Doctor Quotes - BrainyQuote
Keywords: Benefits, communication, doctor-patient relationship, review, strategies has led to the current model of shared decision making and patient- centered health care.7,8,16 The 3 main goals of current doctor-patient communication. Relationships between doctors, nurses and patients significantly affect patients' overall This study examines the relationships between all three .. Talcott Parsons' model of the sick role illustrates the roles and responsibilities of the .. the sections includes direct quotes from interviews with doctors. Practice Implications: Applying theories and models of health education effective doctor-patient relationship at 3 more accredited Iranian universities of . verbatim quotations, which support the theme of barriers to effective.
For instance, a market-based system with health insurance linked to employers' whims, with competitive provider networks and frequent mergers and acquisitions, thwarts long-term relationships. A health plan that includes the spectrum of outpatient and inpatient, acute and chronic services has an opportunity to promote continuity across care settings.
The competition to enroll patients is often characterized by a combination of exaggerated promises and efforts to deliver less.
The Doctor–Patient Relationship
Patients may arrive at the doctor's office expecting all their needs to be met in the way they themselves expect and define. They discover instead that the employer's negotiator defines their needs and the managed care company has communicated them in very fine or incomprehensible print.
Primary care doctors thus become the bearers of the bad news, and are seen as closing gates to the patient's wishes and needs. When this happens, an immediate and enduring barrier to a trust-based patient-doctor relationship is created. The doctor—patient relationship is critical for vulnerable patients as they experience a heightened reliance on the physician's competence, skills, and good will.
The relationship need not involve a difference in power but usually does, 30 especially to the degree the patient is vulnerable or the physician is autocratic.
United States law considers the relationship fiduciary; i. Thus, providing health care, and being a doctor, is a moral enterprise. An incompetent doctor is judged not merely to be a poor businessperson, but also morally blameworthy, as having not lived up to the expectations of patients, and having violated the trust that is an essential and moral feature of the doctor—patient relationship.
Deception or other, even minor, betrayals are given weight disproportional to their occurrence, probably because of the vulnerability of the trusting party R. Thus, a single organization may both provide and pay for care.
Organizations as providers have duties such as competence, skill, and fidelity to sick members. Organizations as payers have duties of stewardship and justice that can conflict with provider duties. Managed care organizations thus have conflicting roles and conflicting accountability. An organization's accountability to its member population and to individual members has a series of inherent conflicts.
Is the organization's primary accountability to its owners, to employer purchasers, to its population of members, or to individual, sick members? If these constituents somehow share the accountability, how are conflicting interests resolved or balanced? For example, the use of the primary care clinician to coordinate or restrain access to other services involves the primary care clinician in accountability for resource use as well as for care of individual patients.
Although unrestricted advocacy for all patients is never really achievable, the proper balance and the principles of balancing between accountability to individual patients, a population of patients, or an organization need to be made explicit and to be negotiated in new ways.
All mechanisms for paying physicians, including fee-for-service reimbursement, create financial incentives to practice medicine in certain ways. We still lack a calculus to minimize or even describe in fine detail how such conflicts affect our ability to justify trusting relationships. Even-handed social attention seems appropriate to all the different mechanisms of payment.
Balanced assessment of how the details of remuneration systems influence doctor's willingness to act on behalf of patients will best protect both the health of the public and the health of doctor—patient relationships.
This is a priority for a new form of empirical, ethical research. Patients correctly wonder if doctors are caring for them, the plan, or their own jobs or incomes the latter is equally problematic in fee-for-service care.
Court orders may be invoked to override a patient's preferences. However, such disregard for the patient's right to noninterference is rarely indicated. Court orders may have a role in the case of a minor; during pregnancy; if harm is threatened towards oneself or others; in the context of cognitive or psychological impairment; or when the patient is a sole surviving parent of dependent children.
However, the use of such compulsory powers is inherently time-limited, and often alienates the patient, making him less likely to comply once he is no longer subject to the sanctions.
What is the role of confidentiality? Confidentiality provides the foundation for the physician-patient relationship. In order to make accurate diagnoses and provide optimal treatment recommendations, the physician must have relevant information about the patient's illness or injury.
This may require the discussion of sensitive information, which would be embarrassing or harmful if it were known to other persons. The promise of confidentiality permits the patient to trust that information revealed to the physician will not be further disseminated. The expectation of confidentiality derives from the public oath which the physician has taken, and from the accepted code of professional ethics.
The physician's duty to maintain confidentiality extends from respect for the patient's autonomy.
Doctor-Patient Communication: A Review
Would a physician ever be justified in breaking a law requiring mandatory reporting? In general, mandatory reporting requirements supersede the obligation to protect confidentiality.
While the physician has a moral obligation to obey the law, she must balance this against her responsibility to the patient. Reporting should be done in a manner that minimizes invasion of privacy, and with notification to the patient. If these conditions cannot be met, or present an intolerable burden to the patient, the physician may benefit from the counsel of peers or legal advisors in determining how best to proceed.
For a discussion on the limits of confidentiality, see the topic page on Confidentiality. What happens when the physician has a relationship with multiple members of a family? Physicians with relationships with multiple family members must honor each individual's confidentiality. Difficult issues, such as domestic violence, sometimes challenge physicians to maintain impartiality.
In many instances, physicians can help conflicted families towards healing. At times, physicians work with individual family members; other times, they may serve as a facilitator for a larger group. As always, when a risk for imminent harm is identified, the physician must break confidentiality.
The Doctor–Patient Relationship
Physicians can be proactive about addressing the needs of changing family relationships. For example, a physician might tell a preteen and her family, "Soon you'll be a teenager.
Sometimes teens have questions they would like to discuss with me. If that happens to you, it's okay to tell your parents that you'd like an appointment.