Doctor patient relationship

Background Literature on difficult doctor-patient relationships has focused on the "difficult patient." Our objective was to determine physician and practice characteristics associated with greater physician-reported frustration with patients. Methods We conducted a secondary analysis of the Physicians Worklife Survey, which surveyed a random national sample of physicians. Participants were 1391 family medicine, general internal medicine, and medicine subspecialty physicians. The survey assessed physician and practice characteristics, including stress, depression and anxiety symptoms, practice setting, work hours, case-mix, and control over administrative and clinical practice. Physicians estimated the percentage of their patients who were "generally frustrating to deal with." We categorized physicians by quartile of reported frustrating patients and compared characteristics of physicians in the top quartile to those in the other three quartiles. We used logistic regression to model physician characteristics associated with greater frustration. Results In unadjusted analyses, physicians who reported high frustration with patients were younger (p 55 per week, higher stress, practice in a medicine subspeciality, and greater number of patients with psychosocial problems or substance abuse. Conclusion Personal and practice characteristics of physicians who report high frustration with patients differ from those of other physicians. Understanding factors contributing to physician frustration with patients may allow us to improve the quality of patient-physician relationships.

This article presents a new avenue for healthcare risk managers to drive improvement for patients and healthcare organizations alike: working to reduce avoidable patient suffering. It briefly describes the problem of patient suffering, differentiates between avoidable and unavoidable suffering, and suggests that common risk management tools can be used to tackle the problem. It also highlights a success story from one large health system.

Given the high rate of psychiatric comorbidity with chronic fatigue syndrome (CFS), we considered two possible correlates of anxiety and depression: lack of illness legitimization and beliefs about limiting physical activity. A total of 105 people diagnosed with CFS reported on their experiences with medical professionals and their beliefs about recovery and completed the depression and anxiety subscales of the Brief Symptom Inventory. Those who said that their physician did not legitimize their illness (36%) had higher depression and anxiety scores (P's<.05) than their counterparts. Those who believed that limiting their physical exertion was the path to recovery (55%) had lower depression and anxiety scores (P's<.01) than their counterparts. Lack of illness legitimization ranked high as a source of dissatisfaction for CFS patients, and it may aggravate psychiatric morbidity. Many CFS patients believed that staying within what they felt to be their physical limits wou...

The aim of this study was to analyse with sequence analysis physician–patient dialogue surrounding patients’ expression of emotional cues. Two samples, sample 1 consisting of 36 cancer patient consultations conducted by four oncologists, and sample 2 consisting 79 consultations of haematology patients conducted by nine specialists, were audiotaped and coded with the Roter Interaction Analysis System (RIAS). Sequence analysis by

Treatment adherence is influenced by factors like illness and patient characteristics, side effects, time taken to improve and the doctor-patient relationship. One of the important patient characteristic which has been reported to influence treatment adherence is their attitudes and beliefs towards medication. 50 subjects of first episode unipolar depression (except for severe depression with psychotic symptoms), aged 18-50 years, duration of depression of more than 1 month, with no comorbid psychiatric disorders and comorbid medical illnesses were assessed twice. At first intake, antidepressant compliance questionnaire (ADCQ) was administered. Second intake was done after 3 months for assessment of treatment adherence by using the questionnaire for assessment of treatment adherence. On component-1 of ADCQ (doctor-patient relationship), 92% agreed that doctor gave sufficient time to listen to their problem, explained the causes of depression sufficiently, felt confident that antidep...

Taking as our starting point Plato's metaphor of the doctor as philosopher we reflect on some aspects of the epistemological status of medicine. The framework to this paper is the hermeneutics of Hans-Georg Gadamer which shows the paradoxical nature of Western medicine in choosing the body-object as its investigative starting point, while in actual fact dealing with subjects. Gadamer proposes a model of medicine as the art of understanding and dialogue, which is capable of bringing together its various constituent parts, i.e. knowledge, knowing how to do and knowing how to be, in medical practice and in the physician's training. The paper concludes with a brief discussion of the dyadic figure of the physician as Platonic "master of the living totality" and wounded healer, capable of activating the patient's self-healing capacity.

The protocols specifying the basic rules of the doctor-patient relationship that have been proposed in the literature are primarily intended for referring physicians, in particular oncologists. With regard to the improving radiologists’ communication skills, a simple tool, RADPED, was developed to help residents in pediatric radiology to memorize the main points of the patient-radiologist interaction. We suggest a protocol, CREDO, more precisely appropriated to the everyday practice of medical imaging, in particular in oncology. This protocol relates not only to the radiologist-patient relationship, but also to the rules common to the department’s entire team. The aims are to establish a partnership with the patient (for this purpose, we suggest using the PERLES model: partnership, excuses (apology), respect, legitimization, empathy, support), carrying out the examination under optimal conditions, listening to what the patient has to say, giving information and, above all, organizin...

El objetivo que guio este estudio fue comparar los puntos de vista que los actores de la relación médico-paciente tienen entre ellos, así como identificar las coincidencias y las diferencias que pueden llevar a lograr una mejor comunicación en el proceso de atención. La metodología empleada fue de tipo cualitativo y etnográfico. Los participantes fueron personas con enfermedades crónicas (principalmente con diabetes) y profesionales de la salud (sobre todo médicos). El análisis de la información se realizó a través de la técnica de análisis de contenido con el apoyo del programa computarizado Atlas-ti. Los resultados muestran que la relación médico-paciente es compleja, implica la negociación o imposición de visiones diferentes para generar formas de comunicación. Una de las coincidencias entre las visiones de los médicos y los pacientes fue el destacar la generación de un clima de confianza, lo que lleva a considerar al médico como un amigo.

Objectives:  The objectives of the study were (1) to assess similarities and differences between breast cancer patients and their husbands in terms of doctor-patient/spouse relationships and shared decision making; and (2) to investigate the association between breast cancer patients and husbands in terms of preference of type of doctor, doctor-patient relationship, and shared decision making regarding medical treatment.Method:  Fifty-seven women with breast cancer, and their husbands, completed questionnaires measuring doctor-patient/spouse relationships (paternalism, autonomy), and decision making regarding medical treatment.Results:  Patients believe they have a key role in the medical decision-making process (93%) and that the participation of their husbands, and their agreement with the decision, is important (84% and 89%, respectively). Both breast cancer patients and their husbands prefer a shared decision-making process to paternalistic or autonomy-based approaches.Conclusion:  In contrast to legal and bioethical approaches, which focus on the patient as the primary decision maker, this study reflects a practical recognition of the role of the breast cancer patient's husband in the decision-making process. It also reflects a relational rather than an individualistic perception of patient autonomy.

The Wei Zexi Incident is coupled with a number of problems that have long existed with with Baidu and the healthcare reform in China. It exploded heated discussions amongst the general public and experts, notably on the circulation of online medical advertisement without proper regulation, the lack of transparency about the outsourcing of medical departments of military-run hospitals to private medical companies which quality was usually in serious doubt, and the limits of the recent round of healthcare reform. This article will provide an overview of these discussions.

How family doctors conceptualise chronic illness in the consultation has important implications for both the delivery of medical care, and its experience by patients. In this paper, we present the results of a re-analysis of qualitative data collected in a series of studies of British family doctors between 1995 and 2001, to explore the ways in which the legitimacy and authority of medical knowledge and practice are organised and worked out in relation to three kinds of chronic illness (menorrhagia; depression; and chronic low back pain/medically unexplained symptoms). We present a comparative analysis of (a) the moral evaluation of the patient (and judgements about the legitimacy of symptom presentation); (b) the possibilities of disposal; and (c) doctors' empathic responses to the patient, in each of these clinical cases. Our analysis defines some of the fundamental conditions through which general practitioners frame their relationships with patients presenting complex but so...

This article looks at the question of sin and disease in bioethics with a spiritual-theological analysis from the book of Job. The biblical figure Job is an innocent and just man who suffered horrendously. His dialogues with others—his wife, his friends, and God—can give many valuable insights for patients who suffer and for those who interact with them. Family, friends, physicians, nurses, chaplains, and pastoral workers can learn from Job how to communicate properly with sufferers. The main question for Job was how to maintain the tension between God’s justice and God’s mercy and not yield to the temptation of cursing God but to speak well of Him in moments of difficulties.