The physician William Osler once said, “the good physician treats the disease; the great physician treats the patient who has the disease.” The patient-doctor relationship plays an important role in the treatment process. Each patient represents a story that includes their disease, their social situation and their beliefs, which need to be considered during check-ups and diagnosis. A good relationship is not only important for social factors, it is also essential for their treatment process. For instance, a good patient-doctor relationship can influence the frequency of doctor visits and also the patient’s self-care habits. There are many factors that make up a good relationship such as, communication, trust and confidentiality. Nevertheless, there are also some factors that affect the patient-doctor relationship, Like modern technology, and sociodemographic characters of doctors.
Patient-doctor relationship plays a significant role in the medical treatment process, because it helps enhancing the accuracy of the diagnosis and increasing the patient’s knowledge about the disease all come with good relationship between the doctor and the patient. Despite that, some people make valid claims that having a solid patient-doctor relationship has no effect on a patient's overall health. Some also think that there is no need to the relationship in the doctor’s office since the patient’s goal is to get treated without caring about personal attachments. Of course, a good patient-doctor relationship is not as important as the doctor’s level of knowledge, or the quality of health care. Katherine Hall, a general practitioner, argues that relationships between doctors and their former patients are almost always unethical. One of the reasons for this, she says, is the persistence of the unequal power distribution in the original doctor-patient relationship, which has implications for the patient’s autonomy and ability to consent (188). However, there is overwhelming evidence that weak relationships between patients and doctors result in lower standards of care, which negatively affects the overall experience of patients and staff in the medical system. Mariusz Jaworski, a psychologist at the Medical University of Warsaw, suggests that the level of support from doctors has a direct impact on the patients' attitude towards the disease, including attitudes towards the treatment and medical personnel (11). Good patient-doctor relationships should therefore be present in every doctor’s office to ensure the best quality of treatment. Otherwise, a weak relationship effects the accuracy of information the patient provides the doctor with which leads to a fragile healthcare system.
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Communication is an important part of any relationship, especially the patient-doctor relationship because it leads to the decision-making process of the treatment. The diagnosing process has improved because of a better understanding of the patient’s problem. Akihito Hagihara, a professor at Kyushu University School of Medicine, suggests that the “doctor’s explanation transmits information, which leads to decisions on treatment, and establishes trust and supportiveness” (31). Thus, good communication gives the patient a full image of the diagnosis likewise the treatment process which helps the patient to make a fully informed consent about the treatment. However, the lack of communication skills results in poor understanding of the diagnosis because “patients often either do not understand or misunderstand their doctor’s explanations” (Hagihara 39). For example, problems may develop related to drugs prescribed for the treatment for elderly patients, who may not fully understand how to take the medication prescribed or what are the side effects of it. Moreover, the effective doctor-patient communication is an essential part of building a therapeutic doctor-patient relationship, which leads to high-quality healthcare. In brief, the practice of good communication skills benefits both patients and doctors because it provides meaningful and trustworthy relationship, which leads to an improved healthcare system.
Even though, communication is so important for the patient-doctor relationship, it is almost impossible to have beneficial communication without trust. Thus, trust is a defining element in the patient-doctor relationship. In medicine, trust results from a number of interactions between patients and doctors which results in assured reliance on the character, ability, and knowledge of the doctor. For doctors to fulfill their commitment to trust, they must meet the expectations of their patients by providing the best treatment possible and by protecting their privacy under any costs. Dr. Carlos A. Pellegrini, Chief Medical Officer for UW Medicine, says that intrinsic trust in the physician is expressed in the discretionary latitude that patients give their physicians to do what is necessary to, hopefully, benefit their well-being (21). Pellegrini suggests that the final treatment goal will not be successfully achieved without the patient’s trust in their doctors.
Trust was never a major problem between patients and doctors except for the past few decades where technology entered the healthcare system (Evans 43). Since then, Patients have expressed their concerns of having their personal information and medical records exposed to technology which might not be secured enough. In 2015, the largest healthcare-related date theft took place. Hackers stole records for almost 80 million patients (“the impact of technology” 15). Recording to the article the hacking impacted the patient’s trust in the health care system even more. On the side of social networking technology, which includes the personal interaction through social media and direct emails, studies show that patient actually lost trust in some doctors that they developed a good trusting relationship with over time due to political or critical posts on their Facebook personal page. Technology in these two cases has affected the relationship and is considered as one of the trust issues in the 21st century’s healthcare system. Moreover, a group of researchers from Kyushu University’s Graduate School of Medicine, admit the negative sides of technology and how it impacts the relationship indirectly. They suggest that:
Although the level of trust in the one-to-one relationship between doctor and patient seems to be important for the use of new communication technology, the reverse also seems to apply: Communicating electronically affects the aspect of trust. This is due to the technology’s creating the potential for changes in social practices. (Andreassen et al. 155)
The interpretation is that a trusting relationship between doctors and patients appears fundamental when the patients construe the new technology as an issue of doctor-patient communication. Nevertheless, some people do think that technology has impacted the health care system in a good way through providing a platform for patients to have access to doctors form different fields all over the world. Technology can help health care systems to deliver accurately and effectively massages through social media platforms. For example, they can send public alerts about contagious diseases, vaccinations reminders and general health advices. Brenda Wiederhold, President of the Virtual Reality Medical Center, thinks that digital medicine stands at the forefront of healthcare evaluation by combining advanced biometric monitoring with more meaningful patient interaction (21). Technology helps in providing the best healthcare possible to patients. Over time, the need of technology in healthcare grows. Technology might be followed by some complications, but it indeed helps in providing the best healthcare experience to patients. One of the best aspects that technology helps improving in medicine is Telemedicine which has been able to compensate by offering better care, greater access to specialists and reducing costs, by eliminating unnecessary emergency room visits or by cutting down patient readmissions. Melissa Powell, COO of The Allure Group, says that “if telemedicine hasn’t revolutionized healthcare, it has certainly revamped it (46). Telemedicine has extended provider’s reach to areas where care might not be readily available.
As indicated, communication and trust are very important elements to the patient-doctor relationship. Yet, they mean nothing without solid confidentiality rules between both parties. this is why there is a rule known as (doctor-patient privilege), which being used broadly to refer to the concept that communication between patients and their doctors is protected from disclosure to third parties and can’t be used against the patient in court or other legal proceedings (“physician-patient privilege” 25). For instance, if the doctor asks about how the patient got the bullet in their shoulder, the patient can be fully comfortable telling the doctor without being afraid of the doctor providing the legal authority with this information. The reason behind the rule is to ensure that patients feel comfortable sharing openly and honestly with their doctors. If the patient feels afraid of sharing the entire truth it might affects the diagnose, which impacts the treatment process in a negative way. Nonetheless, in recent years, many courts have held that doctors also owe duties to protect non-patient who may be harmed by patients. (“doctor-patient confidentiality” 132). For example, courts ask doctors to worn others or the police if the patient is potentially violent or has expressed harmful thoughts. Yet, in many cases a written consent is needed before a doctor can release any information about the patient.
Communication, trust and confidentiality are skills that doctors, and patient might be able to gain to improve their relationship, but what if the patient-doctor relationship is being affected by factors the healthcare system can not control like personal characteristic, including their race, ethnicity and gender or even sexual orientation. This raises an important question which is, does sociodemographic characteristics of doctors affect their relationship with their patients? It is surely does. According to a group of researchers from John Hopkins University, who suggest that doctors are more likely to be judged by their personal characteristic, including their race, ethnicity and gender or even sexual orientation (Cooper 143). These factors have proven to be important for the level of comfort the patients have toward their doctors. However, the biggest struggle that face doctors is gender. The john Hopkins’s Hospital study shows that even though male and female doctors don’t differ in how much biomedical information they have, patients were more likely to choose male doctors over female ones. Moreover, despite that female doctors spend more time with patients and more frequently using a patient-centred approach, women doctors are not evaluated as highly by patients as their male colleagues (Cooper 1870). Another study performed by Haley Nolen et al, at Yale University, shows that effective patient-doctor relationship communication, potentially affected by pre-existing patient preference and gender bias (84). Which highlight the struggle that face females in the medical work environment. Dr. William Argus, Ophthalmologist in Fort Wayne, says in his TEDx talk that women today don’t have to give up their femininity to be successful doctors like how it was a decade ago (“Medical Sexism” 00:02:04 - 00:02:18). This indicates that female doctors had to look and feel like male doctors to be as “successful” as them along with being trust worthy
How good can the patient-doctor relationship be? Which limits should be considered, and which boundaries should be present? Professional boundaries are an essential part of the doctor-patient relationship, but they are sometimes crossed by both doctors and patients. Marika Davies, medicolegal advisor, claims that a series of crossing boundaries may result in the development of sexual relationships between doctors and their patients (38). These boundary crossings may be as simple as a hug after bereavement. Even though, the hug might be beneficial to a patient, Davies considers it a boundary violation. Davies also considers a simple gift or card from a patient as an inappropriate expression of gratefulness. She also thinks that the doctor needs to take a direct action toward the gift, like politely declining the item. Davies describes the foundation of doctor-patient partnership as “patients should be able to trust that their doctor will behave professionally towards them during consolations and not see them by any meaning as potential sexual partner” (20). This indicates that patient-doctor relationship may in some cases becomes a personal and even a sexual relationship. This is the main reason of why boundaries should be present always in the doctor’s office. Pursuing a relationship in any way more than a professional one is an abuse of the doctor’s position and misuse of their power. It is not only morally impermissible, it is also legally wrong. To illustrate, Section 2256 in the state of California indicates that “the commission of any act of sexual abuse, misconduct, or relations with a patient … constitutes unprofessional conduct and grounds for disciplinary action” (“Sexual Relationships” 65). Moreover, it provides that penalty for sexual exploitation requires revocation of the doctor’s license. Hence, the duties of a doctor include terminating the patient-doctor relationship before initiating a dating, romantic, or sexual relationship with the patient.
In conclusion, having a good patient-doctor relationship that includes communication, trust and empathy leads to adherence to treatment. When better adherence to treatment is combined with patient satisfaction with care, better quality of healthcare is the expected result. Even though, some might argue that the relationship between patients and doctors will affect the relationship in negative way. It is a fact that the treatment process will be hard to follow without some personal strengths with the doctor.
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