Chapter 1

Doctor-Patient
Relationship

Vivian (Weiwei Liu)

Public health and
Management
1 Department
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 Stop and think!

why?! the relationships between

doctors and their patients are so bad .
What’s the factor affected the relationships
between them?

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It takes two to make a
quarrel !!!

COMMUNICATION

 The status and power of physicians may encourage patient’s dependency

and, influence how they perceive their health.
health
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 Doctors’ barriers to effective
communication

• lack of specific knowledge

• lack of counselling skills
• lack of time

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 Patient barriers to effective
communication

 Educational level
 Distrust the doctor
 Money (induce demand)

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What make the doctor-patient
relationship become so
strained
 First :The lack of trust
 Second :The false media reports
 Third :The deformity of Chinese healthy
system ……
 What?! doctors can do …

1. Working hard

2. Communication skills

3… …..

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 Basic Principles

 Respect for Persons 尊重他人

 Informed consent 知情同意
 Beneficence 行善
 Justice 公正
 Protect confidentiality 保守秘密

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 Problems between Doctor & Patient

 Japan
- About 90% patients want to get replies directly from doctors.
- 60 ％ of the doctors choose to tell the true conditions to their
family.
 Australia
- 91% of the cancer metastasis in patients think that, if doctors
discussing their condition was impatience or anxiety, they will
“not hopeful”
 American
- Research shows that, in clinical requirements often presented by
patients, but not by the doctor puts forward to establish relations
of cooperation requirement

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  China
- The patient will treat doctors, nurses, family members
as their pillar.
- The patient needs encouragement, sympathy,
medical information and practical guidance.
- The patient need not pessimistic attitude, apathy and
relatives of excessive protection.

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 The possible reasons:

1. Doctors don’t listen to patients.

2. Patients have to wait too long.
3. Doctor just doesn’t care.
4. Doctors make too much money.

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 Patient Doctor
s s

Nurses

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 1. Principles of “doctor-patient
relationship”

 The doctor-patient relationship: refers to

the medical activities of the interpersonal
relationship
 interpersonal relationship: People formed
in the process of psychological relationship
and psychological distance.
 A good relationship between doctors and
patients is the basis for the smooth
development of the medical activities.
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 2. models of Doctor-Patient
relationship:

(1) Basic Models:

SAS ( T . Sxas ) and Howard ( M . Mohade ) in 1956,
they divided them into 3 kinds of doctor-patient
relationship:
– 主动—被动型模式（ active-passive mode ）
– 指导—合作型模式（ guidance-cooperation mode ）
– 共同参与型模式 （ mutual participation mode ）

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  SAS-Howard Model Key point!!~
1. active-passive mode
– parents-baby
relationship
2. guidance-cooperation mode:
– parents-teenager
relationship 　
3. mutual participation mode
– adults-adults
relationship

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 The basic model of doctor-patient
relationship

1 、 Active passive mode:

Medical staff is fully active status, has the absolute authority.
The patient is in complete obedience to the position.
2 、 Guidance cooperation model:
Medical staff and patients in the active position. Doctors on the
treatment scheme is proposed the decisive measures, patients
can also make their own choices, seek medical staff and help
explain.
3 、 Mutual participation model:
physicians and patients have equal interaction position. They
need each other to participate in. The pattern is more common
in patients with chronic.

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 Types of Doctor’s Patient’s Applied Antitype in
mode status status objects life

active- What will do Passive Anesthesia, parents-

passive to the acceptance acute baby
mode patients (no response) traumatic relations
coma patients hip

guidance- Tell patients cooperation Acute infection parents-

cooperation what to do patients teenager
mode relationship

mutual Help patient Fellowship Chronic adults-adults

participation autotherapy (Actively diseases relationship
mode participate in patients and
the whole psychological
process ) treatment
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 (2) Humanistic model:

The doctor and the patient are

cooperation, respond to patients health.
1. Patients are more complex than the disease.
2. Respect for the patient, to become active participants in medical
treatment.
3. Habits, diet, lifestyle and environment, stress and health related to
people’s health.
4. The patient must be involved in the treatment, share rights and
responsibilities with physicians.
5. The doctor should not only have the treatment technology, also
need sympathy.
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 What should patients do ?

What should I do?

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 For the Patient ...

Sharing Your Point of View With Your Doctor

Choosing a Relationship Style

Learning the Information

Actively Cooperate with Your Doctor

Understand and Respect Your Doctor's Work

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 2. Medical role behavior:

(1) Physician role behavior

 Physician role ：
That is in the health care system has medical
knowledge, medical skills and diagnosis, treatment of
patients rights, engaged in the diagnosis, treatment
and prevention of disease professional staff.
 The doctor's responsibilities, rights and obligations:
Responsibilities: dualism, is responsible for
patients and society. On the whole, the goal is
consistent, but sometimes produces contradiction and
conflict.
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 Right: diagnosis and prescription
 Decisions on what patients using various kinds of
effective measures
 Declared whether the patient dead
 In addition: respect, get the proper compensation
Obligation:
 To relieve the suffering of patients
 Protection and respect for the rights of patients
 Medical confidentiality obligations
Occupation moral (Brain storm)

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 (2) The nurse role behavior

 Role of the nurse: refers to the medical and

health system in a nursing professional
education, master the nursing, ward
management knowledge and technology, and
has health prevention ability of the staff.
 Prescribing the executor
 To be the doctor, patient and family’s bridge
 More humanized service
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 (3) Medical staff’s essential
psychological quality

 The positive and optimistic mood

 Good character
 Sharp observation ability
 A strong will
 Good interpersonal skills

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 For the Doctor ...

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 Effective Doctor Patient
Communication

 gathering data,
 establishing a therapeutic rapport
 educating the patient

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 IF YOU ARE A DOCTOR
how do you treat with your patients?...

 Everybody, personality and condition is very

unique and must be treated as such.

 A very thorough history and exam is necessary.

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  ‘Nice’ Doctors Better Doctors

 ‘Nice’ Doctors Better Doctors

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 3. The interpersonal relationship in
clinical medicine

 Interpersonal communication type:

– The doctor-patient relationship
– The nurse-patient relationship
– The doctor-nurse relationship
 Communication type:
– Verbal ways
– Nonverbal ways

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 (1) Verbal communication

1 、 How to guide the patient to talk

2 、 opened conversation / closed conversation
3 、 Good conversation in the silence

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 Problems paid attention to in verbal
communication:

1 、 Avoid the use of noxious language

 Direct damage of language
 Indirect harm language ( negative, suggesting,
whisper to one another )
2 、 Use positive language
 Comfort language
 Encouraging words
 Persuade interpretive language
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 (2) Non verbal communication

 Mainly include: facial expressions, body

language, interpersonal distance.
 Dynamic: facial expressions, eye contact, look,
gesture, tone, speed, distance, facial and body
orientation;
 Static: appearance, posture, gesture, tone of
voice, clothing, instruments etc..

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 The use of facial expressions:
 By means of eye muscle, facial muscles and
mouth muscle changes to show the various
emotional states.
 Look cheerful, ashen face, stamp with rage

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  Use eye contact
 Through physical contact
 Pay attention to interpersonal distance
 亲密间距离： intimate distance <0.5m
 个人间距离： personal distance 0.5~1.2m
 社交性距离： social distance 1.2~3.5m
 大众性距离： public distance 3.5~7.0m
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 (3) Doctor patient communication
problems

 Information is lacking or inadequate

 Communication barriers
 Have not enough Compassion
 The initiative failed to fulfill

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 factors affect Doctor-Patient
relationship
 Demand Care and concern
〓 Respect, recognition
Elder doctor is
 prejudice better 〓 The patient is very weak
 impression The doctor is Trouble patients
hostility 〓
 transposition If I were the doctor If I were the patient
〓
 personality A quick temper
 temper 〓 Slow, gentle

Strange and
terror 〓 Be familiar with, normal

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 The four elements of
communication
 Respect
 Focus on
listening
 Same feeling
 Sincere

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 Discuss: How to deliver bad news to
42 patients and their families?
 cases:

 A man named Peng Shikuan in patients with leukemia after

autologous transplantation, after treatment, he felt unwell after the
operation in the hospital, began rioting, vandalism, sabotage

hospital.
 Until July 10, 2001, he held a fruit knife on the attending
physician Wang Wanlin, chopped 46 knives.
 Because of the excessive loss of blood, rescues the invalid,
Wang Wanlin was dead lastly.
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  48% of the physicians considered the
doctor-patient relationship tense because of
too little communication,50% of the patients
considered the lack of communication.
 Statistics show that, there are 90% medical
disputes with both patients and medical
staff because of the bad attitude during the
service process.

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 The complexity of medicine, because the treatment
outcome is uncertain, the difficult of medical service on
the evaluation is just like other service industries, have
identical to the satisfaction criterion;
 Part of the reform of medical care system can not
adapt to the masses;
 The existing laws and regulations do not apply to
adjust doctor-patient relationship, to resolve medical
disputes when applicable laws of chaos;
 Some of the news media reported on the improper
masses caused misleading.
  On one hand, strengthen the cultivation of
doctors, patients and their families feel fully
understand, satisfy the patient informed
consent requirements.
 On the other hand, the life sciences is one of
the most complex subject, in the case of
patients differ in thousands of ways, is very
difficult to ensure no mistakes or failures.
Therefore, patients should have correct
their understanding.
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  Do you think what causes the doctor-patient
relationship tense?
 In what ways and measures to improve the
doctor-patient relationship?

presentation in the next lecture

(2 groups tasks, for each one
prepared about 30 min.)
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