THE PATIENT – PRACTITIONER RELATIONSHIP COMMUNICATION SKILLS THE PATIENT – PRACTITIONER RELATIONSHIP

THE PATIENT – PRACTITIONER RELATIONSHIP What is a human relationship. Three basic models of the doctor-patient relationship. The model of activity-passivity. The model of guidance-cooperation. The model of mutual participation. The basic models and the psychology of the physician. What is “good medicine”?

What is a human relationship. Traditionally concerned with “ things”, e.g. bacteria ,anatomical structures. In modern times include the concept of “function”.

What is a human relationship. Rather it is an abstraction, appropriate for the description and handling of certain observational facts. It is an abstraction embodying the activities of two interacting systems (persons).

Three basic models of the doctor-patient relationship. The model of activity-passivity: The oldest conceptual model. Based on the effect of one person on another, who is unable to contribute actively. Underlies the application of some of the outstanding advances of modern medicine (e.g. surgery, antibiotics).

Three basic models of the doctor-patient relationship. The model of guidance-cooperation. Underlies much of medical practice. It is employed in situation which are less desperate than those previously mentioned (e.g. acute infection). The patient is expected to “look up to” and to “obey” his doctor.

Three basic models of the doctor-patient relationship. The model of mutual participation: Based on that equality among human beings is desirable. The participants ; Have approximately equal power. Be mutually interdependent. Engage in activity that will be in some ways satisfying to both.

Three basic models of the doctor-patient relationship. PROTOTYPE OF MODLE CINICAL APPLICATION OF MODLE PATEINT’S ROLE PHYSICIAN’S ROLE MODEL Parent-infant Anesthesia ,acute trauma, coma ,etc. Recipient (unable to respond) Does something to patient Activity-passivity Parent-child. Acute infectious processes, etc. Cooperator (obeys) Tells patient what to do. Guidance-cooperation Adult-adult Most chronic illnesses, psycho-analysis, etc. Participant in “partnership” Helps patient to help himself. Mutual participation

Three basic model and the psychology of the physician A physician is simply motivated by a wish to help others, no scientific study of the subject can be undertaken. In the activity-passivity model physician contributes to feelings of superiority.

Three basic model and the psychology of the physician In the guidance-cooperation model physician has an opportunity to recreate the “Pygmalion complex”. Thus, the physician can mold others into his own image.

Three basic model and the psychology of the physician In the mutual participation, the physician's gratification cannot stem from power. The doctor-patient relationship must change according to patient health progress. the physician’s inner needs are most likely to interfere with what is “best” for the patient.

WHAT IS “GOOD MEDICINE”? GOOD means whether or not the object under consideration satisfies us. In activity-passivity model and guidance-cooperation, the treatment means whatever the physician does. In mutual participation the treatment means an abstraction of one aspect of the relationship, embodying the activities of both participants.