Relationship
- Impact of the Doctor-Patient Relationship
Ideally, the surgeon and patient discuss therapeutic options and decide together how to proceed. Eventually, it is the surgeon and her operating team who assume total control during the operation. This transfer of power and control differs substantively from the power dynamics between patients and practitioners in most other fields of medicine.
Medical patients, in general, retain a substantial degree of control over their care. A patient with hypertension, for instance, may listen to her internist explain the risks and benefits of controlling her blood pressure with a variety of medications, but ultimately it is she who chooses to take her antihypertensive medication or modify her diet.
The complete, unavoidable, albeit temporary transfer of autonomy to the physician inherent in surgical therapy makes it imperative that surgeons fully appreciate moral obligations implicit in the surgeon-patient relationship. Of course, these are generalizations, and the medical patient under heavy sedation for a colonoscopy or the surgical patient awake for a cystoscopy also require the patient to cede some control to his or her physician.
Much empirical and ethical examination of the relationship between physicians and their patients has concentrated on the balance between 2 of the prima facie principles, autonomy and beneficence.
Prominent physician-ethicists Emanuel and Emanuel, 10 for instance, define 4 models of physician-patient relationships based on the primacy of either autonomy or beneficence.
On one end of their spectrum, the paternalistic model, the physician asserts control of the clinical encounter by diagnosing and implementing treatment based on his interpretation of what is "best" for the patient. For the patient with gangrene who refuses surgery, for instance, a paternalistic physician would insist on surgery, perhaps by threatening to withdraw services unless the patient complied.
At the other extreme, the informative model, the physician merely lays out the medical options without judgment and allows the patient to choose. This physician would merely state the risks and benefits of surgery compared with nonsurgical "treatment" of gangrene and passively accept the patient's decision. Their preferred model, the "deliberative" model, lies in the middle.
The physician helps the patient to identify pertinent health values and to choose among medical alternatives within a personal context.
Thus, the physician should encourage the patient with the gangrenous leg to understand the risks of surgery and to try to overcome the fear of anesthesia. Furthermore, one should educate the patient about the potential of life after amputation, and the potential to return to a healthy, productive life. Through this process of education and discussion, the surgeon is able to establish or enhance the patient's trust in the physician and his or her surgical judgment.
When a patient presents with a health problem to the surgeon, either emergently or electively, he seeks the skills and advice of an expert who possesses the knowledge and skills inaccessible to the nonsurgeon.
The patient thus trusts the surgeon with his life, well-being, and private information. Moral obligations of the surgeon stem from the establishment of this trust-based relationship. A better understanding of trust-based relationships can serve as a practical guide for behavior in practice. Trust is related to the concept of fiduciary responsibility, defined morally and legally as a duty to "put aside self interest, focus primarily on the interests of the person for whom he or she serves as fiduciary, act to protect and promote that individual's interests, and so earn the trust and confidence of that individual.
This trust relationship has a moral content—fidelity to trust is morally praiseworthy, while betrayal of trust is morally blameworthy. Interpersonal trust relationships are typically found where there are conditions of risk and uncertainty—certainly present in surgery and all of medicine. The trusting patient is placed, sometimes unwillingly, in a position of vulnerability to the surgeon.
The patient grants, sometimes reluctantly, discretionary power to the surgeon to achieve something the patient desires, usually better health or even the preservation of life. It is not only patients who trust the surgeon with their bodies and their health; spouses, parents, or others who care for the patient trust the physician with their loved one.
Once trust, no matter how fragile or forced, has been established, patients hold several expectations.
How to build and maintain trust with patients
First, they have expectations of goodwill and beneficence, that their physician will act to pursue their not the surgeon's or another's interests. Included in expectations of beneficence are expectations of advocacy—that surgeons will advocate with third parties such as insurers or nurses to pursue the patient's good. Your doctor should take your complete history, ask you plenty of questions, and encourage you to talk openly and honestly about your situation.
He should take his time, listening attentively to your concerns. Most doctors are pressed for time today for a variety of reasons, but a doctor who rushes through your visit not only risks making uninformed decisions about your care and treatment, he or she also misses an opportunity to establish a meaningful relationship with you.
If you feel rushed, unheard, dismissed, confused, or unsure during your visit, calmly let your doctor know. Remember that your doctor is a trained professional who needs to know the whole picture in order to accurately diagnose and treat your condition. Also, keep in mind that healthcare providers are only human—being rude or aggressive toward doctors, nurses, and other healthcare personnel is not only distracting and stressful for these caregivers, it can also lead to medical mistakes.
As difficult as your situation may be, the age-old expression applies: This is called shared decision making. If you feel like your doctor is pushing you into accepting a specific treatment plan, this is a warning sign. When it comes to decisions large and small about your healthcare, your doctor should be your partner in the decision-making process. Yet, delivering such news can and should be done honestly and with empathy.
A doctor who is cold, arrogant, impatient, rushed, or who otherwise demonstrates a poor bedside manner can quickly lose your trust and leave you feeling unsure, anxious, frightened, angry, and alone. Perhaps he or she is very direct, talks faster than you can follow, or has a demeanor that makes you anxious or uncomfortable. Use your first visit as a test.