Time and the Patient–Physician Relationship
In medical school, physicians probably learned communication skills such as interviewing (getting information from patients on the reasons for. The doctor-patient relationship is key in receiving quality care. “The general perception is that men are hesitant to go get healthcare. I think that. Patient–doctor gender concordance/discordance is associated with their In addition, women are twice more likely than men to have asymptomatic Understanding concordance in patient-physician relationships: personal.
Physicians generally address patients by their title and last name as a demonstration of respect and regard for patient autonomy. Some consider formal address an important psychological protection against the infantalizing effect of over-familiarity and its potential for coercion and paternalism.
Physicians may wish that a patient use a similarly formal manner of address, but it is difficult to imagine that physicians are exploited if a patient chooses not to do so.
Although the majority of physicians in the Farber study were annoyed by this behavior, their autonomy was not threatened by it.
How about personal questions? Although one third responded with anger, the majority of physicians were not angered when they encountered personal questions from patients.
Advice for Improving the Doctor-Patient Relationship
This indicates that many physicians feel comfortable allowing their patients to know them somewhat personally. It may be that the angry physicians perceived personal questions as attempts to develop a relationship that is too intimate. This may also be true of first names, social invitations, expensive gifts, and overt affection.
Perhaps these behaviors represent a patient's attempt to control the relationship or diminish the high degrees of respect generally afforded to physicians. While these instances may be awkward, we do not believe they meet a standard of exploitation.
Most interesting, from the perspective of social norms and interpersonal expectations, is the pattern of gender-related responses to these patient behaviors.
Time and the Patient–Physician Relationship
Female physicians reported more objectionable behavior and responded more negatively in almost every category, including patient dismissal for serious offenses and anger or annoyance at more trivial ones.
The fact that women in this study experienced more boundary violations and were less tolerant of them is no surprise. Women physicians, as all women, are vulnerable to physical and sexual assault, sexual harassment, and sexual exploitation. Female physicians experience these attacks more often than do male physicians, not only from their patients but also from their professors and colleagues.
Female physicians may also experience more breaches of normative social behavior and greater challenge to their professional status than their male colleagues. In defining professional boundaries as mutually understood rules and roles found in the patient-physician relationship, Farber et al.
This may not always be the case. Social norms are important; they affect interpersonal expectations and behavior. Violations of social norms can be uncomfortable, undeserved, or unkind but are not necessarily exploitation. Also in this issue of the Journal, Schmittdiel et al.
Regardless of patient gender, the investigators found a bias favoring the selection of male physicians. This may be because female physicians violate the social norm by which professional status is ascribed to male gender. The role demands of an authoritative, competent physician may be at odds with the stereotypical female role that implies nurturance, positive expressiveness, and equality. Physicians are generally regarded as male; women physicians may cause confusion.
Advice for Improving the Doctor-Patient Relationship - Renal and Urology News
This confusion may be reflected in the study results. Although not linked directly to gender preferences, communication studies in primary care have demonstrated broad conversational differences between physicians of different genders.
Patients of female physicians disclose more biomedical and psychosocial information and are more positive in their talk. The communication behaviors associated with female physicians are those generally valued by patients and predictive of positive patient outcomes, including satisfaction, recall of medical information, and compliance with medical recommendations 7 as well as health status improvements. On the basis of analysis of two independent studies, we found that both male and female patients of young female physicians reported lower ratings of satisfaction than other patients.
We speculate that other patient values and prejudices, perhaps an inferred lack of authority or expertise because of youth and gender, may offset whatever advantage the female physician might have by virtue of her communication performance. Alternatively, expectations for positive communication skills including partnership and emotional support may have been so high that patients were disappointed despite the superior performance of their female physicians.
In the current study, highest satisfaction ratings were evident for a select minority of males. Let's think about how this very small population of males might differ from the vast majority of male patients who, if opting for a physician at all, opted for a male physician.
There are two hypotheses that can be forwarded.Reaffirming the Doctor-Patient Relationship - Stephen Sanders - TEDxSaintLouisUniversity
First, this small group of male patients may hold nontraditional values that support the choice of a non-normative female physician. Second, these males may have chosen their female doctors for some unmeasured consideration such as personal referral. The situation for female patients is somewhat, but not entirely, different.
Female patients who choose female physicians may, like their male counterparts, hold nontraditional views about professional status and gender. However, Schmittdiel et al. The import of this distinction may be in raised expectations for female physician performance. As noted in our own empirical studies of medical dialogue, female physicians do engage in more of the communication behaviors generally valued by patients.
Advanced Search Abstract Whilst having sexual relationships with current patients is clearly unethical, the ethics of such a relationship between a doctor and former patient is more debatable. In this review of the current evidence, based on major articles listed in Medline and Bioethicsline in the past 15 years, the argument is made here that such relationships are almost always unethical due to the persistence of transference, the unequal power distribution in the original doctor—patient relationship and the ethical implications that arise from both these factors especially with respect to the patient's autonomy and ability to consent, even when a former patient.
Only in very particular circumstances could such relationships be ethically permissible. Sexualization of the doctor—patient relationship: Family Practice ; Introduction All codes of ethics set up by medical professional bodies prohibit sexual relationships between a doctor and a current patient. Although this stance initially provoked a degree of controversy within the country, 2— 6 the deleterious effects of such relationships upon patients have become increasingly recognized and condemned by the medical community.
However, some areas of debate do still remain. One such area is whether sexual relationships with former patients are ever ethically permissible and, if so, under what circumstances.
First, the concepts of boundaries and transference are discussed and a profile of the medical practitioner at risk of offending is drawn. Secondly, three aspects of the doctor—patient relationship are explored: Thirdly, a discussion of the role of autonomous choice and consent is presented.
Boundaries and boundary violations Many boundaries exist in the doctor—patient relationship. These include boundaries of role, time, place and space, money, gifts and services, clothing, language and physical contact. This does not mean that no such type of relationship may exist, but it has not been researched. This suggests that the overwhelming outcome for most, if not all, patients is negative. However, the crossing of boundaries per se does not necessarily mean that an unethical act occurred: Nor do all boundary transgressions between doctor and patient ultimately lead to sexual misconduct.
Clues as to what these other factors should be can be gleaned from examining the profiles of offending doctors. Profiles of doctors who violate boundaries A key factor in the identification of doctors at risk of violating boundaries is the enhanced vulnerability of a doctor to the transference—counter-transference dyad which occurs in varying degrees in every doctor—patient relationship.
Doctors can mistake the feelings of love that arise in a therapeutic relationship as being the same as love that arises elsewhere; it is not. Transferences per se, as with boundary crossings, also occur in normal love relationships, 12 and therefore are also a necessary but not sufficient condition for ethical unacceptability.
However, it is the existence and persistence of this type of transference, linked with the fiduciary relationship and unequal power structure, which makes most relationships with former patients ethically unacceptable see following sections. In turn, to build such a relationship, the unequal power distribution between doctor and patient has to be acknowledged and contained in an ethically correct manner.
The onus of responsibility for this last task falls on the person who has the most power in the relationship which, as I will argue, is always the doctor. To explain why this is always the case, even with former patients, it is useful to consider the sources of medical power in light of a framework suggested by family practitioner and ethicist, Howard Brody.
In his book The Healer's Power, 20 Brody outlines three sources of medical power: Aesculapian, Charismatic and Social. It has also been suggested that another source of power —Hierarchical power, the power inherent by one's position in a medical hierarchy e. Although it does not involve the sexualization of the doctor—patient relationship, it clearly illustrates the importance of recognizing all four types of power, and, in particular, the prominence of Hierarchical power: A consultant specialist was admitted to hospital with a severe multi-system disease causing severe renal impairment.
After 6 weeks in hospital, on the day of his planned discharge, he was accidentally given another patient's medication. Instead of receiving his azathioprine and corticosteroids, he was given a high dose of frusemide and captopril. Simply by the sheer nature of taking on the role of patient, regardless of any other type of power, there is always an unequal power differential between the doctor and patient.