IN THIS PRESENTATION I HAVE DESCRIBED ABOUT DOCTORS AND PATIENTS RELATIONSHIP . History of doctor-patient relationship. Models of doctor-patient relationship. Psychological types of doctors. Basic characters and skills of physician. Communication of doctors. Problems of contemporary healthcare system

1. DOCTORS AND PATIENTS
RELATIONSHIP
KRISHNAMOORTHI BHARANI

2. CONTENT
• History of doctor-patient relationship.
• Models of doctor-patient relationship.
• Psychological types of doctors.
• Basic characters and skills of physician.
• Communication of doctors.
• Problems of contemporary healthcare system.

3. History of doctor-patient relationship
• The practice of medicine is probably almost as
old as the human civilization . First doctors were
considered to be shamans, witches or spiritual
leaders. Their duty was to diagnose and treat
both the body and the sole of the sick members
of the tribe. They were admired and well
rewarded despite the fact that few of their
remedies actually worked and many were
actually quite dangerous . They were worshiped
by their patients because of the power of
interpersonal relationship as a placebo effect
made those patients feel better.

4. History of doctor-patient relationship
• If we compare the knowledge, facilities and skills
of ancient healers and modern doctors, we’ll see
that in recent decades, modern medicine has
improved the knowledge and efficacy of many
treatments, but has degraded the importance of
the doctor-patient relationship. Doctors now too
much focus on the lab results and too little on the
person; they have too little time and too many
patients; they fully rely on scientific achievements
and too little on Hippocratic human caring.

5. History of doctor-patient relationship
• In 400 B.C Hippocrates is most popular , who was the
founder father of medicine . He said the what sort of a
person has a disease is more than what sort of disease a
person has .
• Until 19th century doctors were portrayed as arrogant,
secretive and incompetent.
• 19th century doctor stressed on money and professional
etiquettes.
• 1935 – 1960 : Historic high trust point .
• 20th century : Portrayed doctor as a person who knows
best.
• 21st century era of telemedicine, where there is no need for
doctor to see the patient and doctor leads the patients to
refer by hospitals rather by doctors.

7. Models of doctor-patient
relationship
• The doctor patient relationship needs to be
redefined to allow both the physicians and
patients to take an active role in treatment
decisions. Four models for the physician –
patient relationship have been proposed, they
are :
» Paternalistic model
» Informative model
» Interpretive model
» Deliberative model

8. Models of doctor-patient relationship.
 Paternalistic model - paternal model {doctor guardian}
• In this paternalistic model of the doctor-
patient relationship, the doctor utilises his
skills to choose the necessary interventions
and treatments most likely to restore the
patient's health or ameliorate his pain. Any
information given to the patient is selected to
encourage them to consent to the doctor's
decisions

9. Models of doctor-patient relationship.
Informative model – consumer model
• In the informative model of the physician-patient
relationship, physicians provide patients with all
information relevant to their condition and leave the
decision-making up to them. Many retina specialists
tend to follow this model.
Interpretive model – doctor as an advisor.
• The intent of the interpretive model is for the physician
to determine the patient's values and what he or she
actually wants, then to help him or her select the
medical intervention that realizes these values.

10. Models of doctor-patient relationship.
Deliberative model – doctor as a friend and teacher
• In the deliberative model, the aim of the physician-
patient interaction is to help the patient determine
and make the best health-related decision that can
be realized in the clinical situation.

11. Models of doctor-patient relationship

12. Models of doctor-patient relationship

13. Models of doctor-patient relationship
• Szasz and Hollender 1956 - Parson’s concept
• Activity-passivity Model
• Guidance-cooperation Model
• Mutual Participation Model

14. Models of doctor-patient relationship
• Activity-passivity Model-(Prototype model – Parent –
Infant)
• This is entirely paternalistic in nature.
• This type of relationship places the doctor in total control
of the situation and in this way it gratifies needs for
mastery and contributes to feelings of superiority.
• The patient is regarded as helpless recquiring the expert
knowledge of doctor and treatment is commenced
“irrespective of the patient’s contribution and regardless of
the outcome”.
• Clinicial application of model : Anasthesia, acute trauma,
coma and etc.,

15. Models of doctor-patient relationship
• Guidance-cooperation Model - (Prototype model –
Parent – Child/Adolesent)
• In this type of relationship the doctor will speak of
guidance and the patients will cooperate without any
question
• It is argued that despite the fact that the patient is ill,
they are conscious and thus have the feeling and
aspirations of their own. During this time the patient
may suffer from anxiety and pain and in light of this he
may seek help.
• Clinicial application of model : Acute infectious
processes etc.,

16. Models of doctor-patient relationship
• Mutual Participation Model – (Prototype model – Adult
- Adult)
• It is based on the belief that equality amongst the
human being is mutually advantageous.
• In this model doctor does not confess to know exactly
what is best for the patient, this allows the patient to
take care of themselves. Therefore, the doctor’s
Satisfaction cannot be derived from power nor can it
stem from the control over someone else, but rather
from the unique service he provides to humanity.
• Clinicial application of model : Most chronic illness,
psycho analysis, etc.,

17. Psychological types of doctors

18. Psychological types of doctors
• Compassionate – tender-hearted, merciful, easily responsive to the
patient's sufferings.
• Pragmatic – taking into consideration only the objective side of the
disease in the work with his patients, does not pay any attention to the
patients' sufferings.
• Moralist – inclined to moral admonitions and indignant if the patient
doubts or does not follow his doctor's recommendations.
• Diligent – honest in his work, serious, assiduous, industrious and not
inclined to joke with the patients.
• Activist (public worker) – prefers solving of various organizational
problems and serving of social duties in the medical institution to work
with his patients.
• Dogmatic – strictly follows the mastered diagnostic and therapeutic
directions and schemes, hardly apprehends any new things.

19. • Technocrat – overestimates the significance of laboratory and apparatus
data, does not attach any importance to the patients' sufferings and other
subjective aspects of the disease.
• Psychotherapist – tries to grasp the patient's sufferings, help him with a
piece of advice or making him change his mind.
• Sybarite – likes cosiness and comfort, the patients irritate him with their
complaints, he does not consider much their opinion and is inclined to the
Bohemian mode of life.
• Artist– inclined to demonstration of his knowledge and professional skills
to the patients and their relatives, depending upon the conditions he plays
parts of various doctors, namely: hesitating, attentive, luminary, etc..
• Bored idler – a high self-estimation with a rather modest stock of
knowledge, stereotyped diagnosis and administration of treatment, a
scornful attitude towards his inquisitive colleagues.
• Misanthrope – a doctor under compulsion: a lack of any calling for the
doctor's activity is displayed through the absence of such streaks as
mercifulness, kindness, as well as through rudeness, a disgusted attitude
towards the patients and malicious jokes

20. Basic characters and skills of
physician
• Good communication
• Knowledge
• Confidence
• Passion
• Organisation and conscientious mind
• Caring behaviour
• Curious thought
• Support patients
• Compassion

21. Basic characters and skills of
physician

22. Communication of doctors.
• The most common ways to communicate are :
• Speaking
• Writing
• Visual image
• Body language
• Goals of communication are :
• To change the behaviour
• To get and give information
• To persuade
• To ensure understanding

23. Problems of contemporary healthcare
system.
• One of the major problems of contemporary healthcare
system is the growing number of unsatisfied patients.
• Once a survey was recorded in which respondents
answered almost the same question – what makes patients
dissatisfied with the healthcare system? One of the
surveys was organized in India, the other – in the USA. But
you can see that the results are similar. The commonest
complaints of the patients are: lack of transparent
information and explanation of the case; not enough time
with the doctor and on the contrary – too much time spent
in waiting; rude and lazy staff who don’t care and don’t feel
any compassion; billing mistakes and a lot of cases when
the preliminary cost of treatment increased sufficiently. We
see, that the major complaints are due to poor relationship
between medical personnel and the patients.

24. Problems of contemporary healthcare
system.
• Confidence in the doctor often depends upon the
first impression which develops in the patient
during the first meeting with his doctor, the
doctor's urgent facial expression, gesticulation,
tone of his voice, expressions, as well as his
appearance: if the patient sees that his doctor is
untidy and sleepy for some reasons which are not
caused by his work, he looses any belief
considering that a person who is not able to take
care of himself cannot care for others and be
reliable in his work.