Date C HAPTER 9: D OCTOR P ATIENT I NTERACTION 1. M ODELS OF IN TERACTION A. Szasz and Hollender i. Believe there are three models of patient interaction 1. Activity-Passivity model a. Patient is seriously ill or is on emergency basis b. Situation is critical and doctor has high activity levels c. Power and decision making are on the side of the doctor 2. Guidance-Cooperation a. Patient has an acute, and infection illness b. Patient is conscious and knows what is happening c. Patient can cooperate with Doctor but Doctor makes the decision 3. Mutual Participation a. Dealing with management of chronic illness b. Patient works with the doctor as a full participant c. Patient modifies lifestyle and is responsible for medications i. Ex. Diabetes or heart disease ii. Physician patient relationship is affected by the severity of the symptoms B. Hayes-Bautista
i. Focuses on how patients try to modify treatment that is prescribed ii. They either try to convince the doctor that treatment is not working or they take their own actions iii. Physicians will then point out expertise and point out that health that be threatened iv. Doctors take on many roles to help induce patient adherence v. Interaction is the process of negotiation not just orders C. Patients i. In nonemergency, patients do not act passively ii. Patients ask questions and seek explanations and make judgements iii. They also check information on the internet D. Social Class i. Interactions that take place seem to be affected by class ii. Lower Class 1. Are more passive and have decreased sense of being in control 2. More or less accepting of professional help iii. Upper and Middle Class 1. More consumer oriented and active participants in the relationship 2. More likely to negotiate and involve themselves. E. Marie Haug & Bebe Lavin i. Better educated people were more skeptical ii. People believe the decisions should not be made up all by the doctor iii. Times when patients do not want responsibility 2
iv. Physicians also will exert their authority and make decisions regardless of patients desires 1. Activity passivity model overrides mutual participation F. Rose Weitz i. ICU Doctors 1. Unwilling to share decision making authority 2. Defined informed consent as giving complete consent to make all decisions regardless of how aggressive the procedure ii. Surgeons 1. Tend to retain decision making authority 2. Present information to patients and families that justifies actions 3. Patients feel pressured to adhere to surgeon’s orders iii. Patients can opt for the decision making role G. Extra i. Doctors can make life saving decisions quickly ii. Professional power and authority is exercised in emergency situations iii. Doctors have a moral responsibility to treat the affliction iv. Mutual Participation is the norm of doctor-patient interaction 2. M ISUNDERSTANDING IN COMMUNICATION A. Effectiveness i. Effectiveness depends on the ability for the participants to understand each other.
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- Spring '07
- Sociology, Physician