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Doctor-Patient Relationship

Doctor-Patient relationship is an important step of medicament as the doctor one of the main support circles that surround the patient which give him hope and care

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    Dec 31 2013: Have you heard someone express the position that the relationship between doctor and patient is not important? Just as teachers in their training are taught of the paramount importance of their relationships with students, I expect medical training and training for other sorts of direct service work involve the same.

    Here is a review article that indicates that the modern medical literature contains about 8000 published articles, books, and chapters of textbooks on this central aspect of medical practice and also summarizes some of the content from those sources: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496871/

    Is there another possible side to this "debate" other than the position you have taken?

    Or are you asking more specifically whether the doctor should give a person hope that he will recover, even when an honest diagnosis would suggest his condition is terminal?
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      Dec 31 2013: If I could say yes I heard some doctors unfortunatly express thier overlooking the relationship with thier patient.
      Moreover I think even with patient right to know honestly his diagnosis especially being hopeless case that does not mean giving up hope

      Thanks for for the link
  • Jan 18 2014: Muhammad, I will make another comment trying to answer the real question you might originally purported.
    First I have to explain my view on the relationship of different parties involved.
    The service involving the commodity sold in a small shop, involves a shop salesperson who only tried to sell a particular or several similar commodities. However, each commodity, has been invented/improved by the inventor, then developed into a production model and followed by the design by the production process engineer, then the commodity is manufactured and transported to be sold by the shop. When the commodity was sold to a customer the money paid included the part of the wage of the salesman as well as the shop owner's profit in addition to the its cost. But the doctor/physician, AS A PROFESSIONAL, has a different role to play. He is the examiner, analyzer (diagnose) and process engineer (treatment), all in one. They also spend more time and money to be trained. So, the patient should respect his work (most of the patients do). However, medical science is more an art rather than engineering, certain rate of mistakes are not completely avoidable. Also, one can't always order, or instruct, what the doctor has to do. Of course, the patient has his right to refuse to be treated by a particular doctor, and he/she always have the option of a second opinion, if he/she don't really wanted to be treated in certain way. If the treatment is a mistake, there are court of law to ask for compensation as well as the punishment on the physician and the hospital. On the other hand there are also laws that prevent the doctors to do certain things which are unethical or illegal. For example, the doctor,who gave too much tranquilizers to Michael Jackson by Jackson's demand, now is sentenced for 5 years in prison for his death.
    So doctor-patient relation must be based on mutual respect and trust in communication by both sides. The evidence based medicine, must be rendered by BOTH, to succeed.
  • Jan 12 2014: Wayne, Can you understand that I was saying all along that the patient usually can switch to another doctor, BUT he/she will not necessarily order even the new doctor along either, like my example showed. If you read the the news recently you will find that there is a case that a 14 year old girl went into coma after an operation. Then the physician declared she was brain dead and the hospital wanted to disconnect the respirator, but the family believes there might be a chance for her to recover. that went to court but the judge sided with the hospital and still granted the hospital to disconnect with a delay of one more week. The hospital also refuses to transport the patient to another medical facility unless that facility to come to get her. The reason is that the hospital might be sued if they send a dead patient to another medical facility.
    We are arguing some thing that based on our own interpretation of the so-called "fire" the doctor if he doesn't do what the patient order him to do. If you interpret "fire" as the change of a doctor in another facility, of course that is always permissible, except in a few cases like above. That is more or less true to in the case of student teacher or lawyer client relationship. Because the teachers, lawyers and physicians are professionals who have a duty to carry out their service duties, other than a store clerk whose duty is merely to serve the pleasure of the customers.
    Also, as I already said that the changing of the teacher or the school is more difficult than 60-70 years ago, but let's face it, many K-12 students just drop out of the school or move out of the district, the government can't really go after most of the student delinquencies. Heck, government can't even prevent a few draft dodgers or tax dodgers by renouncing the national citizenship. Therefore you can always change your doctor ,lawyer or teacher or even your government if you are dissatisfied with them. but you DON'T FIRE THEM in the strict sense.
  • Jan 11 2014: Interesting, the doctor-patient relationship has changed. Before, the doctor was the expert and only once in a while would a 2nd opinion would be asked for. Today, it is done all the time and patient will switch doctors when the opinion is not what they think is correct. (example: my wife had bone on bone and tremendous pain in her knee. The orthopedic surgeon refused to replace the knee because she was too young, 58. The standard for many years was 65 due to the artificial knee would wear out in 15 years. The new artificial knees last a lot longer and a different surgeon did the replacement).

    The web also allows the patient to check out the procedures and the percentage of success. It also allows patients to ask reasonable questions.
  • Jan 2 2014: The doctor-patient relationship is similar to the teacher-student relationship. Both of them can't be equal to the shop-customer relationship since the customer has the authority to purchase what he wants and could change the shop for his order with another provider. However, the service provided by the teachers is different. They have a responsibility to teach the student's learning the REQUIRED KNOWLEDGE TO IMPROVE HIS/HER ABILITY TO MAINTAIN HIS/HER FUTURE LIFE IN THE SOCIETY. This responsibility is imbedded into the teacher's job duty so that he/she can't just do whatever the student(s) "told" him/her to do. Of course, the teacher can't order an individual student what to do, but most educators would agree that if a student doesn't learn the minimum requirement for the proper level of the particular grade, the student could be dismissed from the class, or sent to another school facility.
    The situation for doctor-patient relationship, even though it's not the same as the teacher-student relationship, is still similar in the sense that the doctor has some implicit responsibility to the society at large. For example, the doctor shouldn't give a subscription for narcotics, simply because the patient ask him to do. For ordinary medication or procedures, the doctor could offer alternatives with the advantages and disadvantages with each explained and let the patient to choose. Of course, the patient could even refuse all the treatment offered, but again, the patient can't dictate what he/she wants, such as the restricted narcotics, or demand whatever he/she wants.
    With the new ObamaCare law in effect starting this year in the U. S., the situation becomes even more complicated. There are stipulations that the physicians should persuade the patients to reduce body weight to save his medical expense. The law also says that if the doctor doesn't perform, his fees will be reduced. This would be another dilemma for the doctor and patient, if they don't cooperate.
    • Jan 11 2014: Bart,

      your analogy is flawed. As a patient, I choose the doctor and I can fire the doctor. I also on serious thing demand a 2nd opinion. Can a student in k-12 select a teacher? Fire the teacher?
      • Jan 11 2014: : Wayne, my emphasis is the statement that the doctor has to do what the patient wants him to do, that is in contrast to what the doctor, in some legal or conventional sense, is not allowed to do. The legal or ethical binding can be illustrated by the case of Rx of hard dopes and in the case of assisted suicide, etc. This of course is almost certainly applicable to the student teacher relationship obviously. When you say you fire a doctor, you could only mean that you change a doctor by going to another hospital or clinic. This is again analogous to change a class under the system of electives, or otherwise you change a school. (This was quite easy to do 60 years ago, but now the artificial restrain by the government makes it relatively difficult, but the option is still available in certain area)
        In other words, you can't FIRE A DOCTOR, or "ORDER" the hospital/clinic to change an attending physician ESPECIALLY WHEN YOUR DISSATISFACTION IS BASED ON WHEN THE DOCTOR DOESN'T DO WHAT YOU "ORDERED" HIM TO DO. I am not so sure that the hospital will normally agree to furnish a second opinion from the physicians on the staff of the same hospital. As I said before, if the suggested procedure involves serious risk, the hospital usually give you the alternative choices when suggest their treatment method, instead of a second opinion. If you want a second opinion, you have to go outside of the hospital..
        Look, the doctor-patient relationship is simply not analogous to the shop-customer relationship. For instance, can you demand a government employee be replaced because he is too slow or not to do what "you demand him to do"? The best possibility is probably to change a window in the same office. Even that probably couldn't be successful for the "customer".
        • Jan 11 2014: Hate to tell you but doctor shopping is quite prevalent in the US, looking for a doctor to do what the patient wants. The patient has the option to not allow the doctor to do a procedure,

          In k-12 public schools, it is not easy to move from 1 school to another unless you count private school, which could cost 47k per year. I agree that you can switch undergraduate schools easily with little penalty except possibly time. In Grad school that is another issue. If you switch phd programs, it can be the kiss of death to your academic career.

          I know one individual that dropped out of a post doc and join another. It cost him a lot.
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    Jan 1 2014: I don't want a relationship with my doctor. I just want him to do what I tell him to and take direction from me.
    I'm pretty sure most Americans feel this way. At least from my experience.
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      Jan 1 2014: I did not mean it to be a personal relationship between doctors and patients but at least there should be some sort of trust and comfort
      Also I think it is doctor's role to guide you not to take direction from you
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        Jan 2 2014: Nobody guides me. If he does what I tell him to I will trust him.
        I am paying for his expertise and specialized knowledge that comes from practice. I really don't care whatever else he has to say. He better take direction or I will take my business elsewhere. It's my body.
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      Jan 1 2014: I agree with you to some extent Linda. It is MY body we are dealing with, so I like to be well informed regarding the care of the body. I listen to the recommendations of health care professionals, and ultimately, the decisions are mine, I make the choices, and give the directions regarding treatment. I perceive health care professionals as a team, and I am the captain of my team.

      I don't think most Americans feel this way though. I observe most people giving the choices to the doctor. In my perception, it is only a doctor's role to guide the patient when the patient does not have adequate information to make decisions for themselves.
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        Jan 2 2014: I agree Colleen. But some people like to be told what to do. It absolves them from making informed decisions. And if it was the wrong decision, it absolves them from accountability.
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          Jan 2 2014: Looks like we're on the same page with this Linda:>)

          I wholeheartedly agree that people sometimes do not like to make decisions because they may feel that making their own decisions involves responsibility and accountability.....which it does! So, people allow others to make decisions for them. Did you ever hear the saying......"if we don't make decisions for ourselves, somebody else will do it for us".

          Yikes! I prefer to have information and make my own decisions....apparently that is your choice as well:>)

          Happy New Year Linda....may it continue to be more time in which we can learn how to be informed and make our own choices:>)