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  1. 1. Doctor-patient relationship :Need and rational Dr. Md. Nazmul Hossain Resident Surgeon, Department of Surgery Medical College for Women and Hospital, Uttara
  2. 2. Learning objectives By the end of this session audience should be able to:  Describe the different types of doctor- patient relationships;  Social factors influencing this consultation;  Outline some of the sociological perspectives on the doctor-patient relationships.
  3. 3. Contents  Introduction  Types of D-P relationship  Barrier of good communication  Art of interview  Recommendation  Take home massage
  4. 4. Stop and think! In what ways are relationships between doctors and their patients different from other social relationships (e.g. between student and librarian or between passenger and bus driver?
  5. 5. Social relationships  Perhaps patient has just met her doctor, but within seconds s/he tells the doctor very intimate personal details about his/her health. AND  within a minutes, s/he is prepared to remove his/her clothes and submit to a physical examination.
  6. 6. Social relationships  This is a one-way process, it would be highly inappropriate if the doctor started to discuss his/her own bowel movements or if the patient asked his/her personal questions.  The doctor-patient interaction is shaped by their differing social roles and their different needs.
  7. 7. Current practice of “ ConsultationConsultation” Patients are likely to rely on the doctors because ofPatients are likely to rely on the doctors because of their lower education and social status and theirtheir lower education and social status and their high dependency on medical deliberation, andhigh dependency on medical deliberation, and obedience to authority;obedience to authority; while doctors dominate the consultation processwhile doctors dominate the consultation process and the decision-making because they are theand the decision-making because they are the legalized profession, i.e. supported by our sociallegalized profession, i.e. supported by our social institutioninstitution  The status and power of physicians may encourage patient’s dependencyThe status and power of physicians may encourage patient’s dependency and, influence how they perceive their healthand, influence how they perceive their health.
  8. 8. Disadvantages of the currentDisadvantages of the current practicepractice 1.1. Restricts the patient’s inclination to help themselves.Restricts the patient’s inclination to help themselves. 2.2. Restricts the patients in giving their own opinion.Restricts the patients in giving their own opinion. 3.3. Reinforces the patient’s sick role.Reinforces the patient’s sick role. 4.4. Reinforces the hierarchical relationship betweenReinforces the hierarchical relationship between doctor and and patient. 5.5. Assumes the doctor knows everything about the patientsAssumes the doctor knows everything about the patients rather than the patient knowing his or her own conditionrather than the patient knowing his or her own condition better (e.g. pain)better (e.g. pain)
  9. 9. Types Doctor-Patient Relationship Physician control Patient Control Low High Low Default Paternalist High Consumerist Mutuality
  10. 10. Paternalism The traditional D-P relationship Doctor Takes on role of “parent” Patient submissive But currently shift towards Mutuality
  11. 11. The Paternalistic Approach “If I’ve told you once I told you 1,000 times, stop smoking!!”
  12. 12. Patient-controlled consultation “You’re paid to do what I tell you!!”
  13. 13. Doctors’ barriers to effective communication • lack of specific knowledge; • lack of counselling skills; • lack of time; • lack of appropriate resources.
  14. 14. Patient barriers to effective communication  Educational level  Sex  Social  Different languages  Membership of an ethnic minority
  15. 15. Developing a REAL relationship  Have an „open” attitude: whatever is going on between us in interaction is important and intimate, no matter what is being discussed.  Develop in the interviewee a feeling that he/she is being treated  Concentrate all your attention on the interviewee  Help the interviewee to express those contents which are important for the diagnosis • Create a calm and unhurried atmosphere • Listen kindly with empathy • Do not express surprise
  16. 16. First minutes…  Try not to be late…  Concentrate fully and only at the patient  Take care of the patients comfort  Organize the environment  Pay attention to the physical distance  Introduce yourself…
  17. 17. The Art of asking questions  The first question: general, open, refer to the interviewee’s general life situation or the presenting problem • What brings you here? • What can I do for you? • What is your problem? • Why are you here? (in the hospital) • Could you tell me a bit more about …
  18. 18. The Art of asking questions  Narrowing down the questions (general to specific)  Progression (relatively benign to personal)  Direct questions  Leading questions (indirect)  Postponed questions (change of context, better moment)  Projective questions („some people…”, description of interpersonal situation)
  19. 19. Language…  The language must be matched to: • interviewee’s intelectual level • verbal skills • personal experience  Avoid the proffesional language and shortenings
  20. 20. When the interview comes to a close…  Check whether all problems have been discussed and leave some time for their discussion  When time is up – communicate it directly instead of constantly checking the time or „suggesting” that you have to go (e.g.. By gathering the notes impatiently)  Try to summarize the interview  Finish the conversation stressing your interest in the interviewee and in what has been said  You can ask the patient to evaluate the conversation  Say good-bye, get up and thank the interviewee for coming.
  21. 21. How to maintain the rapport?  Verbal signals: • „Yes”, „I understand”, „Yhym” • „Could you tell me more about this?” • Paraphrasing • Silence  Nonverbal signals: • Body posture • Tilt of the head • Facial expression • Gestures • Eye expression • Smiling • Synchronisation
  22. 22. Recommendation Communication and Diagnosis Patients who feel at ease and who are encouraged to talk freely are more likely to disclose the real reason for consulting
  23. 23. Communication and Treatment Advice reassurance and support from the doctor can have a significant effect on recovery The placebo effect Recommendation
  24. 24. 1.1. Both patient and doctor could participate inBoth patient and doctor could participate in discussion and planning for treatments.discussion and planning for treatments. 2. Increase health knowledge and understanding2. Increase health knowledge and understanding among patients.among patients. 3. Treat patients in a humanistic and adult manner3. Treat patients in a humanistic and adult manner  Empowerment of the ptsEmpowerment of the pts Take home message
  25. 25. Thank you