The Doctor-Patient Relationship

Prepared by:
AASHISH CHUGH
GROUP:106
 Doctor Patient Contacts

500,000 GP consultations every working day

The nature of the relationship determines the

success or otherwise of the contact

Central to this is the exchange of information

Communication and Diagnosis

Patients who feel at ease and who are

encouraged to talk freely are more likely to
disclose the real reason for consulting
Communication and Treatment

Advice reassurance and support from the

doctor can have a significant effect on
recovery

The placebo effect

Consultation Styles

It’s serious isn’t it

doctor?
 Parsons’ “Ideal Patient”

Permitted to:
Give up some activities and responsibilities
Regarded as being in need of care

In Return :
Must want to get better quickly
Seek help from and cooperate with a doctor
 Parsons’ “ Ideal Doctor”

Apply a high degree of skill and knowledge

Act for the good of the patient

Remain objective and emotionally detached

Respect the position of privilege

 Conflict of Interest

Interests of patient v society

Interests of patient v other patients

Problems of confidentiality
 Types of D-P Relationship

Physician control
Patient Control Low High

Low Default Paternalist

High Consumerist Mutuality

 Paternalism

The traditional D-P relationship

Doctor Takes on role of “parent”

Patient submissive

Shift towards Mutuality

Patient controlled consultation

“You’re paid to do what I

tell you!!”
 Patients beliefs and expectations

Influenced by:

Previous experience, literature, the media;

Family and friends;Cultural influences;
Social significance.

These beliefs influence outcomes

 The doctor’s consulting style

Doctor centred consultation style:

Paternalistic - doctor is the expert and

patient expected to cooperate
Tightly controlled interviewing style aimed
at reaching an organic diagnosis.
The Paternalistic Approach

“If I’ve told you once I

told you 1,000 times,
stop smoking!!”
The Doctor’s consultation style

Patient Centred consultation style

Less authoritarian - encourages patient to

their own feelings and concerns

Open questioning, interested in psycho-

social aspect of illness
 Patient centred clinical interview

Doctor - history examination investigation

results in a differential diagnosis

Patient - ideas expectations feelings

results in an understanding of patients beliefs

Integration
Length of Consultation

Average 8 minutes

Makes patient centred

consultation styles more
difficult.
Patient influences on consultation

The patient’s ability to exercise and control

depends on a number of factors:

Social and educational level

Sex
Membership of an ethnic minority
 Summary

An intigrated approach to information

gathering.

Seeking to identify physical psychological and

social factors

Is likely to produce a better outcome.