THE NATURE OF THE CLINICAL ENCOUNTER

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Presentation transcript:

THE NATURE OF THE CLINICAL ENCOUNTER AN OVERVIEW

CLINICAL DECISION MAKING EVERY CLINICAL DECISION INVOLVES A MORAL DECISION CHOICES OF ENDS AND MEANS MULTIPLE VIEWS OF “THE GOOD LIFE” IN A PLURALISTIC SOCIETY VALUES; INDIVIDUAL, COMMUNITY, INSTITUTION MEDICAL GOODS AS ONE FACET OF DECISIONS STRATEGIES FOR IMPLEMENTING DECISIONS

THE CLINICAL ENCOUNTER VALUE ENCOUNTER + MEDICAL COMPLAINT COLLABORATION IN COMMON ENTERPRISE PATIENT WEAKNESS [VULNERABILITY] DISEASED STATE IGNORANCE FEAR PATIENT STRENGTH KNOWLEDGE OF, AND COMMITMENT TO, MORAL GOODS FOR SELF CAREGIVER STRENGTH MEDICAL EXPERTISE COMMITMENT TO HEALTH AND HEALING POWER DIAGNOSTIC, PROGNOSTIC, AND THERAPEUTIC KNOWLEDGE, SKILL, AND AUTHORITY FAMILIARITY AND COMFORT CAREGIVER WEAKNESS KNOWLEDGE OF FULL RANGE OF MORAL GOODS FOR PATIENT [KNOWLEDGE OF, AND COMMITMENT TO, MORAL GOODS FOR SELF EITHER AS PROFESSIONAL GOODS OR PERSONAL GOODS]

THE GOALS OF MEDICINE THE HASTINGS CENTER (1996) THE PREVENTION OF DISEASE AND INJURY AND PROMOTION AND MAINTENANCE OF HEALTH THE RELIEF OF PAIN AND SUFFERING CAUSED BY MALADIES THE CARE AND CURE OF THOSE WITH A MALADY, AND THE CARE OF THOSE WHO CANNOT BE CURED THE AVOIDANCE OF PREMATURE DEATH AND THE PURSUIT OF A PEACEFUL DEATH

ASPIRATIONS OF MEDICINE THE HASTINGS CENTER (1996) TO BE HONORABLE AND TO DIRECT ITS OWN PROFESSIONAL LIFE TO BE TEMPERATE AND PRUDENT TO BE AFFORDABLE AND ECONOMICALLY SUSTAINABLE TO BE JUST AND EQUITABLE TO BE RESPECTFUL OF HUMAN CHOICE AND DIGNITY

THE GOALS OF MEDICINE AMERICAN COLLEGE OF PHYSICIANS (1984) PROMOTE HEALTH RELIEVE SUFFERING PREVENT UNTIMELY DEATH MAINTAIN THE DIGNITY OF THE PATIENT NOTE THE EMPHASIS ON THE PATIENT AS THE FOCUS OF HEALTHCARE

HIPPOCRATES THE ART OF MEDICINE FIRST OF ALL I WOULD DEFINE MEDICINE AS THE COMPLETE REMOVAL OF THE DISTRESS OF THE SICK, THE ALLEVIATION OF THE MORE VIOLENT DISEASES, AND THE REFUSAL TO UNDERTAKE TO CURE CASES IN WHICH THE DISEASE HAS ALREADY WON THE MASTERY, KNOWING THAT EVERYTHING IS NOT POSSIBLE TO MEDICINE.

HIPPOCRATES THE ART OF MEDICINE A MAN WHO THINKS THAT A SCIENCE CAN PERFORM WHAT IS OUTSIDE ITS PROVINCE, OR THAT NATURE CAN ACCOMPLISH UNNATURAL THINGS, IS GUILTY OF IGNORANCE MORE AKIN TO MADNESS THAN TO LACK OF LEARNING. WHEN A MAN IS ATTACKED BY A DISEASE MORE POWERFUL THAN THE INSTRUMENTS OF MEDICINE, IT MUST NOT BE EXPECTED THAT MEDICINE SHOULD PROVE VICTORIOUS.

HIPPOCRATES THE ART OF MEDICINE I ASSERT THAT, WHEN THE PHYSICIANS FAIL, IT IS THE POWER OF THE DISEASE WHICH IS RESPONSIBLE AND NOT DEFICIENCIES IN THE SCIENCE OF MEDICINE.