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