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21Aug

Danny Lieberman, founder of Pathcare, the private social network for doctors and patients, asks “What are the ingredients for a successful doctor-patient relationship” and makes a surprising discovery.

A conversation with a twice-divorced colleague, got me thinking about relationships: doctor-patient relationships and marriage relationships.

A-priori, the characteristics of a doctor-patient relationship are totally different from other social relationships.

Americans are famous for being open and surprisingly candid to perfect strangers on planes or lines in Disneyland and telling them the story of their life.

Such openness is not the norm in the rest of the world.

Doctor-patient relationships may be based on story-telling, just a different kind of story telling and with more potent consequences.

In a visit to the doctor, a patient starts telling the most intimate personal details about his health to his doctor within a few seconds. A minute later, the doctor will start suggesting probable causes, and within another few seconds, the patient is preparing to remove clothing and submit to a physical exam.

The doctor-patient relationship is by definition asymmetric; the doctor is trained in medicine and the scientific method and bound by the Hippocratic oath and the patient is an expert in his personal experience, although thanks to Dr. Google; more and more patients come extremely well prepared to their doctor.

In the doctor patient relationship, the patient is seeking expert knowledge beyond Dr. Google and access to treatment and the doctor is the gatekeeper of a scarce social resource called “healthcare services” and in order to decide how to best allocate this resource, the doctor interviews the patients and/or performs additional tests.

In the doctor-patient relationship, the office consultation is an exchange of information. More effective information exchange leads to more effective health outcomes. Skipper and Leonard showed that sharing information with surgical patients improved recovery rates and enhanced outcomes. In the case of chronic diseases such as Parkinsons and diabetes where patients and caregivers manage treatment, good communications in the doctor-patient relationship is central to compliance with the treatment plan and successful outcomes. See J. K. Skipper and R. C. Leonard (Eds.),Social interaction and patient care.

If there is big gap between the doctor and patient’s view of issues, vital information will not be communicated and the treatment plan and health outcome will suffer.

In “Reflections on the doctor–patient relationship: from evidence and experience”. Moira Stewart et al present the 6 components of the doctor-patient relationship in an integrated clinical method.

  1. Exploring both disease and the patients’ illness experience
  2. Understanding the whole person
  3. Finding common ground
  4. Incorporating prevention and health promotion
  5. Enhancing the patient-doctor relationship
  6. Being realistic

The third component is a mutual task of doctor and patient, the task of finding common ground. This component has been found in our research to be the most important in predicting positive patient outcomes and therefore now holds place of prominence as the central task of patient-centred medicine. It focuses on three key areas, the patient and doctor mutually: defining the problem; establishing the goals of treatment and/or management; and identifying the roles to be assumed by patient and doctor

The fourth component highlights the importance of using each contact as an opportunity for prevention and health promotion. These activities may be as broad as the advocacy Sir James Mackenzie incorporated into his professional life. His biographer comments on Mackenzie’s two influences:

One medical and personal and the other social … one effort is directed solely toward the individual patient, while the other is concerned with stirring the public conscience.’

The fifth component is the use of each contact with the patient to build on the doctor–patient relationship and its dimensions of compassion, empathy, trust, spirituality and sharing of power. To accomplish these goals, requires self-awareness as well as an appreciation of the unconscious aspects of the relationship.

The sixth component is being realistic, reminding practitioners that each of us has limitations and that time and teamwork can assist in the multifaceted work in general practice.

(All quotes above are from “Reflections on the doctor–patient relationship: from evidence and experience”. Moira Stewart http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1562329/ )

Consider the components for a successful marriage:

  1. Exploring the experience of both husband and wife
  2. Understanding the whole person
  3. Finding common ground
  4. Incorporating prevention and health promotion
  5. Enhancing the relationship
  6. Being realistic

Voila, it seems that despite our initial conclusion that doctor-patient relationships are different and special, there is in fact almost totally commonality between the ingredients for a successful marriage and successful doctor-patient relationship – something that is at once both totally amazing and yet totally natural.

I ran this by my GP and she said, “Yes, Danny you are right, except you forgot one important thing”:

Smile at the other person and think – I just want for this person to be happy (healthy)”!

 

  

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