Medicine is of great significance for mankind. It deals with the most fundamental aspects of the human condition: birth, life, physical functioning, vulnerability, loss, and death. Estimates show that health and medical care contribute to life expectancy over several years. Moreover, they contribute to improving people’s functional ability and quality of life. However, scientific knowledge and technical abilities are not only requirements of the medical field, but also an understanding of the human nature. As the patient is a human being with own worries and hopes, not just a group of symptoms. Therefore, an intimate patient-physician relationship is stated at true importance in medical practice. It is the medium through which data is gathered from the patient. A decent relation is necessary to provide a successful medical diagnosis and treatment.
Purpose of this report is to demonstrate physician-patient relationship with certain required aspects. The paper includes explanation of the concept and brief concision of its chronological pattern. In addition, it interprets today’s several physician-patient association types based on relative power. Moreover, unveils the concepts of illness behavior and medical jargon which interfere with the relationship, unfolding the terms and discussing their impact on the relationship. Alongside, clinical parts are included in between the whole paper.
A constant encounter between a patient and a healer exists in all countries at all times which is named doctor-patient relationship. The relationship among doctor and patient is a moving and meaningful experience that can be defined as a mutual relationship where one person i.e. the patient, knowingly seeks the help of another i.e. the doctor, who in return knowingly grants him as a patient and provides assistance. Basically, doctor-patient interaction reflects a kind of guardianship or trustee in which the patient’s autonomy and confidentiality is preserved by the physician, simultaneously under the oath (Fallon et al. 2015). A physician must never forget that patients are not just a group of symptoms or “cases”, but helpless human seeking for relief, help, and trust. A successful consultation with a trusted doctor will have beneficial effects irrespective of any other therapy given. In addition, it is the base of an accurate diagnosis, just as effective treatment.
The essence of doctor patient relationship has been examined in various clinical and culturally responsible settings such as breast cancer; individuals living with HIV/AIDS; and people with chronic hepatitis B virus infections; to gain insight from clinicians into the patient’s expectations throughout their therapy. Also, particularly in the case of chronic lifestyle related conditions, many people still favor a long term relationship with their relating physician, because the physician is well concerned of the whole background and record, and the patient gets fully adapted to the relaxing environment.
A number of interesting initiatives have been formulated worldwide to improve doctor-patient relationship, include the utilization of placebo; the advancement of tele-health video consultations; particularly for patient with chronic diseases, requiring substantial self-care at home. Even additional steps are suggested such as physician’s participation in funding programs. It was also proposed that the doctor-patient relationship be applied to a new form of partnership, where many doctors treat a certain patient as a team.
EVOLUTION THROUGH TIME
Throughout the course of history, the domain of doctor-patient relationship has been evolving alongside social scenario, society’s intellectual capacity, and the particular time’s ailments. The chronological overview of the interaction between doctor and patient includes five time frames of Ancient Egyptian, Greek Civilization, Medieval Europe, revolution of Europe and from 1700 onwards. It was these different time frames that resulted in the construction of various models of doctor-patient relationships at the time, and the various types we know of the present time.
Models of Doctor-Patient Relationship
- Szasz T and Hollender M (Szasz 1956) proposed 3 basic models: a.Active-Passive model b.Guidance-Cooperation model c.Mutual participation model
- On the contrary, Emanuel gave 4 models: a. Paternalistic model b. Informative model c. Interpretive model d. Mutual participation
Looking at the basics, these two models could be unified into a single model, which is close to the present time’s illustration, but it is beyond the scope of this paper so only the latest update of doctor-patient relationship is elucidated.
TYPES OF DOCTOR-PATIENT RELATIONSHIP
Various types of doctor-patient relationship arise from the contrast in doctor and patient relative power and control. In reality, such various models may not necessarily exist in pure form, but most consultations nevertheless tend towards a one kind.
1) Paternalistic Relationship
“Guidance-cooperation” or paternalistic relationship , with high doctor control and low patient control, where the doctor predominates and functions as a ‘parent’ figure who determines what he or she considers to be in best interest of the patient ’infant’ and the expression actually originates from Latin term of ‘father’. Such type of relationship has been identified historically in medical consultations. Nevertheless, health consultations at the present time are generally distinguished by greater supervision of the patient and mutual-based interactions.
Patients in paternalistic relationship might gain great comfort at certain stages of the illness, for being able to depend on the doctor in these lines and being soothed of the stressful concern and decision making. Furthermore, it is indeed absolutely justified in the serious emergency framework, as either the timeframe taken to acquire informed consent or involve the patient in decision-making would obviously endanger the safety of the individual. There is additional argument that this paternalistic model is not an interaction since the individual operating on is incapable dynamically participate, an appropriate answer would be that the person is considered ‘powerless’ seeking the doctors special expertise as justified in emergency cases.
2) Mutuality Relationship
A relationship of mutuality is categorized by the active patient association as more progressed, equivalent partners in the consultation and has been depicted as a ‘meeting between experts’, in which the two parties take an interest as a joint venture and collaborate in an exchange of thoughts, ideas and sharing of belief framework. The doctor brings his or her clinical abilities and knowledge to the consultation in terms of diagnostic techniques, information of the causes of malady, prognosis, and preventive strategies, and patients bring their own skill in terms of their encounters and clarification of their illness, and information of their specific social circumstances, perspectives to risk, values and inclinations. Chronic diseases such as diabetes, heart disease, cystic fibrosis, dementia, Parkinson disease reveal the effectiveness of this relationship, as these need lengthy regulations and interpretive, comprehensive interactions.
3) Consumerist Relationship
A consumerist relationship characterizes a situation in which power correlations are switched, the patient acts the active role and the doctor adopts a genuinely passive role, follows the patients’ demands for a subsequent opinion, referral to emergency department, a sick note, and so on. This type has been defined since the boosting of upper class, wealthy patients from the revolution of industry on.
4) Default Relationship
A default relationship can occur if patients keep on adopting a passive role even if the doctor lessens a portion of his or her control, thus lacking adequate and sufficient direction for the consultation. This may emerge if patients are not aware of alternatives to a passive role for the patient or are reluctant to pursue an increasingly collaborative relationship.
Distinct types of relationships, and primarily those marked by paternalism and mutuality, can be considered ideal for specific situations and stages of ailment. For instance, it is commonly necessary for the doctor to be authoritative in emergency cases, while in other circumstances patients should be more actively engaged with their own treatment choices.
MODERN PATIENT-CENTERED MEDICINE
A massive debate has emerged over the last decades which asserted a patient-centered approach to healthcare. Patient-centered medicine is the latest addition to the physician patient interaction, as a fresh concept of medical system in the 21st century. Doctors in this model, each with own skill and strategy collection construct a conceptual framework wherein the patient contributes as a companion while making choices about his or her own care.