Doctor–patient relationship

The doctor–patient relationship is a central part of health care and the practice of medicine.

A doctor–patient relationship is formed when a doctor attends to a patient’s medical needs and is usually through consent.

The patient physician relationship creates affirmative legal obligations: physicians are expected to give their patients unsolicited advice, obtain informed consent, and maintain confidentiality.

A doctor–patient relationship is built on trust, respect, communication, and a common understanding of both the doctor and patients’ sides. 

The trust aspect of this relationship goes is mutual.

The doctor trusts the patient to reveal any information that may be relevant to their situation.

 The patient trusts the doctor to respect their privacy and not disclose this information to outside parties.

The  physician is bonded by oath to follow certain ethical guidelines (Hippocratic Oath) whereas the patient is not.

A quality doctor–patient relationship is essential to keep the quality of the patient’s healthcare high as well as to ensure that the doctor is functioning at their optimum. 

Recently healthcare has become more patient-centered and this has brought a new dynamic to this ancient relationship.

A patient must have confidence in the competence of their physician and must feel that they can confide in them. 

Some medical specialties, such as psychiatry and family medicine, emphasize the physician–patient relationship more than others.

The quality of the patient–physician relationship is important to both the patient and the doctor, and their values and perspectives about disease, life, and time available play a role in building up this relationship. 

A strong relationship between the doctor and patient may lead to better healthcare for the patient and their family. 

A good relationship between the doctor and the patient, enhances the accuracy of the diagnosis.

Increasing a patient’s knowledge about their  disease contributes to a good relationship between the doctor and the patient.

A poor doctor–patient relationship, may impair the physician’s ability to fully assess a patient’s problems, and  may lead to physician mistrust of their diagnosis and treatment.

Such physician mistrust decrease patient adherence to the physician’s medical advice, resulting  in poorer health outcomes.

When mistrust exists, and where there is genuine divergence of medical opinions, a second opinion from another physician may be sought, or the patient may choose to go to another physician that they trust more. 

Placebo effects are based upon the patient’s subjective assessment, conscious or unconscious, of the physician’s credibility and skills.

The doctor–patient relationship seems to has a small, but statistically significant impact on healthcare outcomes.

Medical practice is to show respect to patients and their families and for the doctor to be truthful in informing the patient of their health and asking for the patient’s consent before giving treatment. 

Shared decision making involves both the doctor and patient being involved in decisions about treatment. 

A physician’s communication style is crucial to the quality and strength of the doctor–patient relationship: Patient-centered communications, allowing open-ended questions, expressing a warm disposition, encouraging emotional expression, and demonstrating interest in the patient’s life, all positively affect the doctor–patient relationship. 

A favorable type of communication decreases other negative attitudes/ assumptions the patient might have about doctors or healthcare as a whole.

Favorable communications improve treatment compliance.

Self-disclosure by physicians of personal or emotional information increases rapport, the patient’s trust, their intention to disclose information, and the patient’s desire to continue with the physician. 

A physician’s response to emotional expressions of their patients can determine the quality of the relationship, and influence how comfortable patients are in discussing sensitive issues, feelings, or information that may be critical for their diagnosis or care. 

Passive, neutral physician response styles which allow for patients to elaborate on their feelings have been shown to be more beneficial for patients, and make them feel more comfortable. 

Physician avoidance or dismissal of a patient’s emotional expressions may discourage patients from opening up, and may be harmful to their relationship with their doctor.

Historically, the paternalistic physician model exists, where a physician tends to be viewed as dominant or superior to the patient due to the inherent power dynamic of physician’s control over the patient’s health, treatment course, and access to knowledge about their condition. 

In such a model, physicians tended to convey only the information necessary to convince the patient of their proposed treatment course. 

The physician–patient relationship may be complicated by the patient’s limited ability to relieve their situation without the physician’s intervention, potentially resulting in a state of desperation and dependency on the physician. 

The physician must establish a comfortable, trust-based environment and optimize communication with the patient. 

It may be beneficial for the doctor–patient relationship to create a practice of shared care with increased emphasis on patient empowerment and taking of a greater degree of responsibility for their care.

Discussion of diagnosis, lab results, and treatment options and outcomes in terms that the patient can understand can be reassuring and give the patient a sense of agency over their condition. 

A strong communication between a doctor and their patient can strengthen the physician–patient relationship as well as promote better treatment adherence and health outcomes.

Lying in the doctor–patient relationship is common:   Doctors providing  minimal information to patients after medical errors. 

Patients may lie to doctors to displace culpability for poor outcomes. 

Doctors may avoid giving patients information because they think that the information may confuse patients, cause pain, or undermine hope. 

Doctors may lie to avoid uncomfortable conversation about disability or death, or to encourage a particular treatment option.

Physicians must follow the principles that guide the care of patients in genuinely caring way associated with compassion, respect, and empathy.

Being lied to undermines an individuals trust in others or themselves. 

Patients may lie to doctors for financial reasons such as to receive disability payments, for access to medication, to avoid incarceration, out of embarrassment or shame.

Discussions about obtaining truth is an ongoing process to increase truthfulness in doctor–patient interactions.

Physicians tend  to overestimate their communication skills, as well as the amount of information they provide their patients.

Physicians have high likelihood of underestimating their patients’ information needs and desires.

Individuals personal attributes such as age, sex, and socioeconomic status influence how informative physicians are with their patients.

Patients who are better educated and from upper class positions generally receive higher quality and quantity of information from physicians.

Race, ethnicity and language have a significant impact on how physicians perceive and interact with patients.

Caucasian physicians perceive African Americans to be less intelligent and educated, less likely to be interested in an active lifestyle, and more likely to have substance abuse problems than Caucasians.

Patients of color showed tha having a white physician led to increased experience of microaggressions.

Studies have found that Hispanic males and African Americans were less than half as likely to receive pain medication than Caucasians, despite physicians’ estimates that patients were experiencing an equivalent level of pain.

Ethnic-minority groups of varying races reported lower-quality healthcare experiences than Whites, specifically in treatment decision involvement and information received regarding medications.

Other studies show that physicians exhibited substantially less rapport building and empathetic behavior with both Black and Hispanic patients than Caucasians, despite the absence of language barriers.

Medical mistrust negatively impacts the doctor–patient relationship.

Such mistrust by patients who have little faith in their physician is they are less likey to listen to their advice, follow their treatment plans, and feel comfortable disclosing information about themselves. 

Communications by the physician, such as self-disclosure and patient-centered communication, have been shown to decrease medical mistrust in patients.

Medical mistrust has been shown to be greater for minority groups, and is associated with decreased compliance, which can contribute to poorer health outcomes. 

African American women who received concerning mammogram results were less likely to discuss this with their doctor if they had greater medical mistrust.

Women with higher physician mistrust wait longer to report symptoms to a doctor. 

African American patients had more medical mistrust than white patients, and were less likely to undergo a recommended surgery as a result.

When a disagreement between the physician and the patient occurs for any number of reasons, 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. 

In such situations adherence management coaching becomes necessary to provide positive reinforcement of unpleasant options.

Most patients do not want to call the doctor by his or her first name.

Some familiarity with the doctor generally makes it easier for patients to talk about intimate issues such as sexual subjects.

Transitions of patients between practitioners may decrease the quality of care in the time it takes to reestablish proper doctor–patient relationships. 

Generally, the doctor–patient relationship is facilitated by continuity of care in regard to attending personnel. 

Integrated care may be required where multiple health care providers are involved, including horizontal integration and vertical integration. 

The process of turn-taking between health care professionals and the patients has a profound impact on the relationship between them. 

This can go a long way into impacting the future of the relationship throughout the patient’s care. 

Such speech acts between individuals accomplishes the goal of sharing and exchanging information and meeting each participants conversational goals.

Physicians practice a form of conversational dominance in which they see themselves as far superior to the patient in terms of importance and knowledge and therefore dominate all aspects of the conversation. 

Constant interruptions from the patient while  the doctor is discussing treatment options and diagnoses can be detrimental or lead to less effective efforts in patient treatment. 

Males are much more likely to interject out of turn in a conversation than women.

Men’s social predisposition to interject becomes problematic when it negatively impacts a woman physician’s messages to her patients who are men.

Conversely, male physicians need to encourage women patients to articulate their reactions and questions, since women interrupt in conversations statistically less often than men do.

Patients typically relate their story in chronological order.

Physician tends to design their approach in a step-by-step analytical manner, extracting as much details out of symptomatology, then past medical and social history then tests then coming to a suggested diagnosis and management plan. 

Addressing this pattern upfront at the onset of the visit and carving out time for both contributions can help avoid unnecessary interruptions on either part, improve provider-patient relation and constructively facilitate care.

When other people are present in a doctor–patient encounter they may influence communication.

They may provide psychological support for the patient, but in some cases it may compromise the doctor–patient confidentiality and inhibit the patient from disclosing uncomfortable or intimate subjects.

Having family around when dealing with difficult medical circumstances or treatments can also lead to complications. 

Family members, in addition to the patient needing treatment may disagree on the treatment needing to be done, leading to tension and discomfort for the patient and the doctor, putting further strain on the relationship.

Telehealth is the use of telecommunications and/or electronic information to support a patient’s. Health.

Telehealth is that it increases the quality of the doctor–patient relationship by making health resources more easily available, affordable, and more convenient for both parties. 

Telehealth does make it harder to get reimbursements, to acquire cross-state licensure, to have common standards, maintain privacy, and have proper guiding principles.

Telehealth types of care include general health care (wellness visits), prescriptions for medicine, dermatology, eye exams, nutrition counseling, and mental health counseling. 

A good bedside manner reassures and comforts the patient while remaining honest about a diagnosis.

Bedside manner is affected by vocal tone, body language, openness, presence, honesty, and concealment of attitude.

A poor bedside may result in a patient feeling unsatisfied, worried, or afraid.

The needs of patients from their health care providers: providing reassurance, assuring them it is okay to ask questions, ability to see their testresults and for the doctor to explain what they mean, patients do not want to feel judged by their providers, and  to be participants in medical decision-making.

Body language affects patient perception of care as it has been shown that time spent with the patient is perceived as longer if the doctor sits down during the encounter.

Patient behavior affects the doctor, patient relationship, as rude or aggressive behavior can also distract healthcare professionals and cause them to be less effective or to make mistakes during a medical procedure. 

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