Doctor and Patient Relationship

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Doctor and PatientRelationship

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????????????

• ?????????????????????????? ????????
• ?????????????????????? Doctor and patient
  relationship
• ????????????????????????????????????????????????
• ?????????????????????????????????????
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• Hippocrates
• Do no harm
• To do good

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?.?. 1970

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• ???????????????????????????????????????
• Equity (????????????)
• Utility (???????????????????)
• Equality (?????????????)
• Human Right (????????????)

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Medical ethic V.S. Dt-Pt relationship

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• The doctor-patient relationship is at the CORE of
  the practice of medicine
• ???????????????????? (good rapport)??????????????
  ???????? ??????????????????????????
• ??????????????????????????????????????????????????
  ??? ??? ????????????????????????????????? (cure)
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  ?????

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(No Transcript)
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Rapport

• is the spontaneous, conscious feeling of
  harmonious responsiveness
• that promotes the development of a constructive
  therapeutic relationship
• Understanding, and trust
• Patients feel accepted with both their assets and
  liabilities

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Several aspect of Doctor-Patient relationship

• Use of the biopsychosocial model
• Empathic listening
• Styles of relating
• The concepts of transference, countertransference,
  and the real relationship
• Issues of compliance
• Difficult doctor-patient relationship

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?????????????????????????

• 1. ??????????????????????????????????????
• 2. ?????????????????????????
• 3. ??????????????? ???????????????????????????????
  

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1. ??????????????????????????????????????

• ??????????????????????????????????????????????????
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2. ?????????????????????????

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3. ??????????????? ????????????????????
???????????

• ??????????????????????? ??????????????????????????
  ???????????????????????????? ?????????????????????
  ?? ??????????????????????????

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Medical Interview

• ????????????????????????????? ????????????????????
  ?????????????????????? ????????????????? (data
  collection) ??????????????????????
  ??????????????????????? ????????????????????????
• ??????????????????????????????????????????
  ????????????????????? ??????????????????
  ???????????????? ????????????????????????????
  (emotional support) ??????????

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SOCIAL ROLES OF DOCTORS AND PATIENTS (Parsons
(1951))

• The role of sick people as involving four
• general expectations.
• 1) sick people are allowed, and might even be
  required, to give up some of their normal
  activities and responsibilities,
• 2) they are regarded as being in need of care.
• 3) wanting to get well as quickly as possible
• 4) seeking professional medical advice and,
  cooperating with the doctor

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SOCIAL ROLES OF DOCTORS AND PATIENTS (Parsons
(1951)) cont.

• The role of the doctor complementary with the
  role of patient.
• ?Apply a high degree of skill andknowledge to
  the problems of illness
• ? Act for welfare of patient and community
  rather than for own self-interest, desire for
  money, advancement, etc
• ?Be objective and emotionally detached (e.g.
  employment and household tasks) in terms of
  personal value system or become emotionally
  involved with them)
• ?Be guided by rules of professional practice

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????????? ?????? ?????????? ?????????????????????

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?????????????????

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?????????????????

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?????????????????????? Dr.William Osler

• Imperturbability- ?????????????????????????
  ??????
• Presence of mind- ????????????????????????????????
  ???????????????? (????????) ?????????
  ?????????????
• Clear judgement- ?????????????????????????????
  ???????????
• Ability to endure frustration- ?????????
  ???????????????????
• Infinite patient- ??????????
• Charity toward other-??????? ??????
  ???????????????????????

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?????????????????????? Dr.William Osler

• Search for absolute truth-????????????????????????
  
• Composure- ??????????????????? ??????
  ?????????????
• Bravery- ?????????????????? ???????????????
• Tenacity- ?????????????????? ??????????????????
• Idealism- ??????????????????????????
  ?????????????
• Equanimity- ??????????????????????????????????
  ??????????????????? (???????)

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The Biopsychosocial model

• George Engel (1977) ??????????????????????????????
  3 ??????????? ???
• ??????????????? (Biological factor)
• ?????????????? (Psychological factor)
• ?????????????? (Social factor)

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• ???????????????????????? ?????????????????????????
  ???????????? ????????? ???????????????????????????
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• ??????? 3 ????????????????? ???????????????????
  (interaction)
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  ????????
• Biopsychosocial model ????????????????????????????
  ????????????? (integrated)
• ?????????????????????????????????????????????????
  ????????????????? (disease)

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Empathy (?????????????????????????????)

• ???????????????????????????? ?????? ?????????????
  ??????????????????????????????????????????????????
  ??????????????????????? ??????????????????????????
  ?????????????? ??????????????????(to put oneself
  in another persons place)
• ?????????????????? ???????????????????????????????
  ?? ???? ???????? ???????????????????????
  ?????????????????????????????????? sympathy

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• ?????????????????????????????????
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  ????????????????
• ??????????????????? ???? ???????????? ????????
  ?????? ????? ?????????????????
• ????????????????????
• ????????????????????????????? (empathic response)
  ???????????????????????

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• ???????????????????? (empathic listening)
  ??????????????????????????????????????????????????
  (therapeutic alliance)
• ???????????????????? (empathic response)
  ??????????????????????????????????????????????????
  ???????????????? ?????????????????????
  ???????????????? ?????????????????????

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Styles of Relating

• 1. The paternalistic model
• 2. The informative model
• 3. The interpretive model
• 4. The deliberative model

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1. The Paternalistic model

• The paternalistic model (autocratic style)
• ??????????????????????????????????????
  ??????????????????? ?????????????????
  ????????????????
• Physician style may be warm or
  detached decision are made primarily by the
  physician information is provided to the patient
  from the physician. The physician is dominant in
  the interview process
• ?????????? Emergency situation

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2. The Informative model

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• ???????????????????????????? (consultation)
  ???????????????????????????

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3. The Interpretive model

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  ?????????????????????? (circumstance) ??????????
  ???? ????????, ??????? ???
• ???????????????? ?????????????????????????????????
  ?????(unique characteristic)
• Interaction typically warm
• Shared decision making
• The physician ask more questions and is less
  dominant in the interview

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4. The Deliberative model

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• ????????????????????????????????????????????
  (counselor)
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• ???? ????????????????????????, ???????????????????
  ???????????

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• ??????????????????????????
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• ?????????????????????????
• ???????????????? ??????????????????????????
• ????? ??? ????????? ??????????? ???????????
  ?????????????? ???????????????????????

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The concepts of transference, countertransference
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Transference

• The patient are transfering feeling towards
  other in their life onto the physician
• ??????????????????????????????????????????????????
  ????????????
• The more intense the relationship the more likely
  to evoke feelings related to the past
  relationships

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Countertransference

• The emotional reaction to the patient that often
  involve the physician pasts experience
• ??????????????????????????????????????????????????
  ???????

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Issue of compliance

• ????????????????????????????? (poor compliance)
  ??????????????????????????????
• ????????????????????? ???????????????????????
  doctor and patient relationship

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Factor related to noncompliance

• low level of subjective distress
• denial of illness
• poor communication between physician and patient
• complex regimen
• treatment that embarrassing or humiliating
• patients perception that it is beneficial to
  remain ill
• side effects that are significant for the patient

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Factor that enhance compliance

• Good rapport between physician and patient
• Simple regimen
• Clear instructions that patient can repeat back
  to physician
• Positive feedback for adherance
• Increased level of distress
• Increased time with physician

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Difficult doctor-patient relationship

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• ?????????????????????????????????????? ??????
  ????? ???????? ???????????????????????????????????
  ???????

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Difficult doctor-patient relationship

• ??????????
• ????????? ???????? (demanding)
• ??????????????????
• ???????? ?????????
• ???????????????????????????
• ??????????? ??????????

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Summary

• Eric Cassell ??????????? art of medicine
  ?????????? 4 ????
• ? the ability to acquire and integrate both
  subjective and objective information to make
  decision in the best interests of the patient
• ? the ability to use the doctor-patient
  relationship for therapeutic ends
• ? knowing how doctors sick persons behave
• ? effective communication

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Stress on Physician

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  ?, ???????????, ????????, ??????????
  ?????????????????????
• ???????????????????????? ?????????????????????
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Thank You