Doctor Patient
Relationship
Prepared by
Dr Sirwan K Ali
2012-2013
Good physician treats the disease;
the great physician treats the patient
who has the disease ~ William Osler
(Canadian Physician, 1849-1919)
Content of the lecture:
•Introduction
•Parson ideal patient and doctor
•What do patients want from a doctor
•Styles of Dr-patient relationship
•Communication skill
•Conclusion
The Doctor-Patient Relationship
 At the core of the practice of medicine
 The patient expects a good relationship as
much as a cure
 Dr-patient relationship itself becomes part of
the therapeutic process
Introduction
These two people have just met, but within
seconds one has begun to tell the other intimate
personal details about his health. What is more, it
is likely that, in a few minutes, he will be
prepared to remove some of his clothes and
submit to a physical examination.
The interaction is shaped by their differing social
roles and their different needs.
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
Parsons’ “ Ideal Doctor”
Apply a high degree of skill and knowledge
Act for the good of the patient
Remain objective and emotionally detached
What do patients want from
a physician?
Patients want to be able to trust the
competence and efficacy of their caregivers.
Patients want to be able to negotiate the health
care system effectively and to be treated with
dignity and respect.
Patients want to understand how their
sickness or treatment will affect their lives, and
they often fear that their doctors are not telling
them everything they want to know.
Patients want to discuss the effect their
illness will have on their family, friends,
and finances.
Patients worry about the future.
Patients worry about and want to learn how
to care for themselves away from the clinical
setting.
The four different styles of Dr/patient relations
Paternalistic: The paternalistic approach is
typified by a doctor centered style. It relies on
closed questions designed to elicit yes or no
answers. The doctor will tend to use a disease
centered model and be focused on reaching a
diagnosis, rather than the patients unique
experience of illness.
The Paternalistic Approach
“If I’ve told you once I
told you 1,000 times,
stop smoking!!”
Patient controlled consultation
Consumeristic : Here the
patient knows exactly
what they want and forces
the doctor into a
patient centered approach
“You’re paid to do what I tell
you!!”
Default :
This is where the patient centered style fails.
The doctor is trying to relinquish control but
the patient is unwilling to accept it, The result
is an impasse.
Mutuality:
The doctor uses open questions to
encourage the patient to talk about his
complaint. This approach relies on taking time
to listen and trying to understand the patients
. point of view
Mutual Styles
It’s serious isn’t it
doctor?
Factors which influence
Dr-Patient Communication
 Patient-related factors
 Dr-related factors
 The interview setting
Patient-related factors
 Physical symptoms
 Psychological factors
 Previous experience
 Current experience
Dr-related factors
 Training in communication skills
 Self-confidence in ability to communicate
 Personality
 Physical factors
 Psychological factors
The interview setting
 Privacy
 Comfortable surroundings
 An appropriate seating arrangement
Importance of Effective
Doctor-patient Communication
1. Accurate diagnosis.
2. Enhancing patient compliance to treatment
plans.
3. Contributing to doctor clinical competence
and self assurance.
4. Contributing to patient satisfaction.
Importance of Effective
Doctor-patient Communication
5. Contributing to cost and resource
effectiveness by preventing unnecessary
prescriptions for medication that are either
wrongly prescribed or not properly used by
patients.
Physician need To Acquire
A) Core communication skills:
 Doctor-patient interpersonal skills.
 Information gathering skills.
 Information giving skills.
Physician need To Acquire
B) Advanced communication skills:
 Skills for motivating patient adherence to
treatment plans.
 Skills for specific situations.
Core Communication Skills
1- Doctor-patient interpersonal skills:
 Creating an appropriate physical environment.
 Greeting others.
 Empathy.
 Showing respect and interest.
 Showing warmth and support.
 Using appropriate language.
 Developing a collaborative relationship.
 Closing the interview.
Core Communication Skills
2- Information gathering skills:
a) Using an appropriate balance of open to closed
questions:
* Open question:
 To achieve information.
 To allow patients the freedom of response.
 To establish an atmosphere of two-way communication.
 To assess the type and level of patient vocabulary.
*Closed questions:
 To achieve specific information.
 To allow a limited choice of response.
Core Communication Skills
2- Information gathering skills:
b) Silence:
 To allow time for the patient to collect his
thoughts.
 To assess levels of anxiety.
Core Communication Skills
2- Information gathering skills:

Clarifying the information given to the patient.

Active listening:
To show that the therapist
is attending closely the patient.

Sequencing of events.

Directing the flow of information.

Summarizing.
Core Communication Skills
3. Information giving skills:
They include:
1. Providing clear and simple information.
2. Using specific advice with concrete
examples.
3. Pushing important things first.
4. Using repetition (restatement).
Core Communication Skills
3. Information giving skills:
5. Summarizing.
6. Categorizing information to reduce complexity
and aid recall.
7. Using tools such as diagrams, written
instruction and technical aids to explain the
information being given.
8. Checking patient understanding of what has
been said.
9. Asking patients to repeat back what they had
heard and understood.
Summary
An intigrated approach to information
gathering.
Seeking to identify physical psychological
and social factors
Is likely to produce a better outcome.
Thank
you…