Doctor-Patient Relationship 2020

Doctor-Patient Relationship
“A research assignment | Mohamed Abdulhafeez”

1.Introduction
On the basis level, Health care starts with the relationship between the patient and
the doctor. This relationship has been and remains the core element in the ethical
principles of the health care system. In other words, it is the means in which diagnostic
plans are made, data is collected, and patient treatment and support are provided.

Here are the contents of this research report:

- Introduction
- Historical background of DPR?
- Models of DPR?
- Fundamentals of Dynamic DPR
- Impact of DPR in Medical Specialty
- Conclusion.
- References.

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2.Historical Background
The doctor-patient relationship which characterizes a given situation depends on two
principal categories of variables: the medical situation and the social scene. From
Ancient Egypt up to now, the relationship has undergone long evolutionary process. In
this article, pre and post World War II and their concomitant doctor-patient patterns will
be discussed.

I- Pre World War II

Before the Second World War, the relationship was then a physician-centered.
Physicians were highly regarded, paternalistic and patients trusted them to behave in
their best interests. They were disease oriented and because there were few effective
treatments to offer, the patients had no many choices.

II- Post World War II

After the World War II, it the relationship changed to patient-centered approach. Here,
doctors became more specialized and well-knowledged. Technological advancement
resulted in expulsion of diagnoses and therapeutics. Doctors studied and learnt the role
of the patients in the relationship, and their rights. Political evolution and democracy
have largely contributed to the change in the relationship.

3.Models of Doctor-Patient Relationship

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 Doctor-Patient Relationship 2020

There are three basic models of the doctor-patient relationship. These are: (a) activity-
passivity, (b) guidance-cooperation and, and (c) mutual participation.

i. Activity-passivity involves dealing with completely inactive patient. Here, one part
of the relationship (the doctor) is active and the other part (the patient) is passive,
hence the term "activity-passivity". This is necessary in certain cases like; whenever
the patient is unconscious (e.g., comatose, anesthetized).

ii. Guidance-cooperation suggests that the physician tells the patient what to do and
what is best for them (literally, the medical options available in the case). The patient
may comply, choose one of the options availed or even seek for another doctor's
opinion. Here, both parties are “active” and are actively contributing to the
relationship. The main difference between them is that one part offers the options
available, and suggests the best one among them while the other part listens and
decides what to do.

iii. In Mutual participation, it is more of partnership than it is a relationship. Literally,

the physician helps the patient to help himself. This model is particularly applicable
to the management of chronic illnesses, to psychoanalysis and to some
modifications of psychoanalytic therapy.

4.Fundamentals of Dynamic DPR

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 Doctor-Patient Relationship 2020
It is always important to form a dynamic relationship between a physician and a
patient. This contributes to the diagnosis and treatment of the ill patient. Some basic
features that are important for maintaining a healthy DPR are listed below.

a. Communication
Establishing a healthy and dynamic DPR requires good communication skills. Studies
have shown that effective communication between physician and patient has resulted in
multiple impacts on various aspects of health consequences, including: improved
medical, functional, and emotional condition of patients; better patient compliance with
medical treatment; enhanced fulfillment of patient toward healthcare services; lesser
risks of medical misconduct.

b. Doctor empathy
While empathy is vital and basis in every kind of relationship, it is also considered an
important factor in DPR. This enables the physician to understand the symptomatic
experiences and needs of individual patients. Studies have suggested that physician
empathy improves the therapeutic effect and the patient’s quality of life.

c. Trust
Trust in doctors allows patients to effectively discuss their health issues without fearing
of consequences. Development of trust ensures the patient to comply with the doctor’s
guidance, which in turn results in improvement of health.

d. Informed consent:
This is illustrates the patient's independence in decision making, medically referred to
as "autonomy". It is essentially based on the moral and legal arguments of the patient’s
autonomy. In relation to trust, the physician needs to be honest with the patient and his
family to ensure a quality DPR. The physician has to provide the patient and his family a
genuine assessment of favorable and unfavorable outcome probabilities, along with the
best suggested therapy.

e. Professional boundaries:
This is essential aspect and it is important in DPR. The physician should avoid any
action or behavior that transgresses the limits of the professional relationship, or
boundary violations. For example; burdening the patient with clinically insignificant
personal information.
Patients, on the other hand, should avoid inappropriate phone calls and unscheduled
visits to their doctors, as a sign of respect for their time and work.

5.Impact of DPR in Medical Specialty

While DPR is important in all medical fields, its even more essential in chronic health
and psychiatry.

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I. In Chronic health, good and dynamic DPR improves the patient’s ability to
manage their disease independently while sticking to the advice of doctors. This
includes cases of HTN and Diabetes, which require a large participation and full
compliance of the patient.
II. In Psychiatry, DPR helps in good therapeutic outcomes in the field. The
psychiatrist–patient relationship enables psychosomatic patients to overcome the
mental symptoms through better rapport with them. Studies have revealed that
the psychiatric symptoms in HIV patients are treated by retaining patient’s hope
and giving adequate data regarding the disease and treatment.

6.Conclusion
A patient-doctor relationship exists when a doctor a patient’s medical needs, by mutual
consent. This relationship forms one of the contemporary medical ethics. However, this
relationship gives rise to ethical obligations of the doctor to place the welfare of the patient
above their own self-interest.

In order to hold the best interests of the patient, a doctor is ethically required to use sound
medical judgment. Being a doctor is always a demanding job. Their goal is to cover a broad
range of care delivery tasks on behalf of their patient; therefore, the patient must trust the
doctor and the doctor must fulfill the patient’s wish.

7.References of the research

A. Research Reports:

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1) The Doctor-patient Relationship and its Historical Context, by Thomass.
Szasz, MD and William F. Knoff, M.D. | Available online at:
https://ajp.psychiatryonline.org

2) The patient–doctor relationship: a synthesis of the qualitative literature on

patients' perspectives | Matthew Ridd, Alison Shaw, Glyn Lewis and Chris
Salisbury | Available Online at:
https://www.bjgp.org

3) Dynamics of doctor–patient relationship: A cross-sectional study on

concordance, trust, and patient enablement, by Amitav Banerjee and Debmitra
Sanyal. | Available online at:
https://www.ncbi.nlm.nih.gov

B. Books:
1) The Basics of Bioethics | Robert Veatch
2) The Patient-Physician Relation: The Patient as Partner, Part 2 | Robert
Veatch

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