This is an essay that I wrote on the matter:
May
4, 2013
Essay 3: Doctor-Patient Relationship
The relationship between
patients and physicians has experienced a crucial shift in the past few years.
Through the discovery and implementation of new models, patients are gaining a
much more active role in this relationship. However, the balance within the
collaborative patient-doctor relationship should be maintained. Moreover,
physicians should broaden their roles by offering a much more accessible and
reliable source of medical information to patients.
A central interaction
within the modern health care system, doctor-patient relationship is one
essential step that usually entails some basic set of examinations and a conversation.
The objective is to diagnose and treat; however, those goals may not always be
achieved. In addition to depending on the type of illness or disease, the basic
concept of a medical consultation is clouded with various social elements such
as the hierarchical relationship between the patient and health provider;
arguments or discussions when determining the most suitable treatment; ethical
considerations such as administering the informed consent; as well as a level
of professionalism. Furthermore, the understanding that each party has for each
other’s culture, expertise and stake in the relationship influence the
interaction.
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| Taken in Indonesia |
Currently, numerous
sectors: government, health care professionals, administration, patients, as
well as activists have been in pursuit of the ideal doctor-patient relationship.
What makes the ideal doctor-patient relationship? Is the conventional model too
outdated for today’s society? And yet, is the collaborative model the best
alternative?
The doctor-patient relationship could be
classified into several models based on the social hierarchy within the
relationship and the type of disease/illness/predicament at hand. The
relationship between health professionals and patients could be separated based
on the power dynamics: doctors as superior to patients, an equal stance within
the relationship, as well as patients as superior to doctors, which rarely
occurs (Badcott, 2005, 174).. On the other hand, the type of condition’s
influence on the model may include acute and chronic conditions. For instance,
chronic diseases require a long-term relationship within health care providers
and patients, prompting the need to have a better relationship. In this essay,
I will focus on the categories in doctor-patient relationship based on power
dynamics.
In the past, most
doctor-patient relationships placed the doctor superior to the patient. Doctors
are viewed as credible based on their medical degrees, the perception of their
higher level of intelligence and as experts. Many incidences have suggested
that doctors have the autonomy and knowledge to determine the patient’s
diagnosis and consequent treatment. The misplacement of authority in doctors has
created a dynamic where patients are passive from chiming into the discussion
and choosing their assigned treatment (Salmon and Hall, 2003, 1970). Patients
are also often perceived as victims instead of active players in improving
their own health. Surprisingly some patients prefer this model as it the
responsibility is placed on the health care providers. Gathering information
and finding a cure is not the patient’s obligation. This model undermines the
information and added value that patients bring to the table.
Badcott proposed several models ranging from the
expert patient who owns special knowledge and skills, autonomous patient who
has the liberty to decide, emancipated patient who has freedom from legal or
social constraint, and the empowered patient who is free to act (Badcott, 2005,
177). These modes are implicitly shown in the EPP.
Various
programs have involved a shift towards a more collaborative model of
doctor-patient relationship. The Expert Patient Program (EPP), for instance, is
a self-management program designed to support patients by elevating their
confidence, improving their quality of life, and supporting them in managing
their conditions in a more effective manner. Implemented in England, the
program is particularly designed for those suffering from chronic illness and
conditions, such as diabetes, hypertension,
as well as physical disabilities.
The model was
founded on Bandura’s social cognitive theory of behavior, which stipulates, “Key predictors of successful behaviour changes are
confidence (self efficacy) in the ability to carry out an action and
expectation that a particular goal will be achieved (outcome expectancy). Self
efficacy is seen as an early step in causal pathways of behaviour change in
self management programmes; increasing self efficacy (confidence) is a
prerequisite for behaviour change which, through improved self management may
influence health and healthcare use” (Griffiths, et al., 2007, 1254). Later on
the U.K. health department invested in a task force, which offered programs for
patients with chronic diseases that were led by lay experts.
The EPP creates patients who are actively working
together with the health care professionals, as well as independently gaining
personal expertise regarding their own condition. Research has suggested that
an increase in patient involvement during consultation might result in greater
patient satisfaction, which perhaps could lead to better health. The basic
assumption when adopting the EPP is that better health might be achieved
through active participation determining their treatment. The U.K. NHS expects
that these events would therefore culminate into the reduction of healthcare
use and even mortality. Studies have suggested an increase in patients’
self-efficacy, which resulted in improved psychological health. Patient
involvement modestly increases patients’ self-efficacy, increases psychological
health and might be useful for ethnic minorities (Griffiths et al, 2007, 1255).
In addition to encouragement of the patient’s confidence,
a collaborative model appears to be more effective as it actively includes the
patient, who lives and therefore understands the condition from a different
light. Although diseases, illnesses and conditions have general patterns, they
are often presented differently in various people. A patient’s lifestyle, diet,
and profession may contribute to the individual experience of a condition.
According to Salmon and Hall, having a better understanding of the
individual and illness enables us to determine the shape and content of medical
practice. Salmon and Hall mentioned the usage of the Bio Psycho Social (BPS)
model, which allows medical professionals to expand their power into other
areas of a patient’s life without blaming said patient for their lifestyle
choices. With the BPS approach, patients take on the role of experts in each of
their illness and disease (Salmon and Hall, 2003, 1972).
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| The Hospital |
The BPS has garnered some backlash as it implies the extension of
medical power. Where does the health care professional’s influence begin and
end? Even though this model seems to encourage a more equal relationship
between patient and health care provider, it also galvanizes the doctors’
control on the patients’ lives. For example, when using this model doctors have
the right to determine the patient’s diet, exercise routine, living
environment, as well as day-to-day activities. This model includes both
collaboration between doctors and patient while implementing a restrictive
measures to improve health.
Another argument for an equal power distribution between patient and
health provider is the concept that patient’s own validation will boost his/her
recovery. To attain these goals, Badcott suggested that patients are entitled
to learn more about their illness, especially through the increase in health
information available on-line. This situation will result in the possibility
for anyone who chooses and is capable in digest the information to become
better informed and to participate in decisions relating to his/her illness
(Badcott, 2005, 174).
Alongside the programs involving lay led experts is the informed patient
model, that is said to be reflexive, informed, requires highly specified
information, as well as having highly developed skills and tactics for
acquiring information. This discourse implies that individuals are inclined to
receive more responsibility for their own health (Adams and DeBont, 2007, 274).
Placing the patients as consumers, this model benefits from the heightened
availability of and access to medical information on the Internet. However, in
order to fully use this information and avoid incorrect information, and dangerous
consequences, a patient needs the right skills, such as being able to verify
the information based on its quality and sources. This discourse led to a shift
in the role of health professionals to include providing support, advise, and
help patients in broadening the latter’s medical knowledge via reliable
sources. In contrast, medical professionals aren’t as obligated to provide
superfluous amounts of information to the patient as they can recommend a list
of reliable medical websites.
The collaborative doctor-patient relationship model
is glorified as the solution to many health care problems. However, changes
need to be made in order to improve the circumstances in which information is
presented. General policing is required to ensure that information available
online are credible, safe and trustworthy. Policing should be designed to be a
simple and effortless task, such as the ability to verify information with one
mouse click (Adams and DeBont, 2007, 279).
Yet, how beneficial is a collaborative doctor-patient
relationship? Three of four studies, listed by Griffiths et al., showed no
change in generic measures of self rated health and use of health care. Perhaps
these results were due to the possibility that lay led programs both increased
and reduced consultation; even though unscheduled care may decrease, scheduled
care may have experienced some increase; and it is possible that the program
may not be as effective in countries with universal health coverage and primary
care, such as UK (Griffiths, et al., 2007, 1255).
With the technological advances available various
patient groups continue to rely on their physicians to provide information and
advise them on a certain treatment, indicating that some patients are still
unwilling to take on the responsibility that accommodates the informed patient
program. This phenomenon maintains that much of the responsibility and power
are within the doctors’ hands.
Even though paternalism by doctors and other health
providers will continue to limit patients’ freedom the power to diagnose; choose
the remedy; and decide a treatment plan should lie in both patient and medical
providers, as health professionals are experts in the general patterns of a
condition, however the patient is an expert in his/her own condition (Badcott,
2005, 177). Having additional and more specific knowledge will help in the
diagnosis as well as treatment. Studies have clearly shown the EPP’s and
Informed Patient Program’s positive influences on the patient. With patients
playing a much more active role in determining treatment, a partnership between
the patient and health care professional is still needed to ensure that a
balanced, collaborative relationship in health care is created. This should not
stop the availability and accessibility of medical information to patients who
choose to broaden their knowledge. The
role of the physician will extend to offering and policing online information,
as well as train patients to use and evaluate the information in a safe and
useful manner.
*The author owns rights to the photos above
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