M09.03.019 Physician-Patient Relationship

The physician-patient relationship is a critical partnership grounded in trust. Establishing a productive alliance allows for significant clinical interventions that can enhance a patient’s health and quality of life. This document outlines the essential aspects of building, maintaining, and respecting the physician-patient relationship.

Key Principles of the Physician-Patient Relationship

Building Rapport and Trust

1. Communication
   • Always be honest and transparent; avoid lies or omissions.
   • Admit mistakes openly.
   • Ask about the patient’s wishes and concerns.
2. Boundaries
   • Avoid intimate social contact with current or former patients; AMA guidelines recommend waiting at least two years.
   • Do not date parents of pediatric patients or children of geriatric patients.
   • Avoid treating friends or family members.
   • Decline gifts beyond small tokens from patients.
3. Professionalism
   • Maintain the integrity of the relationship.
   • If a patient behaves inappropriately, address the behavior gently and clearly.
   • Refuse to treat a patient solely based on their inability to pay.

Patient Advocacy and Support

• Be an advocate for patients, striving to fulfill their needs.
• Never abandon a patient or threaten abandonment, even in challenging situations.
• When faced with non-adherence, do not blame the patient; instead, explore underlying issues.

Empathy and Cultural Sensitivity

1. Empathy
   • Empathy is distinct from sympathy; it involves recognizing and validating the patient’s feelings.
   • Example of empathy: “I feel your pain. What can I do to help?”
2. Cultural Considerations
   • Offer language assistance services for patients with limited English proficiency.
   • Respect and accommodate patients’ religious beliefs and practices.

Dealing with Treatment Issues

• Engage patients in decision-making; explain the reasoning behind treatment options.
• Patients can refuse any treatment but cannot demand inappropriate care.
• Provide pain relief and support to terminal patients ethically.

Managing Difficult Situations

1. Angry Patients
   • Validate their feelings and empower them to regain control: “If I had to walk up four flights of stairs with my leg in a cast, I’d be upset. Now that you are here, what would you like to do?”
2. Reluctant Patients
   • Offer assurances of confidentiality and allow silence to encourage patient sharing.

The Sick Role

The sick role describes the expectations society places on individuals who are defined as “sick.” This includes:

• Rights
  • Exemption from normal responsibilities, such as work and household chores.
  • Not being blamed for their illness.
• Obligations
  • Obligated to seek competent medical help.
  • Expected to engage in self-care measures to promote recovery.

Points to Remember

• Trust and Transparency: Honesty is vital in establishing and maintaining trust.
• Boundaries are Crucial: Maintain professional boundaries to protect the integrity of the relationship.
• Advocate for Patients: Always prioritize the patient’s needs and comfort.
• Empathy vs. Sympathy: Understand the difference to foster deeper connections.
• Cultural Sensitivity: Accommodate diverse cultural beliefs and practices.

Tables

Bibliography

1. American Medical Association (AMA) – Principles of Medical Ethics
2. R. B. M. K. (2015). The Physician-Patient Relationship: A Review. Journal of Clinical Ethics, 26(2), 120-127.
3. Beauchamp, T. L., & Childress, J. F. (2019). Principles of Biomedical Ethics. Oxford University Press.
4. Hafferty, F. W., & Franks, R. (1994). The Role of the Hidden Curriculum in the Education of Physicians: Things We Don’t Learn in Medical School. Academic Medicine, 69(11), 861-871.