Good Doctor-patient Relationship Research Articles

Patients have a right to privacy and anonymity in medical publication

The classical ideal of the good patient-doctor relationship implicity accepts the doctor's access to the patient's physical, social, and mental "nudity," as long as this intrusion serves the patient's best interests. Without such an implicit confidence, most clinical work would be impossible. Yet breaches of confidence do occur, sometimes deliberately, sometimes by accident or simply by lack of consideration. Examples may include release of sensitive patient information to the press, gossip in the local medical community, and public disclosures through administrative or legal statements. A relatively new ethical transgression is intrusion into a patient's bodily or social integrity by clinical descriptions and photographs printed in textbooks or medical journals. The phenomenon itself is not new. A quick glance into many old and new textbooks will demonstrate patients portrayed in the nude without any masking or any statement on the patients' informed consent. What is new, however, is that public and

Patients Have a Right to Privacy and Anonymity in Medical Publication

The classical ideal of the good patient-doctor relationship implicity accepts the doctor's access to the patient's physical, social, and mental "nudity," as long as this intrusion serves the patient's best interests. Without such an implicit confidence, most clinical work would be impossible. Yet breaches of confidence do occur, sometimes deliberately, sometimes by accident or simply by lack of consideration. Examples may include release of sensitive patient information to the press, gossip in the local medical community, and public disclosures through administrative or legal statements. A relatively new ethical transgression is intrusion into a patient's bodily or social integrity by clinical descriptions and photographs printed in textbooks or medical journals. The phenomenon itself is not new. A quick glance into many old and new textbooks will demonstrate patients portrayed in the nude without any masking or any statement on the patients' informed consent. What is new, however, is that public and

Doctor-Patient Relationship in Cystic Fibrosis - a Patient's Perspective

Cystic fibrosis (CF) is a complex chronic disorder of young people who will depend on medical care for the rest of their lives. A good doctor-patient relationship is vital to their wellbeing, but can be subject to conflict of independence, conflict between life style and need for medical care, conflict between doctor and patients' interests and conflict of knowledge between a patient and doctor. A successful relationship based on holistic approach is essential to the treatment of CF.

Diminished capacity, friendship, and medical paternalism: two case studies from fiction.

We consider the moral and social ingredients in physicians' relationships with patients of diminished capacity by considering certain claims made about friendship and the physician's role. To assess these claims we look at the life context of two patients as elaborated examples provided in two novels: Woman on the Edge of Time (1976) by Marge Piercy, a radical feminist; and It's Hard to Leave While the Music's Playing (1977) by I. S. Cooper, a prominent physician-researcher. At issue is how the doctor-patient relationship should be structured. In question is whether the physician's friendship and professional expertise, together with the diminished capacity of the patient, authorize medical paternalism. From our examination, we find compelling insights against appealing to friendship both in good doctor-patient relationships and in more typical, not-so-good ones.

Medical Students in Psychiatric Out-Patients

A good doctor-patient relationship is central to the task of gathering information and providing treatment, especially in psychiatry. In a teaching hospital this relationship may be complicated by the presence of one or more medical students, watching in an uninvolved fashion, and possibly changing from visit to visit. If the students are seated to one side or even behind him, the patient may feel increasingly uncomfortable about exposing personal material in the absence of any visual feedback. A passive audience may be permissible in a general medical setting where information is less personal and amateur status is masked behind white uniforms. In psychiatry, however, the youthfulness and comparative immaturity of students may be heightened by casual dress and less formal clinics.

Medical Students' Change of Thought after a Two Year Course on Medical Interview Skills

Purpose: An effective medical interview is essential in the establishment of a good doctor-patient relationship and in the establishment of an accurate diagnosis. This article describes medical students’ change of thought regarding the importance of learning interview skills and other skills before and after an educational course on medical interviewing skills. Methods: First year medical school students enrolled in a course on medical interviewing skills for 12 weeks, 2 hours per week December 2000, for 9 weeks, 2 hours per week August 2001, at Keimyung University Medical School. The students were divided into 10 groups for workshops. Using questionnaire, we obtained the results about the change of students’ beliefs between the first and last class. Statistical analysis using SPSS (version 10.0) software programme, Chi-square test, paired t-test and Pearson’s correlation. Results: The medical students believed that learning interview skills and other skills was more important after the course. There was also an increase in the number of students who thought they could improved their skills. In addition, the students practiced the skills in their personal like with family and friends. After the course, the students chose “kind doctor and average ability” as a future professional description instead of “unkind doctor but very excellent”. The effect of learning the skills to treat patients for future practice was above average. After the course, however, less students perceived the importance of learning such skills for future practice. Conclusion: After the enrollment in an interviewing skills course, medical students believed that learning interviewing and other skills was more important than prior to the course. After the course, however, less students believed the effect of learning the skills for future practice was important. Thus, we thought it was important to consider the optimal time period for such an educational intervention to improve clinical skills and the doctor-patient relationship.

Knowledge and skills necessary in the practice of prosthodontics

The prosthodontist in practice deals with people of various ages, expectations, difficulties, and degrees of health. He must be skilled in establishing a good doctor-patient relationship. He must be sincere and understanding, and he must be able to channel his patient's thinking into constructive processes. He must be skilled in diagnosis, not only of the oral parts which he proposes to replace, but of the relationship of the whole person to the ultimate function which he is trying to improve. Of course, he must have the knowledge of the basic sciences and of the clinical sciences, and he must also be able to put these to use. He must possess a high degree of mechanical ingenuity, because many problems are not stereotyped but require an ingenious approach. He must be technically and artistically competent. Because the prosthodontist is frequently called upon to be the final diagnostician and to decide upon a series of treatment procedures for a patient, he must have knowledge in depth of general practice and of the other specialties, primarily periodontics, endodontics, and oral surgery. In my opinion, these are primary skills required of the dentist. To what degree a man is a specialist, to what extent these skills must be developed, or how broad or narrow the field of specialization should be are questions I leave to your consideration and judgment in the workshop to be held tomorrow morning.

The Management of a Medical Practice.

Too often it is assumed that a physician automatically knows how to resolve the problems arising in office management. Most medical school curricula and subsequent training programs ignore the business and economic aspects of medical practice. Questions about practice management necessarily demand answers, but these answers may often be the wrong ones. Problems in practice management arise when patients become dissatisfied. The introductory chapters of this book analyze the reasons for such a situation and suggest ways of creating good doctor-patient relationships. Then follow sections on basic technique in patient management, including refinements and adaptations required in specialized practice. The final portions of the book are full of practical suggestions about locating in practice, actual office management, and personal financial planning. A physician-writer and medical management consultant have combined their knowledge to produce an excellent collection of practical ideas. In explaining the reasons for their suggestions, the authors have utilized

FURTHER FOLLOW-UP ON HABITUAL ABORTION PATIENTS

Abstract 1. 1. This follow-up report covers a period of over 20 years during which time 427 cases have been observed. These patients have had 1,627 pregnancies before treatment, of which 1,380 or 86.0 per cent had spontaneous abortions. 2. 2. After therapy was begun, 289 of these patients were treated in from one to 6 subsequent pregnancies for a total of 496, of which there were 112 abortions, or 23.5 per cent. 3. 3. The reversal of the habitual abortion tendency may be due to the treatment employed. The essentials of treatment for over 20 years have been early prenatal care, good nutrition, a high citrus diet, vitamin C and K supplements, and a good doctor-patient relationship. 4. 4. During the past 10 years, preconceptional care, uterine anodynes, and a more dynamic and positive type of psychotherapy have been added to the regimen. No improvement was observed in the second decade of the study, perhaps because the patients were older, the incompetent cervix was more common, more patients were in the perpetual abortion class, and more were undergoing psychoanalysis. 5. 5. The success rate between 75 and 80 per cent is in keeping with the results obtained with other regimens reported in the literature. Perhaps all of them have a common denominator, namely, improved nutrition and prenatal care. Yet some isolated factor like the hormones are often given the credit. 6. 6. The perinatal mortality before treatment was 20.9 per cent; afterward, it was 3.6 per cent. The incidence of fetal anomalies and defects was 3.7 per cent before treatment and 1.66 per cent afterward. 7. 7. Most of the cases exhibited psychic conflicts in the marital or environmental situations, yet divorces were few. Fear of a defective child was prominent. Yet the dread of the responsibility of rearing the child and reluctance to interrupt a career were also in evidence. There was little evidence of a desire for large families. Of the 427 patients, 138 never tried another pregnancy; 289 had only one additional pregnancy; 127 of these had two; 54 had three; 26 had four, and only 9 had 5 or more. Only 10 couples resorted to adoption.

Further follow-up on habitual abortion patients

1.1. This follow-up report covers a period of over 20 years during which time 427 cases have been observed. These patients have had 1,627 pregnancies before treatment, of which 1,380 or 86.0 per cent had spontaneous abortions.2.2. After therapy was begun, 289 of these patients were treated in from one to 6 subsequent pregnancies for a total of 496, of which there were 112 abortions, or 23.5 per cent.3.3. The reversal of the habitual abortion tendency may be due to the treatment employed. The essentials of treatment for over 20 years have been early prenatal care, good nutrition, a high citrus diet, vitamin C and K supplements, and a good doctor-patient relationship.4.4. During the past 10 years, preconceptional care, uterine anodynes, and a more dynamic and positive type of psychotherapy have been added to the regimen. No improvement was observed in the second decade of the study, perhaps because the patients were older, the incompetent cervix was more common, more patients were in the perpetual abortion class, and more were undergoing psychoanalysis.5.5. The success rate between 75 and 80 per cent is in keeping with the results obtained with other regimens reported in the literature. Perhaps all of them have a common denominator, namely, improved nutrition and prenatal care. Yet some isolated factor like the hormones are often given the credit.6.6. The perinatal mortality before treatment was 20.9 per cent; afterward, it was 3.6 per cent. The incidence of fetal anomalies and defects was 3.7 per cent before treatment and 1.66 per cent afterward.7.7. Most of the cases exhibited psychic conflicts in the marital or environmental situations, yet divorces were few. Fear of a defective child was prominent. Yet the dread of the responsibility of rearing the child and reluctance to interrupt a career were also in evidence.There was little evidence of a desire for large families. Of the 427 patients, 138 never tried another pregnancy; 289 had only one additional pregnancy; 127 of these had two; 54 had three; 26 had four, and only 9 had 5 or more. Only 10 couples resorted to adoption.

Suicidal behavior in a general hospital

In an eleven-year period twenty-three patients committed suicide in a general hospital with psychiatric facilities, admitting almost exclusively male patients. Of the twenty-three suicides, sixteen were general ward patients, seven were psychiatric patients. The hospital suicide rate was 2.09 per 10,000 patients; for the general ward patients it was 1.55, for the psychiatric patients it was 10.6. In 61 per cent of the cases death occurred by jumping from windows. Typically, the general ward patient was chronically or terminally ill with malignancy, heart disease, central nervous system syndrome or other neurological disease, or a condition which was disfiguring or involved loss of sight. Multiple illnesses were common. Predisposing factors included social difficulties and an over-whelming sense of helplessness and uselessness. Three of the seven suicides in psychiatric patients occurred in delusional schizophrenics. The remaining four had depressive symptoms which appeared to be responding to psychotherapy. In two psychiatric patients and one general ward patient, suicide was preceded by a period of well being. Etiologic theories and indications of suicide are mentioned; various types of suicidal behavior in a hospital are discussed; and suggestions are made for the prevention of suicide. The importance of sensitiveness to the possibility of suicide and of good doctor-patient relationships is stressed.

The Results of Treatment in Various Clinical Syndromes

This is an interesting attempt to compare the results obtained in treatment of disorders, such as ulcerative colitis, peptic ulcer and asthma, in a group of patients under the care of internists with another group who received the attention of psychiatrists and psychoanalysts. Patients under the care of internists whose main emphasis was on diet and medication, did less well than those under the care of a single well-trained internist who devoted more attention to the psychologic factors of the patient's life. The results obtained by the latter type of individual were about as satisfactory as those achieved by psychiatrists and psychoanalysts. The authors suggest that the common denominator in the success in treatment by a properly trained internist and that of psychiatrists is a sincere sympathetic attitude and good doctor-patient relationship, rather than the special technique used by the therapist. This sort of study is sorely needed to provide the basis for good judgement in arranging the medical education provided in the schools and for selecting the proper management for patients in practice.

FACTORS AFFECTING PAIN OF INJECTION

This subject of pain from injections is one with which most adults have had intimate experience. On questioning a professional audience, I found that only one person in a hundred had never received a hypodermic injection of a medicine, vaccine, or test material. Furthermore, of those who had had an injection, only about 10% said they did not dread the next one. If persons were conditioned perfectly to the piqure, there would be no unpleasant associations with it. But it is a sad commentary on current techniques of injection that so many persons have painful memories. Fear of the needle is usually acquired in childhood.1The psychic trauma to millions of the population produced in this way undoubtedly creates obstacles to good doctor-patient relationships, essential diagnostic procedures, and even life-saving therapy. IMMEDIATE PAIN OF INJECTION Attention has generally been focused on how to control pain of injection by rendering