1. The Doctor-Patient Relationship
From Sociology as applied to Medicine

2. Doctor Patient Contacts
500,000 GP consultations every working day
The nature of the relationship determines the success or otherwise of the contact
Central to this is the exchange of information

3. Communication and Diagnosis
Patients who feel at ease and who are encouraged to talk freely are more likely to disclose the real reason for consulting

4. Communication and Treatment
Advice reassurance and support from the doctor can have a significant effect on recovery
The placebo effect

5. Consultation Styles
It’s serious isn’t it doctor?

6. Parsons’ “Ideal Patient”
Permitted to:
Give up some activities and responsibilities
Regarded as being in need of care
In Return :
Must want to get better quickly
Seek help from and cooperate with a doctor

7. Parsons’ “ Ideal Doctor”
Apply a high degree of skill and knowledge
Act for the good of the patient
Remain objective and emotionally detached
Respect the position of privilege

8. Conflict of Interest Interests of patient v society
Interests of patient v other patients
Problems of confidentiality

9. Types of D-P Relationship
Physician control
Patient Control Low High
Low Default Paternalist
High Consumerist Mutuality

10. Paternalism The traditional D-P relationship
Doctor Takes on role of “parent”
Patient submissive
Shift towards Mutuality

11. Patient controlled consultation
“You’re paid to do what I tell you!!”

12. Patients beliefs and expectations
Influenced by:
Previous experience, literature, the media;
Family and friends; Cultural influences;
Social significance.
These beliefs influence outcomes

13. The doctor’s consulting style
Doctor centred consultation style:
Paternalistic - doctor is the expert and patient expected to cooperate
Tightly controlled interviewing style aimed at reaching an organic diagnosis.

14. The Paternalistic Approach
“If I’ve told you once I told you 1,000 times, stop smoking!!”

15. The Doctor’s consultation style
Patient Centred consultation style
Less authoritarian - encourages patient to their own feelings and concerns
Open questioning, interested in psycho-social aspect of illness

16. Patient centred clinical interview
Doctor - history examination investigation
results in a differential diagnosis
Patient - ideas expectations feelings
results in an understanding of patients beliefs
Integration

17. Length of Consultation
Average 8 minutes
Makes patient centred consultation styles more difficult.

18. Patient influences on consultation
The patient’s ability to exercise and control depends on a number of factors:
Social and educational level
Sex
Membership of an ethnic minority

19. Summary An intigrated approach to information gathering.
Seeking to identify physical psychological and social factors
Is likely to produce a better outcome.