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At least 19 recordsLinked to original sources
PubMed1994

Towards authentic conversations. Authenticity in the patient-professional relationship.

The purpose of this paper is to evaluate the significance of the existential notion of authenticity for medical ethics. This is done by analyzing authenticity and examining its implications for the patient-professional relationship and for ethical decision-making in medical situations. It is argued that while authenticity implies important demand for individual responsibility, which has therapeutic significance, it perpetuates ideas which are antithetical both to authentic interaction between patients and professionals and to fruitful deliberation of moral dilemmas. In order to counteract these consequences, an alternative idea of authenticity is introduced. According to this idea, authenticity is not regarded primarily as individual sovereignty, but as an ability to participate in a dialogue in which the subjectivity of both partners is respected. Such practice, based on mutual trust and responsibility, would enhance common decision-making and overcome the alienation between patients and professionals.

Communication↗
PubMed2000

A model for boundary dilemmas: ethical decision-making in the patient-professional relationship.

The current "slippery slope" concept in boundary dilemmas is linked to a rule-based approach to ethical decision making. The author reviews the current "slippery slope" concept and professional ethics pertinent to boundary dilemmas. A graded-risk model for boundary dilemmas is introduced to offer a "process" approach to ethical decision making in boundary dilemmas. This model divides boundary crossings into four categories. Each category considers six variables: (a) the potential harm to the patient, (b) the potential benefit to the patient, (c) the presence or absence of coercive and exploitative elements in the boundary crossing, (d) the professional's motives and intentions, (e) the professional's aspiration to professional ideals, and (f) the context of the boundary crossing. This model of boundary crossings introduces complexity and specificity necessary for clinical decisions, teaching, retrospective judgements, and research in boundary dilemmas.

Coercion↗
PubMed2004

Professional-patient relationships and informed consent.

Four theoretical ethical perspectives on professional-patient relationships-autonomy, justice, virtue ethics, and the ethic of care-are surveyed, and some of their implications for the informed consent requirement in health care are sketched out. The practical issues of competence to consent, adequate information, and voluntariness are reviewed, and examples are given of the ways in which the theoretical perspectives outlined earlier might inform practice in areas such as these. Finally, the situation of patients not competent to consent is considered in the light of the same theoretical perspectives.

Decision Making↗
PubMed2004

[Sympathetic listening or steamrolling? Quality in the health professional-patient relationship in light of new information technology].

In the services sector, the product of labor is not a commodity that can be traded easily. What is sold is a specialized service, basically through an exchange of information to meet the client's needs and expectations. What emerge are thus the social relations between individuals: professionals and clients/consumers. This article presents evidence that the introduction of information technology undermines the quality of the relationship between the health professional and the patient. The article begins by discussing concepts pertaining to quality in the health sector. The health professional-patient relationship is then discussed through a brief review of the health/disease concept and specifically the physician-patient relationship. Analysis of primary data shows some indication that technological, physical, and management changes in health care units are undermining the quality of health care: many technological changes, but few operational changes, and many machines, but few professionals to treat patients.

Delivery of Health Care↗
PubMed2006

Genesis of the professional-patient relationship in early practical experience: qualitative and quantitative study.

CONTEXT: As a rule, undergraduate medical students experience everyday work in health care as spectators. They are not allowed to participate in real-life interaction between professionals and patients. We report on an exception to this rule. OBJECTIVES: The aim of this study was to examine undergraduate students' experiences in developing their first professional-patient relationships on the basis of being responsible for the care of patients. METHODS: The study involved 2 cohorts (2002 and 2003) of medical students, amounting to 503 students. They had all worked in hospitals and/or nursing homes for 4 weeks at the end of their first year of study. Subsequent to this, they produced a case presentation of experiences in this work they perceived as important. These important experiences were the focus of our analysis. RESULTS: Five categories of important experiences were identified. Four of the 5 categories are logically interrelated in that they collectively cover the range of players involved in a caring situation and provide student insights into the interaction between these players. The fifth category is a heterogeneous residue category. Analysis and quantification of these 5 categories reveals a general similarity: students, to an overwhelming degree, are concerned with developing patient-centred care. DISCUSSION: If they are given real responsibility for patient care, undergraduate medical students, of their own accord, tend to develop patient-centred relationships in accordance with the principles of the new professionalism, sometimes in opposition to institutional and/or collegial constraints.

Attitude of Health Personnel↗
PubMed2006

Patients using the Internet to obtain health information: how this affects the patient-health professional relationship.

OBJECTIVE: Health information is one of the most frequently sought topics on the Internet. A review of the literature was carried out to determine the use of the Internet for health information by the patient and how this could affect the patient-health professional relationship. METHODS: This study is a literature review, summarizing multiple empirical studies on a single subject and is not intended to be a meta-analysis. RESULTS: The review showed that the majority of health related Internet searches by patients are for specific medical conditions. They are carried out by the patient: (1) before the clinical encounter to seek information to manage their own healthcare independently and/or to decide whether they need professional help; (2) after the clinical encounter for reassurance or because of dissatisfaction with the amount of detailed information provided by the health professional during the encounter. CONCLUSION: There has been a shift in the role of the patient from passive recipient to active consumer of health information. Health professionals are responding to the more 'Internet informed' patient in one or more of three ways: (1) the health professional feels threatened by the information the patient brings and responds defensively by asserting their 'expert opinion' (health professional-centred relationship). (2) The health professional and patient collaborate in obtaining and analysing the information (patient-centred relationship). (3) The health professional will guide patients to reliable health information websites (Internet prescription). PRACTICE IMPLICATIONS: It is important that health professionals acknowledge patients' search for knowledge, that they discuss the information offered by patients and guide them to reliable and accurate health websites. It is recommended that courses, such as 'patient informatics' are integrated in health professionals' education.

Attitude of Health Personnel↗
PubMed2000

Gadamerian dialogue in the patient-professional interaction.

In his seminal work, Truth and Method, the German philosopher Hans-Georg Gadamer distinguishes between three types of what he calls the experience of the 'Thou'. In this paper, Gadamer's analysis of this experience is explained in terms of his philosophical hermeneutics and brought to bear upon the patient-professional relationship. It is argued that while Gadamer's analysis implies fruitful insights for a dialogical account of the patient-professional interaction, it harbours elements which are conducive to paternalistic practice of medicine. The strong attribution of value to tradition and the respect for authority emphasized in his theory result in a lack of sensitivity for individual self-determination which is needed for a successful account of the patient-professional relationship.

Communication↗
PubMed2003

Cultural issues in cystic fibrosis.

Although current numbers of non-Caucasian CF patients are small, collectively they represent sizeable groups and increasingly more is becoming known about the spectrum of mutations in the CFTR gene in different populations. As such it is important to acknowledge that there will be certain sociocultural challenges in interacting with and managing such patients. This paper explores such developments and considers some of the current and future challenges facing those who treat the disease. Techniques applied in other illness contexts for establishing and maintaining effective patient-professional relationships, reviewing patient education, resolving treatment conflicts and improving adherence are discussed, as are the implications for future research.

Adolescent↗
PubMed2006

Care as a mutual endeavour: experiences of a multiple sclerosis patient and her healthcare professionals.

In Dutch healthcare policy patients are seen as informed, autonomous experts and active decision makers with control over their illness and care. Healthcare professionals are expected to operate as providers of information. The purpose of this article is to argue that the consumerist approach of the patient-professional relationship is not a productive way to envision the patient-professional relationship. We argue that an interpretive/deliberative model is a more productive way to envision this relationship, especially in the care for people with a chronic illness. This is illustrated with a case study. It concerns a study of the experiences of a Multiple Sclerosis (MS) patient and healthcare professionals involved in her care. The presented stories show that the participants did not act in line with the roles and responsibilities embodied in the consumerism rhetoric in Dutch healthcare policy. Expectation of patients and healthcare professionals are better met when care is redefined as mutual endeavour in which the caring abilities of healthcare professionals and the vulnerability of chronically ill patients are taken into account.

Attitude of Health Personnel↗
PubMed2002

The nature of illness experience: a course on boundaries.

With the Accreditation Council for Graduate Medical Education's designation of "professionalism" as one of six core competencies in residency medical education, some educators of residents and medical students believe that the concept of professional role is too restrictive and narrow for grappling with the complex dynamics of professional-patient relationships. The ethical quandaries of abortion and physician assisted suicide illustrate how individual personal values cannot be ignored in the dynamic relationship between health care professional and patient. This article describes a medical school course where students are paired with "patient mentors." Within the dynamic and intimate relationship that unfolds over several months, students explore the "experience of boundaries," and are invited to use this experience to consider their evolving professional identity.

Education, Medical↗
PubMed2001

Expressed emotion in staff-patient relationships: the professionals' and residents' perspectives.

BACKGROUND: Expressed emotion (EE) is a well-established, important predictor of the relapse rate of patients suffering from schizophrenia and other severe psychiatric disorders. EE measures the quality of the social interaction between a patient and his most important (in)formal caregiver. The aim of this study was to investigate the quality of the relationship in the staff-patient dyad as measured by the concept of EE. METHODS: EE was assessed using the Camberwell Family Interview (CFI, professionals) and the Perceived Criticism Scale (PCS, residents and professionals form) in a sample of 56 professional caregivers and their residents in nine sheltered living facilities in Flanders. RESULTS: Depending on the instrument, high EE was found to exist in one out of six (CFI) or one out of three (PCS) relationships. There was a significant positive correlation between the resident PCS and the critical comment scale of the CFI. CONCLUSIONS: The results of this study support the hypothesis that high levels of EE exist in some staff-resident relationships, which are mainly manifest as frequent critical comments and the presence of hostility. Emotional overinvolvement appears to be exceptional. Compared with the PCS, the CFI provides the most information about the quality of the relationship.

Adult↗
PubMed1987

Satisfaction with practices: emergency physicians versus internists.

No comparison has been made of satisfaction with practices of emergency physicians versus other specialists. We used a previously tested questionnaire that measures differences between current and preferred practice conditions, and with items regarding training and practice, and intention to change positions. It was sent to 250 physicians practicing emergency medicine and 250 practicing internal medicine in a metropolitan area. Both specialty types were defined by type of practice, rather than by specialty training or board certification. Ninety-five (38%) emergency physicians and 79 (32%) internists responded. Factor and correlation analyses identified six satisfaction indexes: resources, professional autonomy, administrative autonomy, patient relationships, professional relationships, and status. Physicians practicing emergency medicine were less satisfied, that is, reported more difference between current and preferred conditions, than physicians practicing internal medicine with professional autonomy, patient relations, and status (by t tests, P less than .01 for each). Emergency physicians were more satisfied with professional relationships (P less than .01). Only 40% of emergency physicians, versus 60% of internists, reported no intention to leave their present position within the next two years (P less than .02). Expectation of position change by physicians practicing emergency medicine was predicted by dissatisfaction with professional autonomy, lack of board certification, recency of graduation from medical school, and belief that monetary compensation would be higher elsewhere (R square, 0.35; P less than .01), while variables such as patient load, hours worked per week, and hospital size proved unimportant. We identified areas of dissatisfaction among emergency physicians that differed from those among internists.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1978

Terminating the doctor-patient relationship.

This paper addresses a neglected area of medical student education--terminating the doctor-patient relationship. Rich clinical teaching opportunities are lost when educators fail to illustrate the significant emotional aspects of ending this highly personal affect-laden experience. The author explores these teaching opportunities through examination of elements of doctor-patient relationships, professional development, unresolved doctor-patient conflicts, role underevaluation, patient gifts, and referral procedures.

Conflict, Psychological↗