Physician-patient relationship: Difference between revisions

From Citizendium
Jump to navigation Jump to search
imported>Robert Badgett
imported>Robert Badgett
Line 16: Line 16:


===The length of the visit===
===The length of the visit===
There is not enough time during the typical doctor-patient visit to cover all concerns.<ref name="pmid17548846">{{cite journal |author=Parchman ML, Pugh JA, Romero RL, Bowers KW |title=Competing demands or clinical inertia: the case of elevated glycosylated hemoglobin |journal=Annals of family medicine |volume=5 |issue=3 |pages=196–201 |year=2007 |pmid=17548846 |doi=10.1370/afm.679}}</ref> Increased numbers of medical problems<ref name="pmid9593791">{{cite journal |author=Redelmeier DA, Tan SH, Booth GL |title=The treatment of unrelated disorders in patients with chronic medical diseases |journal=N. Engl. J. Med. |volume=338 |issue=21 |pages=1516–20 |year=1998 |pmid=9593791 |doi=}}</ref> or concerns brought by the patient<ref name="pmid17548846"/> interfere with quality of care. Preventive care alone, if coordinated by the doctor rather than delegated, requires more time than available.<ref name="pmid12660210">{{cite journal |author=Yarnall KS, Pollak KI, Østbye T, Krause KM, Michener JL |title=Primary care: is there enough time for prevention? |journal=American journal of public health |volume=93 |issue=4 |pages=635–41 |year=2003 |pmid=12660210 |doi=}}</ref>
Longer visits are associated with higher quality medical care.<ref name="pmid12528590">{{cite journal |author=Wilson A, Childs S |title=The relationship between consultation length, process and outcomes in general practice: a systematic review |journal=The British journal of general practice : the journal of the Royal College of General Practitioners |volume=52 |issue=485 |pages=1012–20 |year=2002 |pmid=12528590 |doi=}}</ref> Patient visits should probably be at least 20 minutes.<ref name="pmid17986698">{{cite journal |author=Bodenheimer T |title=A 63-year-old man with multiple cardiovascular risk factors and poor adherence to treatment plans |journal=JAMA |volume=298 |issue=17 |pages=2048–55 |year=2007 |pmid=17986698 |doi=10.1001/jama.298.17.2048}}</ref>
Longer visits are associated with higher quality medical care.<ref name="pmid12528590">{{cite journal |author=Wilson A, Childs S |title=The relationship between consultation length, process and outcomes in general practice: a systematic review |journal=The British journal of general practice : the journal of the Royal College of General Practitioners |volume=52 |issue=485 |pages=1012–20 |year=2002 |pmid=12528590 |doi=}}</ref> Patient visits should probably be at least 20 minutes.<ref name="pmid17986698">{{cite journal |author=Bodenheimer T |title=A 63-year-old man with multiple cardiovascular risk factors and poor adherence to treatment plans |journal=JAMA |volume=298 |issue=17 |pages=2048–55 |year=2007 |pmid=17986698 |doi=10.1001/jama.298.17.2048}}</ref>


Revision as of 22:36, 8 November 2007

The physician-patient relationship is defined as the "interactions between physician and patient".[1]

The medical interview

Being an empathetic listener is helpful.[2]

Greeting the patient

One study of videotaped physician-patient encounters concluded that "physicians should be encouraged to shake hands with patients but remain sensitive to nonverbal cues that might indicate whether patients are open to this behavior. Given the diversity of opinion regarding the use of names, coupled with national patient safety recommendations concerning patient identification, we suggest that physicians initially use patients' first and last names and introduce themselves using their own first and last names."[3]

Hearing the patient's story

Although physicians frequently (3/4s of interviews) interrupt patients before the patient finishes listing their concerns.[4][5] It is not clear that this interruption is bad.[6][7] Not asking for the patient's concerns at all may lead to more concerns arising late in the interview.[4]

After the patient finishing stating their chief concern, responding with "Is there something else you want to address in the visit today?" rather than "Is there anything else you want to address in the visit today?" may decrease patients' unmet concerns.[8]

Engaging the patient

Encouraging the patient to participate in decisions may increase engagement.[9] Using stories to describe medical evidence may help communication.[10] It is unclear how to overcome difficulties in communicating quantitative information.[11]

The length of the visit

There is not enough time during the typical doctor-patient visit to cover all concerns.[12] Increased numbers of medical problems[13] or concerns brought by the patient[12] interfere with quality of care. Preventive care alone, if coordinated by the doctor rather than delegated, requires more time than available.[14]

Longer visits are associated with higher quality medical care.[15] Patient visits should probably be at least 20 minutes.[9]

References

  1. ↑ National Library of Medicine. Physician-Patient Relations. Retrieved on 2007-10-22.
  2. ↑ Epstein RM, Hadee T, Carroll J, Meldrum SC, Lardner J, Shields CG (2007). ""Could this Be Something Serious?" : Reassurance, Uncertainty, and Empathy in Response to Patients' Expressions of Worry". DOI:10.1007/s11606-007-0416-9. PMID 17972141. Research Blogging.
  3. ↑ Makoul G, Zick A, Green M (2007). "An evidence-based perspective on greetings in medical encounters". Arch. Intern. Med. 167 (11): 1172–6. DOI:10.1001/archinte.167.11.1172. PMID 17563026. Research Blogging.
  4. ↑ 4.0 4.1 Marvel MK, Epstein RM, Flowers K, Beckman HB (1999). "Soliciting the patient's agenda: have we improved?". JAMA 281 (3): 283–7. PMID 9918487. [e]
  5. ↑ Beckman HB, Frankel RM (1984). "The effect of physician behavior on the collection of data". Ann. Intern. Med. 101 (5): 692–6. PMID 6486600. [e]
  6. ↑ Dyche L, Swiderski D (2005). "The effect of physician solicitation approaches on ability to identify patient concerns". Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine 20 (3): 267–70. DOI:10.1111/j.1525-1497.2005.40266.x. PMID 15836531. Research Blogging.
  7. ↑ Thomas Mordekhai Laurence (2004). Extreme Clinic -- An Outpatient Doctor's Guide to the Perfect 7 Minute Visit. Philadelphia: Hanley & Belfus. ISBN 1-56053-603-9. 
  8. ↑ Heritage J, Robinson JD, Elliott MN, Beckett M, Wilkes M (2007). "Reducing patients' unmet concerns in primary care: the difference one word can make". Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine 22 (10): 1429–33. DOI:10.1007/s11606-007-0279-0. PMID 17674111. Research Blogging.
  9. ↑ 9.0 9.1 Bodenheimer T (2007). "A 63-year-old man with multiple cardiovascular risk factors and poor adherence to treatment plans". JAMA 298 (17): 2048–55. DOI:10.1001/jama.298.17.2048. PMID 17986698. Research Blogging.
  10. ↑ Steiner JF (2007). "Using stories to disseminate research: the attributes of representative stories". Journal of general internal medicine : official journal of the Society for Research and Education in Primary Care Internal Medicine 22 (11): 1603–7. DOI:10.1007/s11606-007-0335-9. PMID 17763914. Research Blogging.
  11. ↑ Ancker JS, Kaufman D (2007). "Rethinking Health Numeracy: A Multidisciplinary Literature Review". DOI:10.1197/jamia.M2464. PMID 17712082. Research Blogging.
  12. ↑ 12.0 12.1 Parchman ML, Pugh JA, Romero RL, Bowers KW (2007). "Competing demands or clinical inertia: the case of elevated glycosylated hemoglobin". Annals of family medicine 5 (3): 196–201. DOI:10.1370/afm.679. PMID 17548846. Research Blogging.
  13. ↑ Redelmeier DA, Tan SH, Booth GL (1998). "The treatment of unrelated disorders in patients with chronic medical diseases". N. Engl. J. Med. 338 (21): 1516–20. PMID 9593791. [e]
  14. ↑ Yarnall KS, Pollak KI, Østbye T, Krause KM, Michener JL (2003). "Primary care: is there enough time for prevention?". American journal of public health 93 (4): 635–41. PMID 12660210. [e]
  15. ↑ Wilson A, Childs S (2002). "The relationship between consultation length, process and outcomes in general practice: a systematic review". The British journal of general practice : the journal of the Royal College of General Practitioners 52 (485): 1012–20. PMID 12528590. [e]
Retrieved from "https://citizendium.org/wiki/index.php?title=Physician-patient_relationship&oldid=316154"