In the past, the physician patient relationship was one of complete trust. Physicians thought they knew everything about medicine, and patients had few other ways of gaining information so they did as they were told. The relationship was deeply rooted in paternalism. However, the influx of medical information readily available in our society as well as a new emphasis on personal care is driving patient empowerment. In addition, the limited time physicians have to spend with their patients have led to less personal relationships and a dramatic decrease in listening to the patient’s concerns and problems. In our time, physicians have little knowledge of their patient’s desires, mentality, and values, which can affect the way they administer treatment. One study even showered that resident doctors spend 12% of their time interacting with patients compared to 40% of their time interacting with the computer. It is difficult to form relationships with patients in this small window of time.
Role of Consent in New Relationship
Robert Veatch argues that consent it a transition concept, an innovation that is only useful as a transition to a more thoroughly revisionary conceptual framework. Veatch argues that with the little information physicians truly know about their patients, their personalities, and their values, there is no way that they can even guess what is in the overall best interest of the patient. Veatch believes that in order for a physician to guess what is the best course for the patient, three assumptions must be true regarding a theory of the good.
- The physician must determine what will best serve the patient’s medical interests.
- The physician must determine how to trade off health interest with other interests.
- The physician must determine how the patient should relate the pursuit of his or her best interest to other moral goals and responsibilities that may conflict.
In our day and age, Veatch believes it improbable to expect a typical medical professional to be able to fulfill even one of these, let alone all three. In addition to arguing that since a physician has little relationship with the patient, they often cannot accurately determine what is in their best interest, Veatch also argues that physicians are only experts in one component of well-being (medical) and therefore are unable to determine what constitutes the good for another being.
Where Do We Go From Here?
Veatch argues that there are two alternatives to informed consent. The first option being to emphasize the concept of choice rather than consent. Since physicians have no way of knowing what is in the patient’s best interest, they should present the patient with a list of plausible treatment options with the potential benefits and risks of each, allowing the patient full autonomy and choice in their course of action. This seems extremely implausible. A more realistic, but still a stretch, of an option is pairing physicians and patients based on their “deep interests” including religious and political affiliations, philosophical and social inclinations, and other worldviews. This would put both provider and patient on the same page of what values are necessary and essential part of health care decision making and allow physicians to provide the course of action that best falls in line with patient’s views and values.
To me, these two alternatives seem a little farfetched. I think where we need to start is by changing the paternalistic physician-patient relationship to more of a partnership. Physicians need to embrace listening, and think of themselves as more of a health coach then the end all and be all of medical knowledge.
9 thoughts on “Creating a New Physician-Patient Relationship”
I think your point about the way that doctor/patient relationships are now is one of the most important issues in healthcare. The minimal time doctors spend with their patients can lead to errors in diagnosis and treatment. Reading the article that Dr. Risjourd posted made me think further about this issue, and how your blog relates to it. I found the statement about shifting towards “caring with” instead of “caring for” (in the New York times article) very interesting. I think that “caring with” can go in both a positive and negative direction. It could mean that doctors listen to patients more, and therefore take into account unique situations when making a diagnosis or treatment plan. Or it could mean that the patient, who may not be medically competent, is taking decisions into his own hands and away from the expert, and making choices that they may not know the full consequences of. I know that the article focuses on the tough decisions that doctors have to make about autonomy, but it also brought in ideas of patient/doctor relationships. I do think that there needs to be a shift to a more personal patient/doctor relationship. The way that the health care system is now (more patients, more surgeries, more money) may see the most results, but does not always produce the best results.
I think your point about the way that doctor/patient relationships are now is one of the most important issues in healthcare. The minimal time doctors spend with their patients can lead to errors in diagnosis and treatment. Reading the article that Dr. Risjord posted made me think further about this issue, and how your blog relates to it. I found the statement about shifting towards “caring with” instead of “caring for” (in the New York times article) very interesting. I think that “caring with” can go in both a positive and negative direction. It could mean that doctors listen to patients more, and therefore take into account unique situations when making a diagnosis or treatment plan. Or it could mean that the patient, who may not be medically competent, is taking decisions into his own hands and away from the expert, and making choices that they may not know the full consequences of. I know that the article focuses on the tough decisions that doctors have to make about autonomy, but it also brought in ideas of patient/doctor relationships. I do think that there needs to be a shift to a more personal patient/doctor relationship. The way that the health care system is now (more patients, more surgeries, more money) may see the most results, but does not always produce the best results.
I completely agree with the idea that there is a major issue regarding how little time physicians spend with their patients nowadays. The fact that 40% of a physician’s time is spent on the computer versus only 12% with patients is shocking. These statistics should be completely reversed if the physician-patient relationship was as in-tact. Doctors definitely need to get to know more about their patients before making assumptions about what is best for them, so I like your propositions. I think the idea of making a list with possible costs and benefits is an incredible idea, and it is not as farfetched as you might think. This eliminates disclosure and lack of informational issues by providing everything of importance up front. The other proposition: pairing a doctor and patient based on values definitely seems a bit unapproachable, however, the underlying ideas are understandable. Another potential approach could be to discuss consent forms and make information less electronic. Before technology was overused, physicians and patients had to discuss problems and communicate personally. Nowadays, technology has become a third party seemingly interfering with physician-patient relationships. If doctor’s offices required less impersonality and perhaps a specific appointment required where the physician and patient review and propose questions regarding consent forms, then I believe we can begin to eliminate this major issue.
I agree with you when you say that those alternatives are farfetched because I don’t really see any of those things happening. If the doctor would give the patient a list of possible treatments, more times than not, the patient won’t even understand what the options are and will probably want the physician to choose regardless. Also, pairing physician to patient based on religious beliefs and everything you said also isn’t a good solution because that in and of itself takes a lot of time pairing, and it’s difficult to pair people when you don’t really know their personal backgrounds.
I believe that the doctor-patient relationship needs to improve. I agree with your point about how physicians should develop this relationship in order to know what’s in the best interest for the patient because physicians should know what the personal interests of the patients are. Just because a medical decision may be the “right” decisions, a doctor should take into account the patient’s background and responsibilities. For example, a doctor may suggest that a patient gets surgery for, let’s just say, a hip replacement. However, what if that patient is passionate about, let’s say, playing tennis and doesn’t want to give that up so soon in his or her life? Doctors need to consider the personal interests and responsibilities of the patients before jumping to any medical decisions.
I agree in that the patient/doctor relationship should be strengthened, but it there is a current gap in this relationship due to BOTH parties (patients AND doctors). As I’ve stated in my blog post, “First, Do No Harm,” patients are often intimidated by the physician and are afraid to be their own advocate. Physicians seem too pushy when it comes to treatment options, which can further intimidate the patient. However, one of the two solutions that you discussed isn’t all that problematic. In fact, physicians are trained to develop multiple diagnoses and treatment options and are encouraged to discuss these with the patient. This is a very crucial step of the treatment process; therefore, the physician should be allotted more time to explain the possible treatment options and answer any questions that the patient may have. The second solution is faulty because physicians are trained to remain objective in a patient’s procedure otherwise it could jeopardize the patient’s treatment (making decisions based on strong emotions can be dangerous). Another option perhaps is to lessen the amount of patients a doctor has. Unfortunately, this would require a lot more doctors, and the medical field is already running on a deficit of medical professionals.
Mckenzie, I agree with you in your opinion that Veatch’s two alternatives are implausible. I don’t think it is a good idea to give the patient a “choice” about which treatment to follow through with. Most patients do not have medical expertise and may pick a treatment option that has detrimental consequences for their health. The whole role of the doctor is to provide the patient with viable options and to weigh out the positives and negatives to the course of action for the patient. Sure, physicians are not able to balance every concern perfectly, however they probably do a better job than the patient would at least in the medical realm. As stated in class medical expertise does not equal moral expertise, which brings Veatch to his next suggestion: pairing physicians with patients based on their personal beliefs. While this seems like a good option in theory, I don’t think you could practice it because it is too complex and would require reconfiguring the medical community and medical schools. However, I don’t think the physician-patient relationship should be a partnership either. To work together as equals seems questionable and would undermine the expertise of the physician. Something else needs to give to establish better medical relationships.
I find it interesting that you propose the solution for the issue you raise to be a progression towards “partnership”. While I agree with this, I have to say that this is not adequate. One of the solutions the author suggests must follow. This is because even in a partnership, each person has their role. The doctor could easily still view himself as the more informed one. This brings us back to the slippery slope towards paternalism. I enjoyed the eloquence you brought to explaining the context of this issue- the “influx of medical information readily available in our society as well as a new emphasis on personal care is driving patient empowerment.” I was happy to see your explanation of time management as well. This does indeed affect the patient doctor relationship.
When you mention that Veatch argues that physicians are only experts in one component of well-being (medical) and as a result are unable to determine what constitutes the good for another being- I immediately thought that this is upsetting. There is no excuse in this day and age for NOT having integrative medicine. Doctors have more access to information, too. They need to do their best to promote genuinely healthy lives. If there are barriers preventing them from doing this, then the problem needs to be addressed further upstream, as that would be a problem with the healthcare system.
One option presented to address the changing nature in medical care was pairing physicians and patients based on “deep interests”. I agree with Mckenzie, that this idea is farfetched. When the patient-physician relationship is becoming less and less personal, it would be unlikely for physicians to be willing to be matched with patients on a more personal level. In fact, this pairing might even make the relationship too personal, causing physicians and patients alike to have a difficult time separating themselves from the relationship and concentrating on the medical situation. Furthermore, there are other problems that could arise from pairing patients and physicians based on characteristics such as religious or political affiliations. Many assumptions might be made by both parties that are incorrect. For example, just because two people share the same religious faith or are part of the same political party, does not mean that their views on medicine would align. If a patient places too much trust on a physician simply because they share the same religious or political beliefs, they might find that the physician isn’t actually making decisions that they agree with. Thus, it is essential for patients to remain as informed as possible, and not make faulty assumptions regarding medical treatment.
As you mentioned in the last paragraph about the physician-patient relationship, it makes me wonder about how deep the relationship or partnership should be. Should the doctors spend more time getting to know the patients by talking not just about the medical history in order to know the patient’s medical interests? And is there enough time for a doctor to build a relationship with each of his patients? Also, by building these relationships, is it going to cause a waste of time and many patients waiting outside? Another issue that may rise is that doctors may put into too much feeling to the patients that causes the doctors not being able to make an objective solution. Therefore, doctors should know how close the relationship with the patients should be that their emotions would not affect their judgment. This might need a lot of experiences in order for the doctors to achieve the appropriate relationship with patients, but still doctors should always try their best for the their patients to understand the situations.
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