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Definition of DPR
Why does DPR matter?
Parson's Ideal Doctor & Patient
Types of DPR
Importance of DPR
Elements of DPR
Key components of DPR
Communication between Doctor & Patient
Barriers in communication
Factors influencing DPR
How to improve DPR
Patient Education
Definition of DPR
Why does DPR matter?
Parson's Ideal Doctor & Patient
Types of DPR
Importance of DPR
Elements of DPR
Key components of DPR
Communication between Doctor & Patient
Barriers in communication
Factors influencing DPR
How to improve DPR
Patient Education
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
An Introduction To Community Medicine (Basic Definitions) | SurgicoMed.comMukhdoom BaharAli
Community Medicine is the new branch of medicine recently added with a concept to provide
health all of the community as it is the basic right of the community. Community Medicine may
be defined as;
“Community Medicine is a system of delivery of comprehensive health care to the people by a
health team in order to improve the health of community.” (WHO Definition)
The Philippine Board of Ophthalmology embarks on a difficult task of mandating teaching of ethics and professionalism for residency Training Programs in Ophthalmology in the country. This is the first lecture in that conference defining both ethics and medical professionalism.
The course imparts the basic concepts and understanding in Sociological and Anthropological subject matter, theories, concepts, trends and cultural systems. The course aims to impart the basic concepts and the knowledge in medical sociology/anthropology, socialization in health, culture and health, provider consumer relationships in public health, indigenous health care system and alternative health care practices.
presentation on patient perspective of illness.pptxanzlaliaqat
Illness:a disease or period of sickness affecting the body or mind.
Illness is condition of pronounced deviation from normal healthy status
Illness is subjecting experience.
Illness behavior:The manner in which individuals monitor their bodies, define and interpret their symptoms, take remedial action, and utilize sources of help as well as the more formal health care system
Examples:Inflammation
Sickness
Behavior
Depression
Determination of illness behavior:Recognizability of illness behavior
The extent the person perceives symptoms as serious
Information, knowledge and cultural assumptions
Disruption in family work and social activity
Frequency of appearance
Tolerance Level
Physical proximity of treatment resource
OUTLINE:
Introduction: Doctor’s relationship and roles
Professionalism and Professional Attributes
Doctor’s duties towards himself/herself
Doctor’s duties towards his/her colleagues
Doctor’s duties towards his/her profession
Doctor’s duties towards his/her community
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
An Introduction To Community Medicine (Basic Definitions) | SurgicoMed.comMukhdoom BaharAli
Community Medicine is the new branch of medicine recently added with a concept to provide
health all of the community as it is the basic right of the community. Community Medicine may
be defined as;
“Community Medicine is a system of delivery of comprehensive health care to the people by a
health team in order to improve the health of community.” (WHO Definition)
The Philippine Board of Ophthalmology embarks on a difficult task of mandating teaching of ethics and professionalism for residency Training Programs in Ophthalmology in the country. This is the first lecture in that conference defining both ethics and medical professionalism.
The course imparts the basic concepts and understanding in Sociological and Anthropological subject matter, theories, concepts, trends and cultural systems. The course aims to impart the basic concepts and the knowledge in medical sociology/anthropology, socialization in health, culture and health, provider consumer relationships in public health, indigenous health care system and alternative health care practices.
presentation on patient perspective of illness.pptxanzlaliaqat
Illness:a disease or period of sickness affecting the body or mind.
Illness is condition of pronounced deviation from normal healthy status
Illness is subjecting experience.
Illness behavior:The manner in which individuals monitor their bodies, define and interpret their symptoms, take remedial action, and utilize sources of help as well as the more formal health care system
Examples:Inflammation
Sickness
Behavior
Depression
Determination of illness behavior:Recognizability of illness behavior
The extent the person perceives symptoms as serious
Information, knowledge and cultural assumptions
Disruption in family work and social activity
Frequency of appearance
Tolerance Level
Physical proximity of treatment resource
OUTLINE:
Introduction: Doctor’s relationship and roles
Professionalism and Professional Attributes
Doctor’s duties towards himself/herself
Doctor’s duties towards his/her colleagues
Doctor’s duties towards his/her profession
Doctor’s duties towards his/her community
MANAGED CAREEthical concerns, issues and challenges.docxinfantsuk
MANAGED CARE
Ethical concerns, issues and challenges
MANAGED CAREThe History of managed care
The managed care is identified to be within the health maintenance organization. There are techniques which involve within the range of personal health profit program. This technique play a role like to cut back the price of providing health advantages and improve the standard of care Certainly, the managed care is therefore omnipresent within United States thus tend to attract an overall goal tackling dominant medical prices. Due to standards regarding U.S healthcare delivery, managed care sharply involved in critics regarding impact of the physicians-patient relationship.
*
ETHICAL CONCERNSManaged care ethics
The ethical issues in managed care are similar to physical health whereby the structural differences complicate an ethical analysis. This explores that the managed health care could limit access. This trend involves managed mental health care which is based on assertion in empirical evidence. This enhances access to care and to patients preferably to obtain services in timely and appropriate manner. This is because the evolution of managed care has posed ethical problems for the physicians, patients and administrations.
*
ETHICAL CONCERNSIssues and challenges
Managed care organization is responsible for managing care of the population through health care system which monitors and coordinates care through entire range of service, emphasizes prevention and health education, encourages provision of care preferably in most of the setting and promotes cost-effective use of services through aligning incentives.
*
ISSUE CONCERNS AND CHALLENGESManaged care ethicsIssues regarding medical ethics
The managed care involves social context of ethical decision making through different stakes of traditional medical ethics. Ethically, the managed care realizes separation of ethical concerns from the political and social environment. The ethical panes indicate that the ethical obligation of managed care tends to explore care and physicians as well as obligation of patient to honor the social contract. Therefore, parents have an obligation not to lie so as to get what they should have in their perfection.
*
OVERVIEW OF MANAGED CAREAn overview of how managed care impacts the physician–patient relationship.
The managed care is identified to have emerged as a dominant method of health care provision in USA. Moreover, the new organization of medicine has threatened the role of physicians as professional. The survey contacted indicates that, the physicians believe managed care is impacting their professional obligations. The managed care on medical practices is evolving and the clinicians, lawyers, medical ethicists and other observers have raised the concerns about physicians-patient relationship. Also the studies have explored the effects of managed care on the physician satisfactory.
*
OVERVIEW OF MANAGED CAREMethods applied
The me ...
A system of moral principles that apply values and judgments to the practice of medicine
MCI amended their guidelines of professional conduct, etiquette and ethics for the Doctors
Achieving Rapid Cost Reduction and Revenue Improvement by Engaging Clinicians...PYA, P.C.
PYA Principal Kent Bottles, MD, gave the keynote address, “Achieving Rapid Cost Reduction & Revenue Improvement by Engaging Clinicians & Administrators,” at the recent Healthcare Financial Management Association’s (HFMA) 2014 Fall Institute in Bloomington, Indiana. In the presentation, he talked about how to engage physicians in all of the efforts needed to respond to the Affordable Care Act and healthcare payment reform.
Ethics and Learning Health Care: an overview of the differences between what is considered research and what is considered clinical care, and an introduction to the ethical issues that arise from this boundary being blurred.
Romana Hasnain-Wynia: Incorporating the Patient’s Perspective in ResearchNIHACS2015
Romana Hasnain-Wynia, MS, PhD, is the Director of the Addressing Disparities Program at the Patient-Centered Outcomes Research Institute (PCORI). During the conference, she gave a presentation on incorporating the patient’s perspective in research.
View the webinar on NEET PG counselling - https://www.youtube.com/watch?v=ndtirntqMOM&t=8s
This ppt enumerates all key points to be considered in NEET PG counselling procedure.
View the webinar on NEET PG counselling - https://www.youtube.com/watch?v=ndtirntqMOM&t=8s
Guidance for choosing branch and college post MBBS for PG - MD/MS
Video presentation - https://www.youtube.com/watch?v=45CjKnJaIC0
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Video presentation - https://www.youtube.com/watch?v=45CjKnJaIC0
Learn Community Medicine along with me : https://t.me/drvkspm
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Learn Community Medicine along with me : https://t.me/drvkspm
Learn Community Medicine along with me : https://t.me/drvkspm
Be my friend by connecting with me through:
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Learn Community Medicine along with me : https://t.me/drvkspm
Video of 30 career options after MBBS - https://www.youtube.com/watch?v=Zjkx7yHwa0I
Learn Community Medicine along with me : https://t.me/drvkspm
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Youtube video of this presentation - https://www.youtube.com/watch?v=aIOPf72M3aI&t=8s
Learn Community Medicine along with me : https://t.me/drvkspm
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Learn Community Medicine along with me : https://t.me/drvkspm
This ppt discusses about
What is Community based participatory research?
Principles of Community based participatory research
Advantages of Community based participatory research
What is Focus Group Discussion?
Why Focus Group Discussion?
Steps in Focus Group Discussion
Advantages and limitations of Focus Group Discussion
Conclusion
This powerpoint covers the following subtopics:
What is obesity?
Pathogenesis
Burden
Epidemiology of obesity
Assessment of obesity
Consequences of obesity
Prevention and Control
This powerpoint presentations briefs about:
Financial ratios
Categories of Financial ratios
Generating stock ideas
The Due diligence – Checklist
Equity Research
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptx
Doctor Patient Relationship - Medical Sociology
1. Medical Sociology
Doctor – Patient Relationship
Dr Pragya Kumar
Additional Professor
Dept. of CFM
AIIMS Patna
Presenter:
Dr Venkatesh Karthikeyan
2nd year PG
Dept. of CFM
AIIMS Patna
Dr Purushottam Kumar
Senior Resident
Dept. of CFM
AIIMS Patna
Moderators:
1
Medical Sociology : Doctor - Patient Relationship
2. Contents
• Why is this topic important?
• Patient – related factors
• Doctor – related factors
• Health system related factors
• Framework for action
• Conclusion
Medical Sociology : Doctor - Patient Relationship 2
3. Introduction
• Medical Sociology
• Aka health sociology
• Study of the social causes and consequences of health and illness
• Areas of focus:
• Social determinants of health and disease
• Social behaviour of patients and health care providers
• Social functions of health organizations and institutions
• Social patterns of the utilization of health services
• Relationship of health care delivery systems to other social institutions
• Social policies toward health.
Medical Sociology : Doctor - Patient Relationship 3
6. Doctor – Patient Relationship
• Reasons for strain
• Commercialization
• Over medication
• Over specialization
• Heavy reliance on technology
• Decreased interaction
• Lack of training in medical ethics
• Lack of communication skills
• Authoritarian behavior
• Changing expectations
• Faults in the system
Medical Sociology : Doctor - Patient Relationship 6
• Results of strain
• Mistrust
• Dissatisfaction
• Resentment
• Litigations
• Assault
• Destruction of properties
10. Patient related factors
• Background of the patient
• Cultural context
• Reluctance to access healthcare
• Challenges in accessing care
• Overcrowding and waiting time
• Expectations of patient
• Rising expectations
Medical Sociology : Doctor - Patient Relationship 10
11. Patient related factors (Contd.)
• Barriers in understanding the doctors
• Receiving end of insensitive behavior
• Need for respect, dignity and understanding
• Empathetic treatment
• Unregulated Commercialization
• Out of Pocket expenditure
Medical Sociology : Doctor - Patient Relationship 11
14. Doctor – related factors
Pre-interaction with patient:
• Aptitude of medical aspirants
• Foundation course for MBBS students
• Course on ethics
• Medical sociology
Medical Sociology : Doctor - Patient Relationship 14
15. Doctor – related factors (Cont.)
During interaction with patient:
• Not displaying interest
• Being authoritative
• Inability to communicate
• Addressing the concerns of the patient
• Pillars of positive dialogue
• Answering the questions
• Empathetic patient care
• Human rights
• Gender sensitivity
• Breaking the bad
Medical Sociology : Doctor - Patient Relationship 15
16. Doctor – related factors (Cont.)
Post interaction with patient:
• Measuring patient satisfaction
• Managerial skills
• Record keeping
• Upgrading the clinical skills
• Relationship with pharma companies
Medical Sociology : Doctor - Patient Relationship 16
17. Health system related factors
• Who will be blamed?
Medical Sociology : Doctor - Patient Relationship 17
19. Health system related factors
• Patient facilitation
• Educating patients about their responsibilities
• Standard operating protocols
• Patient safety
• Patient load and time availability
• Patient centered care
• Health promotion and disease prevention
Medical Sociology : Doctor - Patient Relationship 19
20. Health system related factors (Cont)
• Development of a referral system
• Grievance redressal system
• Legal assistance
• Accreditation of hospital
• Media relations
Medical Sociology : Doctor - Patient Relationship 20
21. Health system related factors
Role of Medical councils
• Teaching of ethics
• CME
• Regulating relationship between pharma companies and doctors
• Punishment for unethical conduct
• Give recognition and incentives for doctors with exemplary ethical conduct
• Protect doctors from unnecessary harassment and unjustified malpractice
suits
Medical Sociology : Doctor - Patient Relationship 21
22. Framework for action
• Therapeutic relationship
• Patient participation in decision making
• Patient satisfaction
• Patient’s charter
• Organizations to improve the doctor-patient relationship
• Reduce the strain
Medical Sociology : Doctor - Patient Relationship 22
23. References
• Strengthening the doctor-patient relationship [Internet]. [cited 2022 Apr 8]. Available from:
https://apps.who.int/iris/handle/10665/205942
• World Health Organization, Regional Office for South-East Asia. Module for teaching of medical
ethics to undergraduates. New Delhi: WHO-SEARO, 2009. Document No. SEAHSD- 321.
• Leape LL, Berwick DM. Five years after to err is human what have we learned? Journal of the
American Medical Association. 2005; 293(19): 2384–2390.
• Macrodimitris S, Sherman EM, Williams TS, Bigras C, Wiebe S. Measuring patientsatisfaction
following epilepsy surgery. Epilepsia. 2011 Aug; 52(8): 1409-17 –
http://www.ncbi.nlm.nih.gov/pubmed/21762442 - accessed 10 June 2013.
• Kleinman, A. Catastrophe and caregiving: the failure of medicine as an art. The Lancet.2008 Jan
5; 371(9606): 22-23. doi:10.1016/S0140-6736(08)60057-4 –
http://www.lancet.com/journals/lancet/article/PIIS0140-6736(08)60057-4/fulltext – accessed
10 June 2013..
• Turner-Warwick M. The patient–doctor partnership over 60 years and the role of the
royalmedical colleges. Clinical Medicine. 2008 Dec; 8(6): 573-575.
• Das A. Public health in India: the challenge of politics. Indian Journal of Public Health.2012 Jul-
Sep; 56(3): 245. doi: 10.4103/0019-557X.104269 - accessed 09 June 2013.
Medical Sociology : Doctor - Patient Relationship 23
As a continuation of our webinar series on medical sociology, we will be discussing about doctor patient relationship today
Areas of focus under medical sociology
For today’s discussion, we are going to highlight second point
When this social behaviour of patients and health care providers is disturbed, it results in these kind of incidents
In recent days, we are coming across these kinds of news about
All these shows that the doctor-patient relationship is not smooth these days
So here comes the importance of a good doctor-patient relationship
*it was common for people to regard doctors as members of their families and the trusted them extended to matters even beyond the medical needs of the family. But these days, this relationship is strained
Very often, the doctor is blamed for faults in the system over which he has no control. One of the causal factors is
the design of the health care services delivery systems, a system that waits for people to get sick and come to the health care centre for treatment
The patient, doctor and the system are responsible for this strain – result of this is?
Pubmed search – “Workplace violence” – we can see this as increase in prevalence of violence against doctors as well as increased awareness and reporting of incidents (380 articles in 2021) –A study done by purushottam sir (82 doctors- community based cross sectional study)
Similarly, a study done by doctors of AIIMS kalyani
So, what are the factors influencing doctors – patient relationship – when all these 3 broad group of factor works good in a synergestic fashion, it will result in a perfect doctor-patient relationship
So, first we will discuss the patient related factors, which is going to influence the doctor-patient relationship
1)role of the patient is mediated through the social, economic and cultural context within which he or she is based on . This context will shape his or her interaction with the institutions and practitioners who provide care - The response of the patient and his or her ability to interact with the doctor is also shaped by f gender, race, caste and class – all these interact dynamically to shape social and economic access to care, thus influencing upon the patient’s ability to continually seek care
2) In countries like India, care of patients is something that is often taken up by family – not only the patient is to be convinced, it is important to convince the family of the patient – hence we should understand the patients’ backgrounds, economic and social capacitites- and we should have a good rapport with family
3) Out of fear of judgement and retort, the patients often do not disclose various kinds of efforts that they might have made in order to handle the problem that they are faced with. The often insensitive behaviour towards people from poorer backgrounds contributes to the patient’s reluctance to access health care offered by practitioners of modern medicine.
4)Transportation, loss of wages, expenditure on attendants, food – all these results in inappropriate treatment or inability to complete the proper treatment – this results in worsening of existing health condition – and ultimately ending up in higher tertiary care centres
5)As a result of poor distribution of facilities and the flooding of tertiary care facilities in urban centres with patients, the overworked doctors are barely able to spend time with patients. The interaction is thus very mechanical. the patients are rarely able to build a relationship with their doctors. They may not experience the comfort or the ease that they require from an interaction meant to heal. In the case of poor patients, this interaction becomes strained further by differences in framework, the severe hardships that they have to undergo merely to physically approach allopathic providers and the paucity of money that results
in breaks in treatment which may be misconstrued by doctors as defaulting or refusal to adhere to instructions about treatment and care.
6)a person experiencing illness is a sufferer and expects to be cured and healed. He or she expects to be treated with care, sensitivity and dignity which are the cornerstones of the healing process.
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7)We should remember that, unlike in older times, we are no longer dealing with uninformed patients. – and we are aware about the trend on doctors shopping, where patient takes opinion from multiple consultatns – and read a lot of articles from google before coming to us – and people believe that better can be given by private hospitals than government hospitals – and when they are spending their hard earned money for medical treatment, their expectation would obviously rise – when when this ever rising expectation is not met accordingly, it is going to hinder the doctor patient relationship
1)Even despite all these, if a patient approaches a doctor, he may be unable to understand the doctor’s explanations about their health conditions and the reasons for being asked to follow certain regimens. Language barriers and educational backgrounds are important determining factors causing the divide
2)Patients , especially poor ones and women face discrimination by HCW. – they often have limited access to educational and economic resources – they are often at the receiving end for insensitive behavior and judegments by medical professions – sometimes doctors stereotype them am uninformed, ignorant and consider patient to have irrational health practices – this is going to ultimately affect the health seeking behavior of the patients
3)Needed in addition to technical competence and sound treatment – but allopathy doctors are not very good at it – it is clearly evident from the roaring practice of quacks, who are excellent in communication, even though they lack technical competence
4)Sometimes patient might have undertaken some home remedies or alternative medicines – but allopathic doctors usually consider that it is non scientific and ineeficacious – though this attitude might be technically correct and we may scold patients sometimes for this – this has a bad psychological impact on patient – now what will happen? – patient will stop revealing the details of treatment and this is ultimately going to affect the patient care
5) Unregulated commercialization like commission in drugs and diagnostic services has contributed to the increasing tendency of malpractice. This often leads to patient dissatisfaction and may result in litigation to implicate the doctors for errors that are real or imagined. All these increases the suspicion on the doctors, thus affecting the doctor patient relationship.
6) Studies show that Private expenditure exceeds 65% of the total expenditure on health care in countries such as Bangladesh, India, Indonesia, Myanmar and Nepal. Of this, out of pocket (OOP) expenditure constitutes about three fourths of the expenses.This puts in-patient care out of reach of large populations in these countries. In-patient health care expenditures are known to be among the leading causes of debts for rural populations in countries such as India. Cost of care is also seen to escalate due to over-specialization, inappropriate use of drugs and diagnostic technologies and the aggressive intrusion of pharmaceutical companies into health-care settings
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.OOP is the expenditure incurred by the community members for availing healthcare services(IAPSM) – share of out of pocket payments of total current health expenditure (WHO) - (BMJ) Per person monthly OOP is defined as total monthly OOP divided by household size for each household (can be defined as share of total non-food expenditure of household.
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Catastrophic health expenditure (WHO)- when health expenditure is grater than or equal to 40% of the capacity to pay – some studies define it if the total health expenditure is more than 10% of annual income
Out-of-pocket expenditure (% of current health expenditure) - India
Share of out-of-pocket payments of total current health expenditures. Out-of-pocket payments are spending on health directly out-of-pocket by households.
World bank data – India : 54.7%, US – 11.3%, uk – 17.7% - world – 18, Armenia – 85%
1)How do we enter medical colleges? – we give NEET UG examination and get MBBS seats – this exam is going to assess only our knowledge – but the aptitude of a person wanting to become a doctor is never taken into consideration into medical colleges – the entrance examinations donot/maybe cannot assess whether a person has enough empathy towards patients – this on long run might have a significant impact on doctors’ patient relationship
2)While I joined MBBS – I was taken to dissection hall on day one, all first year classes started immediately, we had exams every week, everything went in a hurry towards completion of curriculum – I didn’t have enough breathing space and time to adjust – but 3 years down the lane, the whole trend changed – MBBS freshers were given orientation for several weeks – my college organized foundation courses where students were taught about communication, leadership, medical ethics and many such soft skills. I believe that such kind of foundation courses should be promoted everywhere – it might be on paper for all colleges – but college managements should actively implement it – so that the fresh medical students understand the importance of soft skills – which is going to make them better doctors
3)It is a recommendation from WHO that teach ethics for medical ethics. Even there is a wing called UNESCO Chair in Bioethics, which does a wonderful job of spreading knowledge about bioethics across the globe. Such kind of initiatives promoting ethics should be encouraged – and all medical councils should take interest in implementing teaching of ethics and assessment of the same
4)I do not remember coming across a term called medical sociology during MBBS – active efforts must be taken to include sociology in curriculum - this will create in medical students – the respect for the patients – and it will inculcate the spirit of equality in his relationship with patient – many a teams the greatest fear of patients is that doctor will scold him or treat without dignity - teaching medical sociology right from early stages would help students under the social aspects of medicine – even I see this initiative by department to conduct PG seminars on Medical sociology as a very noble one – I believe that the result of such seminars will make us much better doctors
1)As doctors, we should be mindful of the fact that the patients usually travel long distances and spend a lot of time waiting to see the doctors – but doctors in their busy schedule, sometime fail to even display interest – a doctor might be highly qualified and may have good intentions on the patient by heart – but if he fails to display that intent, then the patient considers that there is a lack of concern from doctor side - in a study, it has been shown that 33% of patinets of a country stated that doctors had no interest in them as persons - even a simple smile and few kind words can address the issue.
2)In a doctor-patient relationship, it goes without saying that doctor is more powerful – hence, it can be easy for the doctor to be authoritative – and attitude is not acceptable to patients – even though they don’t say it on our face
3)In recent times, we could see a change in doctor patient relationship due to change in doctor’s behaviour towards patient as well. It is mainly due to inability of the doctor to communicate with the patients and the attendants. This is probably because most of the medical colleges do not focus on communication skills during UG. Either this could be the reason or the doctor does not have time to communicate with the patients. Either way, patient is disappointed with the apparent lack of communication – which he considers to be apparent lack of concern – and this might ultimately lead to malpractice suit
4)The patient needs to believe that the doctor follows an ethical code of conduct – he needs to set aside any of his concern regarding investigations, duration of hospital stay, mode of treatment ,etc – if patient has any suspicion that this doctor is making me do these many tests unnecessarily, or prescribing medicines for commissions – then this will reduce the confidence of patients on doctors – which is going to retard the healing process
5)There are three pillars of a positive dialogue between the doctor and a patient – they are trust, communication and personalized care. Trust and personalize care are closely related to the communication skills of the doctor – it not only means the verbal communication, but also non-verbal communication like a proper eye contact and a gentle touch – the patient must feel that the doctor is interested not only in the disease – but also interested in the patient himself as a person – doctor should try to understand the perception and needs of the patient – he should treat the patient with dignity and courtesy
6)A good doctor should not only answer the questions of patients, but also should encourage the patient to ask many questions - this is because patient is already in a new environment which makes him feel insecure – in such a condition, if questions are brushed aside with annoyance or irritation, it will lead to negative impact on doctor patient relationship – lack of time should never be a reason for rude behavior
7) We all should understand that whenever patient comes to visit us, he is already in stress – he would have waiting a long time to see us, he would have travelled a long distance, he would have taken leave from his routine work – so patient comes to us in such a condition – we should try to approach him with empathy – we should not be too keen on entering data in computer/writing case sheet - if this trend continues, then no patient will hesitate to miss an opportunity to file a malpractice suit against doctors.-we should try to involve the patient in decision making process – i.e, is should be more of patient centric than doctor centric – and once again we should never display irritation or annoyance to the patient – patient is not responsible for any of our personal problem or lack of time
8) We should learn to respect the rights of patients as human as well. Like you might have watched Mumbai dairies series, where a police and criminal would have been admitted in the same time – just because he is a criminal, we should not deny the basic right of getting treatment – as doctors, we should be non judgemental and behave professionally, giving equal care to all – be it police or criminal, army or terrorist, all are our patients
9)Also, we should respect the gender sensitivity. If a male doctor is examining a female patient, it is always better to have female attendant along with.
10)Due to lack of communication skills – doctors cannot properly interact with patients – it is not because they do not want to, but in many cases – it is because they do not know how to – and in many cases they are not trained to breaking the bad news as well – all this will ultimately lead to a hampered doctor patient relationship
Doctor and the hospital should try to regularly measure the patient satisfaction – this will help us identify the lacuna in the healthcare being provided and facilitate working towards improving it
We should also develop good managerial skills – though we may not receive any formal training for it, it is a much required skill for a smooth doctor patient relationship – for example, I am posted in RHTC – and if patient comes for checking his CBG and there is no lancet available in the NCD clinic, then patient is unable to avail the service – I cannot say that arranging lancet is not my responsibility- because non availability of lancet is ultimately going to hinder the healthcare service provided and in turn affects the doctor patient relationship
3) we, being professionals, do not consider other non-professional activities u as priorities – one example is the proper record keeping of the patients – fortunately or unfortunately record keeping is a priority today – mbbs students should be taught regarding the same – it is being done in some premier insitutes like ours – in form of taking mbbs students to MRD visit – all medical colleges should do the same, so that they realise the importance of it and this will protect them from malpractice suits in the future
4)Medicine is ever evolving – and it is the duty of doctor to keep himself updated – he should upgrade himself continuously by attending CMEs and other academic events – Also, today we are living in the era of internet, where even a layman has access to latest treatment guidelines for his disease – if we are not updating ourself, then the patient’s confidence on us will decrease , ultimately affecting our relationship with the doctor
5)These days, patients feels that doctors write them unnecessary medication – even if it necessary, he writes the brand name of company which gives him more commission- he orders CT MRI unneccasrily even for one day headache – all these thoughts are increasing in patients mind these days – doctors should behave in such a way that patients do not feel that way – even if we are prescribing a costly medicine, we should try to explain the patient why we are doing so, so that patient gains our conference
*in a doctor patient relationship- You as a doctor can be good – patient is also good – but when the system is not good, again the relationship gets affected –
we would have seen that during peak of covid second wave, there were no beds , severe shortage of drugs and oxygen – but ultimately doctors were blamed, doctors were beaten up – it is not practical to expect that patient will understand the difference between errors committed by a doctor vs a mistake that is due to failure of system – hence a good health system is need to nurture the doctor patient relationship
1) Patient also needs to be educated to clearly understand the functioning of the health system – they need to understand the role of various professionals who provide healthcare – hospital should have a patient friendly approach – hospital should employ staffs who can guide the patients, answering the questions patiently and make sure their waiting time is reduced – even the waiting time should be a patient friendly environment – hospitals should think of improving the comfort of the patients – like in our medical college hospital, they increased the OPD time late in the evening , so that working professionals can comfortably come to hospital without taking a day off – similarly mobile health services can be provided wherever possible
2) It is not uncommon to encounter patient coming to us asking for a drug of their choice or asking for a CT head themselves, without even consulting a doctor – and there is trend of doctor shopping also these days, where patient goes from one doctor to the other – patients tends not to disclose other treatments undertaken , especially if it belongs to alternate streams of medicines – it could lead to serious interactions – like these there are many things which needs to be changed from patient side as well, for a healthy doctor patient relationship
3) Doctors should be protected by a system of patient safety measures, as they would not have to be at the receiving end of criticism for failure of systems – there should be regular audits and each case of failure or error needs to investigated – tehre should be regular meets to review the systems in place – this will allow us modification of the system, or even the replacement of the systems
4) The patient goes to a hospital to get well, it is unacceptable if the patient life is endangered by being admitted into the hospital. Deaths due to adverse medical events and reactions due to negligence do happen these days – one of the main reasons is the prescription errors - wrong drug, wrong duration too many drugs, poor handwriting, irrational use of antibiotics,etc hampers the patient safety
5) Main constraint of a doctor is the limited time available for each patient – the magnitude is much more in government hospital like ours – it becomes highly challenging to develop a personal rapport in such a short span of time – what can we do? – and that too patients generally want to be seen by the senior most and best qualified doctor – we need to explore how much and in what ways other paramedics like nurses could reduce our workload – for example, in OPDs, nurses should take vitals for the patient and then send him to doctor for consultation, so that time is saved
6) The health systems need to be patient centered and patient friendly, leading to confidence and trust of the patient in the hospital –appropriate steps to increase the comfort of patients should be taken - like waiting time is to reduced to as minimum as possible – the system must be transparent and things should be explained to patient in detail – also there should be a sound complaint redressal system
7) Consider an oncologist who handles a lot of lung cancer patients daily- if the system was better, then there would be strict regulations on sales on tobacco products – awareness campaigns would be conducted effectively – when the patient visited any doctor/health professional for any complaints earlier, he would have strongly explained the ill effects of smoking – because there was some weak link in this , this oncologist is being overburdened by lung cancer cases now – also, the pubic themselves should develop the attitude of taking care of their own health
1) A proper referral system should be in place so that cases can be managed appropriately, according to the level of disease
2) Having a GRS will prevent the unjustified blame on the doctors - there should be an active system available to all patients and attendants , as well as the employees of the hospital which would help the hospital understand the drawbacks and constraints – the opportunity to talk about and share the experience will itself have a calming influence on both the doctors and patients – this will definitely decrease the number of malpractice cases being filed against the doctors
3) every hospital should have a mechanism for providing legal help for doctors – this will increase the confidence of doctors as well as make him aware of the code and conduct in hospital
4) There should be a system of accreditation and the hospital should be accredited by bodies like NABH, which will instill more confidence in patients
5) Doctors should have a good relationship with media – doctors should aid in dissemination of legitimate health information - media tends to highlight the unpleasant experiences and portray doctors as sinners in certain cases – when we are in good terms with them, it will help us overcome this bad impression – also we must actively try to highlight our success stories in media as well – we should try our best to facilitate fair and balanced reporting of health issues
Medical councils are regulatory agencies for doctors. The role of medical councils is restricted not only to laying guidelines , but also in ensuring that guidelines are being followed – in addition to the ethical guidelines, medical councils should look after whether doctors follow code of etiquette as well.
Read all the points
When the medical council functions effectively, it will facilitate better practices by doctors, ultimately leading to a good doctor patient relationship
1)Satisfaction with the doctor patient relationship is a crucial factor in a patient opting for treatment from a specific practicioner. A long term good relationship between a patient and the doctor could be developed into a personal relationship , and such relationship is a key component of patient centred care – it has the potential to have positive health outcome for patients as it allows a therapeutic relationship between the physician and patient – this relationship begins not during the end of first treatment session, but at the very moment patient sees a doctor
2)Patients should be encouraged to ask more questions and make them feel that they are being given a free hand in decision making regarding their treatment – if such a liberty is not given, it is very difficult to earn the trust of the patient – this might lead to decreased confidence on us and decreased compliance as well
3)There are studies showing that the patients who have good and trusting relationship with the clinics are more satisfied and the satisfied patients get better clinical results – they are more willing to follow what the doctr said – they are motivated to take care of themselves and are more comfortable seeking help when problem arises – giving patients such a level of comfort will also protect us from assaults and malpractice suits
4) The Patients' Charter is an official document by the government or an organization that enlists various Patients' Rights and Responsibility along with the Code of Practice, followed by a medical personnel. Such charters should be made available and accessible to everyone.
5)There are several organizations trying to improve the doctor patient relationship as much as possible and these efforts should be organized and harmonized – there should be an harmony between the NMC, State medical councils, medical associations and professional bodies.
6)Due to a variety of reasons, the doctor-patient relationship is under strain - increasing specialization, overdependacne on technology – commercialization – unregulated relationship with pharma companies – effects of private health insurance companies – all the factors we discussed in the past 30 mins – everything contributes to stress in the relationship, and increases the stress of the patient, who is already stressed by ill health
So doctors, patients as well the system should harmoniously work together to improve the doctor patient relationship for a healthier community and for a healthier nation – thank you
How to make notes project in my notes along (try extend) – Alt F5
Conclusion slide
