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A Conceptual Approach to Patient-Physician Relationship

Year 2021, Volume: 15 Issue: 1, 14 - 18, 09.03.2021
https://doi.org/10.21763/tjfmpc.716051

Abstract

The quality of the patient-physician relationship affects the patient's compliance with the treatment and satisfaction with the interview. Szasz and Hollender (1956) described three types of patient-physician relationships. In the relationship based on activity-passivity, the physician is equipped with broad powers, regardless of the patient's consent. Relationship based on guidance-cooperation defines the relationship between the patient who is ready to apply the commands of the physician and the physician who offers his professional experience. Relationship based on mutual participation is the patient-physician relationship when the physician provides professional support for the individual to contribute to his or her health. Patient-physician relationship was modeled by Emanuel EJ and Emanuel LL (1992) with a four-component classification. The physician who adopts authoritarian attitude in the paternalistic model can ignore his patient's preferences. In the informative model, all the information about the situation is presented to the patient, the patient makes his own choice and the physician applies the selected medical intervention. In the interpretive model, the physician sets out the patient's expectation, while doing so, takes the patient's values as reference and shapes the treatment on this basis. In the deliberative model that encourages shared decision-making between the physician and the patient, the physician and the patient discuss mutually about what options the patient can choose during the treatment process and the path to be followed. It should not be forgotten that the type of relationship to be adopted in the clinical interview may vary depending on the condition of the patient and the nature of the disease.

References

  • 1) Ataç A. İletişim, tıp etiği ve tıp uygulamalarında yansıması. Hacettepe Tıp Dergisi 2009;40:89-95.
  • 2) Foucault M. Hermenötiğin Kökeni: Kendilik Hakkında-Dartmouth Konferansları 1980. Çiltaş Solmaz Ş, çev.editörü. L'origine de L'herméneutique de soi. İstanbul: Ayrıntı Yayınları; 2017.p.19-20.
  • 3) Szasz TS, Hollender MH. A contribution to the philosophy of medicine; the basic models of the doctor-patient relationship. AMA Arch Intern Med 1956;97(5):585-592.
  • 4) Habiba MA. Examining consent within the patient-doctor relationship. J Med Ethics 2000;26(3):183-187.
  • 5) Öngören B. Hekim-hasta ilişkisi ve sağlık hizmetlerinde iletişim 2. Tıbbi Sosyal Hizmet Dergisi 2017;(10),57-69.
  • 6) Epstein RM. The patient-physician relationship. In: Mengel MB, Holleman WL, Fields SA, editors. Fundamentals of Clinical Practice. Boston:Springer; 2002. p.403-429.
  • 7) Oğuz NY. Klinik uygulamada hekim-hasta ilişkisi. Tıbbi Etik 1995;3(2-3):59-65.
  • 8) Vertinsky IB, Thompson WA, Uyeno D. Measuring consumer desire for participation in clinical decision making. Health Serv Res 1974;9(2):121-134.
  • 9) Atıcı E. Hasta-hekim ilişkisi kavramı. Uludağ Üniversitesi Tıp Fakültesi Dergisi 2007;33(1):45-50.
  • 10) Coulter A. Paternalism or partnership? Patients have grown up-and there's no going back. BMJ 1999;319(7212):719-720.
  • 11) Tuckett D, Boulton M, Olson C, Williams A. Review of Meetings between experts: an approach to sharing ideas in medical consultations. Family Systems Medicine 1987;5(2),264-266.
  • 12) Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA 1992;267(16):2221-6.
  • 13) Lazaro J. Doctors’ status: changes in the past millenium. Lancet 2000;354:17.
  • 14) Savulescu J. Rational non-interventional paternalism: why doctors ought to make judgements of what is best for their patients. J Med Ethics 1995;21(6):327-33.
  • 15) Örs Y. Geçmişte ve günümüzde hekim-hasta ilişkisi. Tıp Dünyası 1975;48(6):224-30.
  • 16) Siegler M. The progression of medicine. Arch Internal Medicine 1985;145:713-715.
  • 17) Wells RE, Kaptchuk TJ. To tell the truth, the whole truth, may do patients harm: the problem of the nocebo effect for informed consent. Am J Bioeth 202;12:22-29.
  • 18) Salmon P. Conflict, collusion or collaboration in consultations about medically unexplained symptoms: the need for a curriculum of medical explanation. Patient Education and Counseling 2007;67:246-54.
  • 19) Balint M. The doctor, his patient, and the illness. Lancet 1955;1:683-8.
  • 20) Pendleton D, Schofield T, Tate P, Havelock P. The consultation: an approach to learning and teaching. London: Oxford University Press; 1984. p:34-38.
  • 21) Epstein RM, Street RL Jr. The values and value of patient-centered care. Ann Fam Med 2011;9(2):100-103.
  • 22) Entwistle VA, Cribb A, Watt IS, Skea ZC, Owens J, Morgan HM, et al. "The more you know, the more you realise it is really challenging to do": tensions and uncertainties in person-centred support for people with long-term conditions. Patient Educ Couns 2018;101(8):1460-1467.
  • 23) Carvallo A. Physicians and professionalism. patients and information. Rev Med Chil 2005;133(2):253-258.
  • 24) Borza LR, Gavrilovici C, Stockman R. Ethical models of physician-patient relationship revisited with regard to patient autonomy, values and patient education. Rev Med Chir Soc Med Nat Iasi 2015;119(2):496-501.

Hasta-Hekim İlişkisine Kavramsal Yaklaşım

Year 2021, Volume: 15 Issue: 1, 14 - 18, 09.03.2021
https://doi.org/10.21763/tjfmpc.716051

Abstract

Hasta-hekim ilişkisinin niteliği, hastanın tedaviye gösterdiği uyumu ve görüşmeden memnuniyetini etkilemektedir. Szasz ve Hollender (1956) üç tür hasta-hekim ilişkisi tanımlamışlardır. Etkinlik-edilgenlik temeline dayanan ilişkide hekim hastanın onamından bağımsız olarak, geniş yetkilerle donanmıştır. Yol gösterme-iş birliği etme temeline dayanan ilişki hekimin komutlarını harfiyen uygulamaya hazır hasta ile hastanın karşısında mesleki deneyimini sunan hekim arasındaki ilişkiyi tanımlar. Karşılıklı katılım temeline dayanan ilişki hekimin, bireyin kendi sağlığına katkı sunması için profesyonel destek sağladığı hasta-hekim ilişkisidir. Hasta-hekim ilişkisi Emanuel EJ ve Emanuel LL (1992) tarafından dört bileşenli bir sınıflama ile modellenmiştir. Paternalistik modelde otoriter tutumu benimseyen hekim hastasının tercihlerini görmezden gelebilir. Bilgilendirici modelde durumla ilgili tüm bilgiler hastaya sunulur, hasta kendi seçimini yapar ve doktor seçilen tıbbi müdahaleyi uygular. Yorumlayıcı modelde hekim, hastanın beklentisini ortaya çıkarır, bunu yaparken hastanın değerlerini referans alır ve tedaviyi bu temelde şekillendirir. Hekim ve hasta arasında ortak karar vermeyi teşvik eden uzlaşmacı modelde hekim ve hasta, hastanın tedavi sürecinde ne tür seçenekleri tercih edebileceği ve nihai olarak izlenecek yol konusunda karşılıklı tartışırlar. Unutulmamalıdır ki, klinik görüşmede hangi ilişki türünün benimseneceği hastanın durumuna ve hastalığın özelliğine göre değişebilecektir.

References

  • 1) Ataç A. İletişim, tıp etiği ve tıp uygulamalarında yansıması. Hacettepe Tıp Dergisi 2009;40:89-95.
  • 2) Foucault M. Hermenötiğin Kökeni: Kendilik Hakkında-Dartmouth Konferansları 1980. Çiltaş Solmaz Ş, çev.editörü. L'origine de L'herméneutique de soi. İstanbul: Ayrıntı Yayınları; 2017.p.19-20.
  • 3) Szasz TS, Hollender MH. A contribution to the philosophy of medicine; the basic models of the doctor-patient relationship. AMA Arch Intern Med 1956;97(5):585-592.
  • 4) Habiba MA. Examining consent within the patient-doctor relationship. J Med Ethics 2000;26(3):183-187.
  • 5) Öngören B. Hekim-hasta ilişkisi ve sağlık hizmetlerinde iletişim 2. Tıbbi Sosyal Hizmet Dergisi 2017;(10),57-69.
  • 6) Epstein RM. The patient-physician relationship. In: Mengel MB, Holleman WL, Fields SA, editors. Fundamentals of Clinical Practice. Boston:Springer; 2002. p.403-429.
  • 7) Oğuz NY. Klinik uygulamada hekim-hasta ilişkisi. Tıbbi Etik 1995;3(2-3):59-65.
  • 8) Vertinsky IB, Thompson WA, Uyeno D. Measuring consumer desire for participation in clinical decision making. Health Serv Res 1974;9(2):121-134.
  • 9) Atıcı E. Hasta-hekim ilişkisi kavramı. Uludağ Üniversitesi Tıp Fakültesi Dergisi 2007;33(1):45-50.
  • 10) Coulter A. Paternalism or partnership? Patients have grown up-and there's no going back. BMJ 1999;319(7212):719-720.
  • 11) Tuckett D, Boulton M, Olson C, Williams A. Review of Meetings between experts: an approach to sharing ideas in medical consultations. Family Systems Medicine 1987;5(2),264-266.
  • 12) Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA 1992;267(16):2221-6.
  • 13) Lazaro J. Doctors’ status: changes in the past millenium. Lancet 2000;354:17.
  • 14) Savulescu J. Rational non-interventional paternalism: why doctors ought to make judgements of what is best for their patients. J Med Ethics 1995;21(6):327-33.
  • 15) Örs Y. Geçmişte ve günümüzde hekim-hasta ilişkisi. Tıp Dünyası 1975;48(6):224-30.
  • 16) Siegler M. The progression of medicine. Arch Internal Medicine 1985;145:713-715.
  • 17) Wells RE, Kaptchuk TJ. To tell the truth, the whole truth, may do patients harm: the problem of the nocebo effect for informed consent. Am J Bioeth 202;12:22-29.
  • 18) Salmon P. Conflict, collusion or collaboration in consultations about medically unexplained symptoms: the need for a curriculum of medical explanation. Patient Education and Counseling 2007;67:246-54.
  • 19) Balint M. The doctor, his patient, and the illness. Lancet 1955;1:683-8.
  • 20) Pendleton D, Schofield T, Tate P, Havelock P. The consultation: an approach to learning and teaching. London: Oxford University Press; 1984. p:34-38.
  • 21) Epstein RM, Street RL Jr. The values and value of patient-centered care. Ann Fam Med 2011;9(2):100-103.
  • 22) Entwistle VA, Cribb A, Watt IS, Skea ZC, Owens J, Morgan HM, et al. "The more you know, the more you realise it is really challenging to do": tensions and uncertainties in person-centred support for people with long-term conditions. Patient Educ Couns 2018;101(8):1460-1467.
  • 23) Carvallo A. Physicians and professionalism. patients and information. Rev Med Chil 2005;133(2):253-258.
  • 24) Borza LR, Gavrilovici C, Stockman R. Ethical models of physician-patient relationship revisited with regard to patient autonomy, values and patient education. Rev Med Chir Soc Med Nat Iasi 2015;119(2):496-501.
There are 24 citations in total.

Details

Primary Language Turkish
Subjects ​Internal Diseases
Journal Section Letter to the Editor
Authors

Genco Görgü This is me 0000-0002-5420-0230

Makbule Neslişah Tan 0000-0002-3262-7815

Vildan Mevsim 0000-0002-3546-9146

Publication Date March 9, 2021
Submission Date April 7, 2020
Published in Issue Year 2021 Volume: 15 Issue: 1

Cite

Vancouver Görgü G, Tan MN, Mevsim V. Hasta-Hekim İlişkisine Kavramsal Yaklaşım. TJFMPC. 2021;15(1):14-8.

English or Turkish manuscripts from authors with new knowledge to contribute to understanding and improving health and primary care are welcome.