Transcript Doctor-Patient Interaction

Doctor-Patient Interaction
SOCI 1050
Chapter 10
Guided by Parson’s Sick Role
• Doctor helping patient deal with a health
problem
• Physician has dominant role because he
or she has medical knowledge and
expertise
• Patient holds subordinate position oriented
toward accepting, rejecting or
negotiating recommended treatment
Sheff’s Medical Decision Rule
• Since the work of the physician is for
the good of the patient, physicians tend
to impute illness to their patients rather
than to deny it and risk overlooking or
missing it
– Leads to prescribing medications and ordering
tests and X-rays
• Patients demand services and
doctors are trained to meet these
demands
• The quality of physician-patient
interaction is sometimes problematic,
yet the process is important because
of its potential for affecting the care
being provided.
• Key Topics to be covered
– Models of interaction
– Misunderstandings in communication
– Cultural differences
– Problems in patient compliance
Models of Interaction
• Szasz and Hollender – physicianpatient interaction falls into one of
three possible models
– Activity-passivity model
– Guidance-cooperation model
– Mutual participation model
Activity-Passivity Model
• Applies when the patient is seriously ill or
being treated on an emergency basis in a
state of relative helplessness due to
severe injury or lack of consciousness
• Physician works in high state of activity to
stabilize patient’s
condition
• Decision-making and power on side
of the physician
• Patient is passive and contributes
little or nothing
Guidance-Cooperation Model
• Arises most often when the patient
has an acute (especially infectious)
illness
• Patient knows what is going on and
can cooperate with the physician
following his/her guidance in the
matter
• Physician still makes the
decisions
Mutual Participation Model
• Applies to management of chronic
illness in which the patient works with
the physician to manage the disease
• Patient makes lifestyle adjustments,
complies with treatment plan and
seeks periodic check-ups
Hayes-Bautista Model
• How do patients modify the
physician’s treatment plan?
– Try to convince doctor it is not working
– Counter the treatment with actions of their
own
• Physicians counter with assertions of
expertise
Luffey’s findings
• In applying Hayes-Bautista model,
Luffey found that physicians take on
various personas
– Cheerleader
– Educator
– Detective
– Negotiator
– Policeman
Socioeconomic Correlations
• Lower class patients tend to be more
passive in dealing with doctors as
authority figures
• Middle and upper-class patients tend
to be more consumer-oriented and
active
– More skeptical of motives (i.e., in
ordering tests)
Misunderstandings in
Communication
• Effectiveness of communication depends
on the ability of participants to understand
one another
• Status, education, professional training
and authority may inhibit communication
• Physicians may evade patients’ questions
• Class and gender differences further
complicate the communication
process
Gender Differences
• Lack of male sensitivity to women
patients was a major factor in the
formation of the women’s health
movement to combat sexual
discrimination in medicine
– i.e., childbirth issues, self-help groups,
funding for research in women’s health
issues, recognition of rights and
intelligence of patients
– Negative stereotypes of women persist
among many health care professionals
Women Physicians
• Sometimes being a woman is more
significant than being a physician
– Seen as less of an authority figure
– Not seen as “real doctors” by some patients
• Adverse attitudes and stereotypes are
beginning to be modified
• Sexism may still be found
– Doctors who are mothers find it difficult to
negotiate schedules and hours on the job
Cultural Differences in
Communication
• Medical interviews cause a problem
because of social class, language,
power, modesty issues
• Physicians mainly emulate middle
class values and are technologically
oriented – patients may not identify
with either of these orientations
Communication and Compliance
• Compliance requires comprehension by
the patient and communication is the key
to avoiding non-compliance
• The motivation to be healthy, perceived
vulnerability to an illness, the potential for
negative consequences, effectiveness of
the treatment, sense of personal control
and effective communication are the
strongest influences on compliance.
Consumerism
• Consumer wants to make informed
choices about the services available and
not to be treated as inferior
• Shift to consumerism increases the power
of the patient in the physician-patient
interaction
• However, third-party payers have strongly
influenced and intruded in the physician
and patient relationship
Technology
• Medical practice in advanced
societies has become more and more
dependent on increasingly
sophisticated technologies –
computers and bioengineering
• Internet is a source of medical
information for both patient and
physician
New Genetics
• More information about susceptibilities
• Gene therapy has potential to eliminate
diseases before they happen
• Basis for “designer” drubs tailored to
match the DNA of a particular individual
• Issues of privacy and gene ownership
• Prenatal screenings may be controversial
because of availability of abortion
• Cloning of individuals and/or organs