Doctor-patient relationship
The doctor-patient relationship and interaction is a central process
in the practice of medicine. There are many perspectives from which
to understand and describe it.
An idealized physician's perspective, such as is taught
in medical school, sees the core aspects of the process as the physician
learning from the patient his symptoms, concerns and values; in
response the physician examines the patient, interprets the symptoms,
and formulates a diagnosis to explain the symptoms and their cause
to the patient and to propose a treatment. In more detail, the patient
presents a set of complaints or concerns about his health to the
doctor, who then obtains further information about the patient's
symptoms, previous state of health, living conditions, and so forth,
and then formulates a diagnosis and enlists the patient's agreement
to a treatment plan. Importantly, during this process the doctor
educates the patient about the causes, progression, outcomes, and
possible treatments of his ailments, as well as often providing
advice for maintaining health. This teaching relationship is the
basis of calling the physician doctor, which originally meant "teacher"
in Latin. The patient-doctor relationship is additionally complicated
by the patient's suffering (patient derives from the Latin patiens,
"suffering") and limited ability to relieve it on his
own. The doctor's expertise comes from his knowledge about, or experience
with, other people who have suffered similar symptoms, and his presumed
ability to relieve it with medicines or other therapies about which
the patient may initially have little knowledge.
The doctor-patient relationship can be analyzed from
the perspective of ethical concerns, in terms of how well the goals
of non-maleficence, beneficence, autonomy, and justice are achieved.
Many other values and ethical issues can be added to these. In different
societies, periods, and cultures, different values may be assigned
different priorities. For example, in the last 30 years medical
care in the Western World has increasingly emphasized patient autonomy
in decision making.
The relationship and process can also be analyzed
in terms of social power relationships (e.g., by Michel Foucault),
or economic transactions. Physicians have been accorded gradually
higher status and respect over the last century, and they have been
entrusted with control of access to prescription medicines as a
public health measure. This represents a concentration of power
and carries both advantages and disadvantages to particular kinds
of patients with particular kinds of conditions. A further twist
has occurred in the last 25 years as costs of medical care have
risen, and a third party (an insurance company or government agency)
now often insists upon a share of decision-making power for a variety
of reasons, reducing freedom of choice of both doctors and patients
in many ways.
The quality of the patient-doctor relationship is
important to both parties. The better the relationship in terms
of mutual respect, knowledge, trust, shared values and perspectives
about disease and life, and time available, the better will be the
amount and quality of information about the patient's disease transferred
in both directions, enhancing accuracy of diagnosis and increasing
the patient's knowledge about the disease.
In some settings, e.g. the hospital ward, the patient-doctor
relationship is much more complex, and many other people are involved
when somebody is ill: relatives, neighbors, rescue specialists,
nurses, technical personnel, social workers and others.
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