Doctor–patient relationship
[2][3] Additionally, the healthiness of a doctor–patient relationship is essential to keep the quality of the patient's healthcare high as well as to ensure that the doctor is functioning at their optimum.
Some medical specialties, such as psychiatry and family medicine, emphasize the physician–patient relationship more than others, such as pathology or radiology, which have very little contact with patients.
The doctor and patient's values and perspectives about disease, life, and time available play a role in building up this relationship.
[4] In a poor doctor–patient relationship, the physician's ability to make a full assessment may be compromised and the patient may be more likely to distrust the diagnosis and proposed treatment.
Additionally, the benefits of any placebo effect are also based upon the patient's subjective assessment (conscious or unconscious) of the physician's credibility and skills.
In addition, a Canadian physician known as Sir William Osler was known as one of the "Big Four" professors at the time that the Johns Hopkins Hospital was first founded.
Historically in many cultures there has been a shift from paternalism, the view that the "doctor always knows best", to the idea that patients must have a choice in the provision of their care and be given the right to provide informed consent to medical procedures.
The spectrum of a physician's inclusion of a patient into treatment decisions is well represented in Ulrich Beck's World at Risk.
A majority of physicians employ a variation of this communication model to some degree, as it is only with this technique that a doctor can maintain the open cooperation of his or her patient.
Patient-centered communication, which involves asking open-ended questions, having a warm disposition, encouraging emotional expression, and demonstrating interest in the patient's life, has been shown to positively affect the doctor–patient relationship.
Historically, medical teaching institutions have discouraged physicians from disclosing personal or emotional information to patients, as neutrality and professionalism were prioritized.
Concurrently, this type of strong communication between a doctor and their patient can strengthen the physician–patient relationship as well as promote better treatment adherence and health outcomes.
[25]: 166 Patients may lie to doctors for financial reasons such as to receive disability payments, for access to medication, or to avoid incarceration.
[31] Another study showed that ethnic-minority groups of varying races reported lower-quality healthcare experiences than non-Hispanic Whites, specifically in treatment decision involvement and information received regarding medications.
[34] Other studies show that physicians exhibited substantially less rapport building and empathetic behavior with both Black and Hispanic patients than Caucasians, despite the absence of language barriers.
Medical mistrust negatively impacts the doctor–patient relationship, as a patient who has little faith in their physician is less likey to listen to their advice, follow their treatment plans, and feel comfortable disclosing information about themselves.
[35][36] Medical mistrust has been shown to be greater for minority group patients, and is associated with decreased compliance, which can contribute to poorer health outcomes.
Research of breast cancer patients showed that African American women who received concerning mammogram results were less likely to discuss this with their doctor if they had greater medical mistrust.
[37] Another study showed that women with higher physician mistrust waited longer to report symptoms to a doctor and receive a diagnosis of ovarian cancer.
In such cases, the physician needs strategies for presenting unfavorable treatment options or unwelcome information in a way that minimizes strain on the doctor–patient relationship while benefiting the patient's overall physical health and best interests.
[43] Men's social predisposition to interject becomes problematic when it negatively impacts a woman physician's messages to her patients who are men: she may not be able to finish her statements and the patient will not benefit from what she was about to say, and the physician herself may fall prey to the socially conventional man's interjection by letting it cut short her professional commentary.
[43] A hurdle can arise from how the thinking process goes: a patient typically relates their story in chronological order, where symptoms, test results, consulting opinions, diagnoses and treatment are intertwined.
A provider tends to design their approach in a step-by-step analytical manner, extracting as much details out of symptomatology, then past medical and social history then tests then coming to a suggested diagnosis and management plan.
Addressing this upfront and at the onset of the visit and carving enough time for both can help avoid unnecessary interruptions on either part, improve provider-patient relation and constructively facilitate care.
When visiting a health provider about sexual issues, having both partners of a couple present is often necessary, and is typically a good thing, but may also prevent the disclosure of certain subjects, and, according to one report, increases the stress level.
[45] An important fact about telehealth is that it increases the quality of the doctor–patient relationship by making health resources more easily available, affordable, and more convenient for both parties.
Challenges with using telehealth are that it is harder to get reimbursements, to acquire cross-state licensure, to have common standards, maintain privacy, and have proper guiding principles.
[48] Researchers and Ph.D.s in a BMC Medical Education journal conducted a recent study that resulted in five key conclusions about the needs of patients from their health care providers.
A study showed that staff who received or witnessed rude behaviour by patients relatives had reduced ability to effectively carry out some of their simpler and more procedural tasks.
This is important because if the medical staff are not performing sufficiently in what should be simple tasks, their ability to work effectively in critical conditions will also be impaired.
