June 26, 2007

The Patient-Physician Encounter

What a great article from About.com - even though it’s primarily about arthritis, the concepts are exactly the same for every patient-physician encounter. Read about it.

The Patient-Physician Encounter

From Carol & Richard Eustice

The good physician treats the disease; the great physician treats the patient who has the disease ~ William Osler (Canadian Physician, 1849-1919)

The Patient-Physician Encounter

What do patients want from a medical encounter with a physician?

In the thoughts of one physician (Delbanco,1992):

Patients want to be able to trust the competence and efficacy of their caregivers.
Patients want to be able to negotiate the health care system effectively and to be treated with dignity and respect.
Patients want to understand how their sickness or treatment will affect their lives, and they often fear that their doctors are not telling them everything they want to know.
Patients want to discuss the effect their illness will have on their family, friends, and finances.
Patients worry about the future.
Patients worry about and want to learn how to care for themselves away from the clinical setting.
Patients want physicians to focus on their:
                  pain
                  physical discomfort
                  functional disabilities

The Relationship Between Patient And Physician

The relationship between patient and physician has been analyzed since the early 1900’s. Prior to when medicine was more science than art, physicians worked to refine their bedside manner, as cures were often impossible and treatment had limited effect.

In the middle of the century when science and technology emerged, interpersonal aspects of health care were overshadowed. There is currently a renewed interest in medicine as a social process. A physician can do as much harm to a patient with the slip of a word as with the slip of a knife.

Instrumental And Expressive Components

The patient-physician encounter crosses two dimensions:

The "instrumental" component involves the competence of the physician in performing the technical aspects of care such as:

expressive
performing diagnostic tests
physical examinations
prescribing treatments

The "expressive" component reflects the art of medicine, including the affective portion of the interaction such as warmth and empathy, and how the physician approaches the patient.

3 Common Patient-Physician Relationship Models

#1) The Activity-Passivity Model - Not The Best Model For Chronic Arthritis

It is the opinion of some people that the differential in power between the patient and physician is necessary to the steady course of medical care. The patient seeks information and technical assistance, and the physician formulates decisions which the patient must accept. Though this seems appropriate in medical emergencies, this model, known as the activity-passivity model, has lost popularity in the treatment of chronic conditions such as rheumatoid arthritis and lupus. In this model the physician actively treats the patient, but the patient is passive and has no control.

#2) The Guidance-Cooperation Model - The Most Prevelant Model

The guidance-cooperation model is the most prevalent in current medical practice. In this model, the physician recommends a treatment and the patient cooperates. This coincides with the "doctor knows best" theory whereby the doctor is supportive and non-authoritarian, yet is responsible for choosing the appropriate treatment. The patient, having lesser power, is expected to follow the recommendations of the physician.

Part 2 of 2 - The Patient-Doctor Relationship Can Impact Success of Treatment

3 Common Patient-Physician Relationship Models -

#3) The Mutual Participation Model - Shared Responsibility

In the third model, the mutual participation model, the physician and patient share responsibility for making decisions and planning the course of treatment. The patient and physician are respectful of each others expectations and values.

Some have argued that this is the most appropriate model for chronic illnesses such as rheumatoid arthritis and lupus, where patients are responsible for implementing their treatment and determining its efficacy. The changes in the course of chronic rheumatic conditions require a physician and patient to have open communication so as to determine the success of a treatment plan.

What Is The Optimal Patient-Physician Relationship Model For Chronic Arthritis?

Some rheumatologists feel that the optimal patient-physician relationship model is somewhere between guidance-cooperation and mutual participation.

In reality, the nature of the patient-physician relationship likely changes over time. Early on, at the time of diagnosis, education and guidance is useful in learning to manage the disease. Once treatment plans are established the patient moves towards the mutual-participation model as they:

monitor their symptoms

report difficulties

work with the physician to modify their treatment plan

The Efficacy Of Treatment

Arthritis is not a single disease. There are over 100 types of arthritis and related conditions. The effectiveness of treatment is largely dependent on the patient carrying out the directions of the physician. Treatment options for arthritis may involve:

taking prescribed medications
arthritis-friendly exercises
joint protection techniques
natural remedies
pain relief techniques
changes to diet and nutrition
weight control
changing or adapting your work habits
physical therapy and occupational therapy
mutual support and other coping strategies

Non-adherence to the physicians treatment plan does imply a negative outcome. In this regard, non-adherence suggests a complete failure to follow a prescribed treatment. The assumption here is that:

the treatment is appropriate and effective

there is an association between adherence and improved health

the patient is able to carry out the treatment plan

What Are The Effects Of An Effective Patient-Physician Relationship?

What are the effects of an effective patient-physician relationship? When the PATIENT-PHYSICIAN RELATIONSHIP includes:

competence

communication

an effective style

These factors can provide for PATIENT SATISFACTION WITH CARE which leads to better ADHERENCE TO TREATMENT.

When better ADHERENCE TO TREATMENT combines with PATIENT SATISFACTION WITH CARE, this often promotes IMPROVED HEALTH with a BETTER QUALITY OF LIFE.

BOTTOMLINE: The adherence to a treatment plan by a patient and the success of the treatment can be greatly impacted by the patient-physician relationship.

_{Source: Understanding Rheumatoid Arthritis by Stanton Newman, Ray Fitzpatrick, Tracey A. Revenson, Suzanne Skevington, and Gareth Williams}

Filed under Posts by Terrie Wurzbacher