The good physician treats the disease; the great physician treats the patient who has the disease ~ William Osler (Canadian Physician, 1849-1919)
The Patient-Physician Encounter
What do patients want from a medical encounter with a physician?
In the thoughts of one physician (Delbanco,1992):
- Patients want to be able to trust the competence and efficacy of their caregivers.
- Patients want to be able to negotiate the health care system effectively and to be treated with dignity and respect.
- Patients want to understand how their sickness or treatment will affect their lives, and they often fear that their doctors are not telling them everything they want to know.
- Patients want to discuss the effect their illness will have on their family, friends, and finances.
- Patients worry about the future.
- Patients worry about and want to learn how to care for themselves away from the clinical setting.
- Patients want physicians to focus on their:
- pain
- physical discomfort
- functional disabilities
The Relationship Between Patient And Physician
The relationship between patient and physician has been analyzed since the early 1900's. Prior to when medicine was more science than art, physicians worked to refine their bedside manner, as cures were often impossible and treatment had limited effect.
In the middle of the century when science and technology emerged, interpersonal aspects of health care were overshadowed. There is currently a renewed interest in medicine as a social process. A physician can do as much harm to a patient with the slip of a word as with the slip of a knife.
Instrumental And Expressive Components
The patient-physician encounter crosses two dimensions:
- instrumental
- expressive
The "instrumental" component involves the competence of the physician in performing the technical aspects of care such as:
The "expressive" component reflects the art of medicine, including the affective portion of the interaction such as warmth and empathy, and how the physician approaches the patient.
3 Common Patient-Physician Relationship Models
#1) The Activity-Passivity Model - Not The Best Model For Chronic Arthritis
It is the opinion of some people that the differential in power between the patient and physician is necessary to the steady course of medical care. The patient seeks information and technical assistance, and the physician formulates decisions which the patient must accept. Though this seems appropriate in medical emergencies, this model, known as the activity-passivity model, has lost popularity in the treatment of chronic conditions such as rheumatoid arthritis and lupus. In this model the physician actively treats the patient, but the patient is passive and has no control.
#2) The Guidance-Cooperation Model - The Most Prevelant Model
The guidance-cooperation model is the most prevalent in current medical practice. In this model, the physician recommends a treatment and the patient cooperates. This coincides with the "doctor knows best" theory whereby the doctor is supportive and non-authoritarian, yet is responsible for choosing the appropriate treatment. The patient, having lesser power, is expected to follow the recommendations of the physician.
