You are on page 1of 19

The Doctor-Patient Relationship

From Sociology as applied to Medicine


Mutiara Budi Azhar
Faculty of Medicine, Sriwijaya University
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




Its serious isnt 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
Youre 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 doctors 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 Ive told you once I told you
1,000 times, stop smoking!!
The Doctors 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 patients ability to exercise and control
depends on a number of factors:

Social and educational level
Sex
Membership of an ethnic minority

Summary
An integrated approach to information
gathering.

Seeking to identify physical psychological and
social factors

Is likely to produce a better outcome.

You might also like