The physician-patient relationship within the field of social security comprises adjustment to . Paul defines medical-legal procedures or forensic medicine as a specialty in which the principles and .. If I wanted it, I should go to a hospital”. The doctor–patient relationship has been and remains a keystone of care: the A series of organizational or system factors also affect the doctor–patient relationship. . or for coordinating care between doctors' offices, hospitals, nursing homes, . As patient advocates, physicians must ensure that policies and procedures. Physicians frequently encounter ethical dilemmas in all aspects of patient care. not obliged to treat a patient and may end a doctor-patient relationship if they wish, Definition: the psychological and/or legally capability to process information, . Hospitals that receive payment from Medicare must discuss organ donation.
Failure to hold individuals accountable may contribute significantly to risk of adverse events and may lead to a focus of patient safety away from the autonomous responsibility of physicians to a systems-based approach. In the current issue of the Canadian Medical Education Journal we have included six major research contributions, two systematic review papers and three brief reports.
Each of these addresses some aspect of patient safety, medical errors, practice guidelines and evidence based medicine.
Major Research Contributions Bass, Geddes, Wright, Coderre, Rikers and McLaughlin studied how experienced physicians benefit from analyzing initial diagnostic hypotheses. They began with the premise that most incorrect diagnoses involve at least one cognitive error, of which premature closure is the most prevalent. Thus Bass et al conducted an empirical study to evaluate the effect of analytic information processing on diagnostic performance of nephrologists and nephrology residents from the University of Calgary and Glasgow University.
Participants were asked to diagnose ten nephrology cases. Participants were primed to use either hypothetico-deductive reasoning or scheme-inductive reasoning to analyze the remaining case data and generate a final diagnosis.
The results indicated that both experienced nephrologists and nephrology residents can improve their performance by analyzing initial diagnostic hypotheses thus reducing the rate of misdiagnoses. Documenting feedback during clinical supervision using field notes FN is a recommended competency-based evaluation strategy to improve communication.
But what factors influence the intention to adopt FN during training? They found that the intention to use FN were attitude, perceived behavioural control and normative beliefs.
Doctor–patient relationship - Wikipedia
They concluded that the implementation of field notes should be preceded by interventions that target the identified salient beliefs to improve this competency-based evaluation strategy. Does empathy towards patients in students change during medical school? What factors affect pre-clerkship changes in empathy?
Students reported both negative and positive changes in empathy. These changes occur due to time constraints, objective lessons in empathy, and a changing identity. Positive changes included an increased awareness of the impact of illness, and increased ability to read feelings. These changes result from increased exposure to patients, discussions surrounding the psychosocial impact of illness, and positive role models. They collected more than student surveys over 4 years that focused on components of usefulness, enjoyment and facilitator effectiveness.
A retrospective self-assessment of learning was used for both content knowledge of palliative care and knowledge of the other professions participating in the module. Medical students reported lower gains in knowledge than those in other programs. Scores were moderately high for usefulness and facilitator effectiveness.
Scores for enjoyment were very high. McKee et al concluded that there is strong theoretical and empirical evidence that PBL is a useful method to deliver IPE for palliative care education. Paslawski, Kearney and White addressed the factors that contribute to tutor participation in PBL in a medical training program, examining tutor recruitment and retention within the larger scope of teacher satisfaction and motivation in higher education.
Semi structured interviews approximately one hour in length were conducted with 14 people - 11 who had tutored in PBL and 3 faculty members who had chosen not to participate in PBL. Thematic analysis was employed as the framework for analysis of the data. Seven factors were identified that affects the recruitment and retention of tutors in the undergraduate medical education program. They studied the use of ultrasonography, a method increasingly used for teaching physical examination in medical schools.
Surveying the opinions of involved educators, they identified potentially useful aspects ultrasonography: Examinations thought to be potentially most harmful included: Ma et al caution that when initiating an ultrasound curriculum for physical examinations, educators should weigh the risks and benefits of examinations chosen. Systematic Reviews In the first of two systematic reviews, Al Alawi, Al Ansari, Raees and Al Khalifa, focused on the use of multisource feedback to assess pediatricians.
Additionally evidence for content, criterion-related and construct validity was reported in all 6 studies.
They concluded that multisource feedback is a feasible, reliable, and valid method to assess key competencies such as communication skills, interpersonal skills, collegiality, and medical expertise. The second systematic review of educational resources for teaching patient handover skills to resident physicians and other healthcare professionals was done by Masterson, Richdeep, Turner, Shrichand, and Giuliani.
As the transfer of patient care is a time of heightened risk to patients, it is important to identify effective training models for handover skills. A number of such studies have now been published. Masterson et al found that physicians, residents and other healthcare practitioners should receive training in handover skills to improve patient care and thus reduce the risk of medical errors.
Brief Reports In the first of three brief reports, Thomson, Harley, Cave and Clandinin studied the enhancement of medical student performance through narrative reflective practice NPR.
This process putatively helps medical students become better listeners. Employing 3rd-year University of Alberta medical students from the same class, they found that the group receiving NRP training scored higher 4.Physician-Patient Relationship - Medical Video Essay
The second brief report focused on the Triple C curriculum for preparing residents for family practice. Residents perceived themselves as prepared to engage in most practice areas and their intentions to engage in various practice domains were positively correlated to their ratings of preparedness. Residents perceived this program as comprehensive and relevant to their development as a family physician and they perceived a high degree of encouragement for inter-professional practice.
These results provide some preliminary evidence that an integrated competency-based curriculum, with an emphasis on inter-professional practice, has the potential to effectively prepare residents for practice in family medicine. There were no significant differences between the global scores of the Scholar stations showing that the overall knowledge and effort of the residents was similar across both stations 3.
No significant differences between senior residents and junior residents were detected or between internal medicine residents and non-internal medicine residents.
In this issue the major research contributions, systematic review papers, and brief reports each address some variant of improving medical practice and therefore improving patient care and safety. In addition we are publishing commentaries and letters to the editor and two brief essays by students on the future of medical and health care education. The Oldest Code of Laws in the World: Lawbook Exchange, Ltd; History of Medicine, Volume II: Early Greek, Hindu, and Persian Medicine.
Oxford University Press; The Professor of Secrets. National Geographic Publishing; To Err Is Human: National Academy Press; Engineering a safe landing: Would you be willing to take this information and find out when the next support group meets? What will make it easier for you to take this medication? Dilemmas may arise when a patient refuses medical intervention but does not withdraw from the role of being a patient.
For instance, an intrapartum patient, with a complete placenta previa, who refuses to undergo a cesarean delivery, often does not present the option for the physician to withdraw from participation in her care see: In most cases, choices of competent patients must be respected when the patient cannot be persuaded to change them.
What can a physician do with a particularly frustrating patient?
Physicians will sometimes encounter a patient whose needs, or demands, strain the therapeutic alliance. Many times, an honest discussion with the patient about the boundaries of the relationship will resolve such misunderstandings. The physician can initiate a discussion by saying, "I see that you have a long list of health concerns. Unfortunately, our appointment today is only for fifteen minutes.
Let's discuss your most urgent problem today and reschedule you for a longer appointment. That way, we can be sure to address everything on your list. What do you think we could do to meet everybody's needs?
And yet, physicians may not abandon patients. When the physician-patient relationship must be severed, the physician is obliged to provide the patient with resources to locate ongoing medical care.
Physician-Patient Relationship: Ethical Topic in Medicine
When is it appropriate for a physician to recommend a specific course of action or override patient preferences? Under certain conditions, a physician should strongly encourage specific actions. When there is a high likelihood of harm without therapy, and treatment carries little risk, the physician should attempt, without coercion or manipulation, to persuade the patient of the harmful nature of choosing to avoid treatment.
Court orders may be invoked to override a patient's preferences. However, such disregard for the patient's right to noninterference is rarely indicated. Court orders may have a role in the case of a minor; during pregnancy; if harm is threatened towards oneself or others; in the context of cognitive or psychological impairment; or when the patient is a sole surviving parent of dependent children.
However, the use of such compulsory powers is inherently time-limited, and often alienates the patient, making him less likely to comply once he is no longer subject to the sanctions.
What is the role of confidentiality? Confidentiality provides the foundation for the physician-patient relationship. In order to make accurate diagnoses and provide optimal treatment recommendations, the physician must have relevant information about the patient's illness or injury. This may require the discussion of sensitive information, which would be embarrassing or harmful if it were known to other persons. The promise of confidentiality permits the patient to trust that information revealed to the physician will not be further disseminated.