Patient-Physician relationship dynamics

"The good physician treats the disease; the great physician treats the human who has the disease"- Sir William Osler (Canadian Physician & Founder of modern medicine, 1849-1919)

The way a physician engages with the patient determines whether the physician is good or great. A good physician-patient relationship does not only define how great a doctor is, determines treatment outcome but it's also one of the top things making doctors feel their job is rewarding.

Models of Physician-Patient Relationship:

There are three basic models

1) Active – Passive Model: It is based on the physician acting upon the patient, who is treated as an inanimate object. This model may be appropriate during an emergency when the patient may be unconscious or when a delay in treatment may cause irreparable harm.

2) Guidance – Cooperation Model: A doctor is placed in a position of power due to having medical knowledge that the patient lacks. The doctor is expected to decide what is in the patient’s best interest and to make recommendations while the patient is expected to comply with these recommendations.

3 )Mutual –Participation Model: The mutual participation model is based on an equal partnership between the doctor and the patient. The physician’s role is to elicit the patient’s goals and to help achieve these goals. This is the model that we follow at Revive Medical Group

How can Physician-Patient relationships flourish?

Enhancing the Physician – Patient relationship is based on the following principles:

1) Enhancing knowledge, skills and attitudes of physicians, patients and plans with encouraging attention to psychosocial aspects of care and monitoring patient satisfaction.

2) Fostering continuity of care. The patient should adhere to the care plan he/she agreed to, unless an emergency happens which should be shared with the physician.

3) Protecting the interests and preferences of patients through promotion of a patient-centered culture and separation of administrative role from patient care.

4) Protection of patient confidentiality.

5) Minimization of conflict of interest. Both the physician and the patient need to have clear communication about what they need from each other.

Termination of a Physician – Patient Relationship

There are a variety of reasons why a physician may decide that a doctor-patient relationship has irrevocably broken down. These include:

  • Unacceptable patient behavior: this may involve verbal abuse, threatened or actual violence, it may also involve unacceptable behavior towards practice staff, rather than the physician. Breaking terms of service and disrecpect.
  • Loss of mutual trust and respect and/or a breakdown in communication.
  • Continual non-compliance with management recommendations: This especially can disrupt the physician's plans and care provided for other patients. When a patient fails to adhere to their treatment, or does not show up for follow-ups, they put the physician and staff under the stress of rescheduling to compensate for other patients as well which may affect the physician's care for other patients.

What Does the Physician-Patient Relationship Mean for Chronic Conditions? and why are we talking about this?

A patient who has a chronic condition needs to establish the best possible relationship with their physician. The patient needs to feel safe with a physician who knows them well and understands their psychosocial aspects enough to be able to trust their recommendation. The physician also needs to bond with the patient to be able to design a treatment plan that is effective and within the capability of the patient.

A chronic condition takes a long period and many changes, so the physician here is expected to use combined Guidance-Cooperation model right after the diagnosis and Mutual-Participation model to educate the patient and make sure he/she understands all the options available for the treatment plan.

Once this is achieved, they can safely navigate with the Mutual-Participation model because the patient has acquired expertise on his/her condition. This allows the patient to be competent to choose his/her way through the treatment plan, which is important to satisfy the patient and make sure he/she is compliant with the plan.

After that, the patient is expected to respect the physician and adhere to the treatment they both agreed on.

Why are we sharing this? for two reasons, first to convey to you how as a medical organization we take this relationship seriously in all its details and models to provide our member patients with the highest level of care, secondly, to also shed some light on how doctors at the other end of this relationship receive and assess things.

As humans it could be very tricky when closeness is established to see boundaries clearly and a refresher on the dynamics of this sacred relationship with whats ok and whats not, what model do we follow is important in the continuity of a patients health journey and goals achievement.

Cheers to a continuous progress on your health journey

Dr, Zeyada.

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