Topic 8 - Nature and Concept of Physician - Patient Relationship

Nature and concept of physician
–patient relationship
By
Mahesh Deshpande
Definitions- Physician, Patient
• Physician-- a person who is legally qualified to
practice medicine; doctor of medicine.
• a person who is skilled in the art of healing.
• Patient-- a person who is under medical care

or treatment.
Definitions- Relationship
• a connection, association, or involvement.
• connection between persons by blood or
marriage.
• an emotional or other connection between
people : the relationship between teachers
and students.
• a sexual involvement; affair.
Nature
• Physician- skill, will, bill
empathy and understanding
• Patient- ill, worried, hopeful, trusting, seeking
relief
A human being, not just a bundle of symptoms
• Quality of relationship diagnostic
accuracy and therapeutic efficacy
Concept
• A constructive bond mutually benefitting
• For conveying highly personal and confidential

matters
• In a safe and protected environment

The Hippocratic Oath
• ‘‘The regimen I adopt shall be for the benefit
of
• my patients according to my ability and
judgment,
• and not for their hurt or for wrong.
Primum non nocere
Contd
• Whatsoever house I enter, there will I go for
the benefit of the sick,
• refraining from all wrongdoing or corruption,
• and especially from any seduction, of male or

female.
Contd
• Whatsoever things I see or hear concerning
the life of men, in my attendance
• on the sick or even apart there from, which
ought not be noised abroad,
• I will keep silence thereon,
• counting such things to be as sacred secrets.’’
Changing relationship
• Early and mid 18th C – Patient dominance,
symptoms oriented approach
• Late 18th C- hospitals, diagnostic techniques,

expert knowledge, doctor dominance –
patient dependence
active passive relationship (paternalism)
Relationship types*
• Active passive
• Guidance and cooperation
• Mutual participation
*Szasz and Hollender (1956)

Contd
• Emergence of psychology and psychotherapy
• Importance of listening to the patient
• Genuine communication
• Active participation
• Patient centric
Informed Consent Definition*
• “The process of informed consent occurs
when communication between a patient and
physician results in the patient’s authorization
or agreement to undergo a specific medical
intervention.”
American Medical Association*

Informed Consent-Essential Elements
• Description of the research and the role of the
participant, including an explanation of all
procedures relevant to the participant
• Description of reasonably foreseeable risks
• Description of expected benefits
• Alternatives to participation, such as other
studies or services in the area
Contd
• Explanation of confidentiality
• Explanation of compensation for injuries or
health problems resulting from participation
in the study
• Whom to contact about the research if the
participant has questions or concerns
• Explanation that participation is voluntary
Form
• I have read and I understand the provided
information and have had the opportunity to
ask questions.
• I understand that my participation is
voluntary and that I am free to withdraw at
any time, without giving a reason and without
cost.
• I understand that I will be given a copy of this
consent form. I voluntarily agree to take part in
this study.
Confidentiality
• an agreement between the researcher and
participant,
• through the informed consent process,
• Non-disclosure of the participant's identity,
personal information, responses, etc.
• to anyone outside of the research team unless
otherwise agreed upon.
Contd
• to protect the privacy of all persons,
• to build trust and rapport with study

participants, and
• to maintain ethical standards and the integrity

of the research process
(Baez, 2002).
Duty of care
• Legal obligation
• responsibility of an individual to not harm
others through carelessness.
• A control mechanism (an entry gate) to
distinguish legally significant cases
• Theoretical basis: Donoghue v Stevenson
(1932) AC 562.
Contd
• Neighbour concept:
• "You must take reasonable care to avoid acts or
omissions which you can reasonably foresee would be
likely to injure your neighbour. Who, then, in law, is my
neighbour?
• The answer seems to be-persons who are so closely
and directly affected by my act that I ought reasonably
to have them in contemplation as being so affected
when I am directing my mind to the acts or omissions
which are called into question."
• - Lord Atkin, Donoghue v Stevenson, at 44.

Standard of care
• The measures that a reasonable person (in the
circumstances of the defendant) takes to
reduce the risk of harm.
• An objective standard where the 'reasonable
person' test is applied to determine if the
defendant has breached his duty of care.
• A response of a reasonable person to a
foreseeable risk.
Contd
• the level at which an ordinary, prudent
professional with the same training and
experience in good standing in a same or
similar community would practice under the
same or similar circumstances.
Contd
• A diagnostic and treatment process that a
clinician should follow for a certain type of
patient, illness, or clinical circumstance.
(New England Journal of Medicine, 2004)
Contd
• the level at which the average, prudent
provider in a given community would practice.
• how similarly qualified practitioners would
have managed the patient's care under the
same or similar circumstances.
• medical malpractice plaintiff must establish
the appropriate standard of care and
demonstrate that the standard of care has
been breached.

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Nature and concept of physician

• Patient-- a person who is under medical care

• For conveying highly personal and confidential

• In a safe and protected environment

• refraining from all wrongdoing or corruption,

• and especially from any seduction, of male or

• Late 18th C- hospitals, diagnostic techniques,

• Guidance and cooperation

*Szasz and Hollender (1956)

American Medical Association*

• to build trust and rapport with study

• to maintain ethical standards and the integrity

• - Lord Atkin, Donoghue v Stevenson, at 44.

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