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The ABC Homeopathy Forum

Doctor Patient Relationship

Doctor-Patient Relationship
By
Dr. Prasenjit Ray
BHMS (cal) PGT (Psychiatry)


Physicians who are sensitive to the effects of history, culture, environment & psychology of the doctor-patient relationship can work with people with multifaceted symptom-complex of the patient.
In many cases of psychic origin or psychosomatic origin can improve radically with a strong doctor-patient relation.
To elicit the mental symptoms, of which we think but often fail to, such relation is a supreme necessity.
Models Of Disease
The biopsychosocial model of Disease
There are three systems of approach to human behavior & to disease as per Engel Gorge.
Biological system: Deals with anatomical, structural & molecular substrates of disease & it’s effects on biological functioning.
Psychological system: Deals with effect of psychodynamic factors, motivation & personality on the experience of & reaction to illness.
Social system: Deals with cultural, environmental, & familial influences on the expression & experience of illness.
Meaning of being SICK
The sick role is described as the society ascribes to sick people because they are ill. Edward Suchman described 5 stages of illness.
The symptom experience stage.
The assumption of sick role.
The medical care contact stage.
The dependent-patient role stage.
The recovery or rehabilitation stage.
Assessment of Individual illness behavior
The essential areas to be addressed in assessing:
Prior illness episodes (especially of standard severity
Cultural beliefs about the particular problem.
Personal beliefs about particular problem.
Specific questions are to be asked to elicit the explanatory model of the patient.
What do you call your problem? What is the name it have?
What do you think caused your problem?

Why do think it started when it did?
What does your sickness do to you? How does it work?
How severe is it? What about it’s course?
What do you fear most about your sickness?
What are the chief problems that your sickness has caused to you?
What kind of treatment do you expect to receive? What are the expected results do you expect to receive?
What have you done so far for your sickness?
Doctor-Patient Models
Doctor-patient relationship has different models which most often derive from the personalities, expectation, & needs of both doctor & patient.

Though mostly neither the doctor nor the patient are fully aware of choosing the model of such relationships, as it varies from case to case.

Doctor should be aware of which model operates with which patient & must be able to shift from one to another as per the case & clinical condition demands.
Types of Doctor-Patient Relations
Active-passive model:
Implies a patient’s passivity & the physician taking control. Here the patient remains virtually non-responsible for there care & treatment. Effective in patient who are unconscious, immobilized, delirious.
The teacher-student model:
Here the physician’s role is paternalistic & controlling; the role of the patient is of dependence & acceptance. This model is observed in post-surgical & children patients.


Mutual Participation model:
Implies equality between doctor & patient; both participants require & depend on each other’s input.
Here the doctors active participation is obvious in the treatment of chronic cases. The patient’s knowledge & acceptance of the treatment procedure is critical to the success of treatment. This model is effective in both psychic & somatic chronic diseases.
Friendship model:
This type of relation is generally considered as dysfunctional if not unethical. It most often reflects a primary, underlying psychological problem. Who may have a emotional need to turn patient’s care into relationship of mutual sharing . It ultimately turn into inappropriate ending & blurring of doctor-patient relation boundaries & professionalism.
Interviewing effectively
For every effective interview there are three main components.
The 4 dimension model of Othmers
 
  homeo_psychiatrist on 2006-06-01
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