Therapeutic aspects of the clinical encounter

Journal of General Internal Medicine, 1999

Annals of Internal Medicine, 1973

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Canadian family physician Médecin de famille canadien, 2008

EC Cardiology, 2021

This third part of the paper we cope the different psychological aspects of communication with the patient that influences his relationship with the doctor. The words used in talking with the patient and the story that he tells, the capability of listening by the doctor, the attitudes and the ability to create empathy shall be considered with attention in the doctor-patient relationship due to the influence that they have on it. Above all, to cure (medically) and to care (psychologically) patient, taking the responsibility of his pathway are emphasized seen the implications that this behavior has in the management of the patient with his disease. One must be a doctor to do the doctor well without forgetting that patient with his disease is the final goal of the medical profession.

Acta bio-medica : Atenei Parmensis, 2008

Communication among doctors when making diagnoses, when communicating information to the patient, and when evaluating a doctor's own satisfactions and frustrations in terms of practicing medicine is shown to be crucial to any definition of good medicine. The wide range of literature in English on the topic of doctors and good communication suggests that a focus on its importance could be a tool for learning and a source for sensitizing Italian doctors to its crucial role in healing. Doctors need to be aware of their power when they deal with patients. How words are used can play a major role in how a patient faces a long-term disease. Communication is fundamental to good medicine; its rewards are immeasurable for both patient and physician.

Israel Journal of Health Policy Research

Background: The issue of patient-physician relationships in general, and particularly the trust of patients in their primary care physician has gained much interest in academia and with practitioners in recent years. Most research on this important topic, however, focused on how patients view the relationship and not how the physicians see it. This research strives to bridge this gap, with the resolution of leading to an improved appreciation of this multifaceted relationship. Methods: A survey of 328 actively practicing physicians from all four health maintenance organizations (HMOs) in Israel resulted in a hierarchical formation of components, indicating both the relative as well as absolute importance of each component in the formation of the patient-physician relationship. The sample conducted was a convenience one. Methodologically, we used two different complementary methods of analysis, with the primary emphasis on the Analytic Hierarchical Processing (AHP), a unique and advanced statistical method. Results: The results provide a detailed picture of physicians' attitudes toward the patient-physician relationship. Research indicates that physicians tend to consider the relationship with the patient in a rather pragmatic manner. To date, this attitude was mostly referred to intuitively, without the required rigorous investigation provided by this paper. Specifically, the results indicate that physicians tend to consider the relationship with the patient in a rather pragmatic manner. Namely, while fairness, reliability, devotion, and serviceability received high scores from physicians, social interaction, friendship, familial, as well as appreciation received the lowest scores, indicating low priority for warmth and sociability in the trust relationship from the physician's perspective. The results showed good consistency between the AHP results and the ANOVA comparable analyses. Conclusions: In contrast to patients who traditionally stress the importance of interpersonal skills, physicians stress the significance of the technical expertise and knowledge of health providers, emphasizing the role of competence and performance. Physicians evaluate the relationship on the basis of their ability to solve problems through devotion, serviceability, reliability, and trustworthiness and disregard the "softer" interpersonal aspects such as caring, appreciation, and empathy that have been found to be important to their patients. This illustrates a mismatch in the important components of relationship building that can lead to a loss of trust, satisfaction, and repeat purchase.

Social science & medicine, 1972

In order to investigate the claims that the quality of doctor-patient relationship has deteriorated, the experiences of 330 ambulatory care patients and of 360 hospitalized patients were collected by means of a mailed questionnaire. The relationships between three groups of variables were studied : background variables describing the doctor and the patient; variables pertaining to certain salient instrumental, communicative, and expressive factors of the doctor-patient relationship, and variables measuring the success of this relationship.

Adherence to medical prescriptions reaches 50% in chronic illnesses. Doctor-patient encounters have been dissected, searching for responsible factors or components in order to uproot them painlessly, mimicking scientific approaches of natural sciences, thus replacing these relationships by subject-object artificial gaps. Our empirical study is an instance of a phenomenological interpretive approach that brings forth adherence related issues both in non-chronic patients and in doctors, with customized interviewing procedures in the background. Drawing on Ricoeur, medical visits were considered subplots that acquired meaning in the context of the main plot in each patient´s ongoing life. Interviews addressed professional issues of doctors and narratives of patients in the context of their ongoing life plots. Results showed that doctors considered themselves patient educators, repeating standardized messages endlessly, otherwise leaning on patients' relatives or medical communities for help when these procedures failed. They considered relational issues psychological, foreign to medical scope. Patients, instead, scanned doctors precisely in terms of their commitment and adherence depended on the doctors' comprehensive grasp of patients' priorities. Medical training routinely underestimates the relationship, a professional crux: being at the service of another, listening and talking to him/her.

The physician-patient relationship has changed over time: in the nineteenth century it was characterised by professional dominance; in the twentieth century a unilateral aleatory contract came into being between the professional and his client; it is expected that in the future medical practice will come to be based on individual genetic predisposition, where treatment will precede early symptoms and illnesses will be treated with personalised remedies and medicines. Until now, government policies have mainly aimed at safeguarding patients' health; today evermore attention is being paid to patients' right to self-determination. Society's perception of the physician has also changed: the physician is no longer seen as the custodian of an absolute knowledge, but rather as a service provider and the patient has come to be seen as a consumer.Over the last decades patients' protection has seen the rule of informed consent and efforts to favour patients under the law. Europe now fears that this favouritism will eventually trigger a crisis similar to the one which overwhelmed the U.S.A: in the U.S. the consequence was the halting of the lay standard in favour of the professional one; in Europe a defensive practice has come into being. This practice is based on complex risk management procedures and strict protocols consisting of many forms and very detailed information leaflets. Today, these two aspects -the preference of patients' right to self-determination and defensive practices -are the main reasons behind the physicianpatient relationship transformation. Traditional one-way physician-patient communication is being replaced by dialogue. The move is one from information to counselling. The paternalistic approach of traditional medicine has already been replaced by the principle of physician-patient cooperation, which is a prelude to modern "talking medicine". This paper focuses on describing this medical approach change and the juridical and practical implications that come with it.

Beyond Diagnosis: Relating the Person to the Patient - The Patient to the Person, 2014

Thank you, I feel so much more like a person now,' I told the Intensive Care Unit (ICU) nurse after the morning bath. The words came out spontaneously, and she was startled. What made me feel 'more like a person' at a time when my life was at risk, and I was tied to machines and entirely dependent on others' care? If becoming a patient entails the experience of vulnerability and ultimately the exposure to one's mortality, how does a patient remain a person in the midst of acute illness? Can a patient remain a person if she is regarded primarily as a malfunctioning body and/or mind? To what extent is the patient's self-perception shaped by others' perceptions of her? Can she contribute by reshaping those that prove harmful? By arguing for the need to listen to the patient's 'biological and biographical stories' in the interest of good clinical practices, John Launer pinpoints the limitations of a biomedical approach that splits the body from the person, and argues for the need to reconnect biology and biography within the therapeutic relation. 1 Indeed, one of the most striking conclusions of Klitzman's study on doctors who became patients is the stigmatisation of patienthood among the medical profession. Not only did doctor-patients feel diminished as patients and experienced the dissociation between body and person, but they also complained of the split between professional and personal responses from their colleagues. 2 The patient's split between body and person thus seems to find a correlate in the physician's split between professional and person, and both may be symptomatic of pervasive cultural practices. How to connect biology and biography, the professional and the personal in the clinical encounter is the question addressed in this chapter, which draws on personal testimony, illness memoirs, and literature on clinical practice.