Patient-Physician Relationship

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Patient-Physician Relationship

• What is the ideal patient-physician relationship
  of the 21st century
• Why does it matter?
• And who should decide?

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Why Does It Matter

• Because of the rapidly changing environment that
  characterizes health care today,
• However, we need to understand what physicians
  and patients must do to protect and nurture that
  relationship.

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An Increasingly Central Role for Patient

• "Just as the molecular and chemistry-oriented
  sciences were adopted as the 20th-century medical
  paradigm, incorporation of the patient's
  perspective into a relationship- centered medical
  paradigm has been suggested as appropriate for
  the 21st century."

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Why Does It Matter

• The patient-physician relationship is fundamental
  to providing and receiving
• excellent care
• To the healing process
• to improved outcomes
• Therefore, it is important to understand what
  elements comprise the relationship and identify
  those that make it "good."

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Patient-Center

• One of the clearest themes to emerge is the
  centrality of patients.
• Increasingly, they are not simply recipients of
  care or subjects of research but active, informed
  individuals who wish to know more about their
  condition and exert greater control over their
  own care

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• "nothing about me without me."

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An Increasingly Central Role for Patient

• A knowledgeable, beneficent and genuinely caring
  physician guiding the treatment of
• respectful
• trusting
• grateful patients ,
• However, the nature of the patient-physician
  relationship appears to be far more complex.
  Sweeping changes within and outside the health
  care sector

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The Impact of Health Care Costs on the
Relationship

• Such as the growing preponderance of
• chronic illnesses,
• new medical technologies,
• shifting reimbursement practices,
• the Internet, government regulations, rising
  costs and changing social norms
• constantly molding patient and physician behavior.

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The Impact of Health Care Costs on the
Relationship

• Physicians feel overwhelmed by
• Rising malpractice premiums,
• The cost of new medical technology,
• Constraints on reimbursement
• upward pressures on nurses wages due to the
  national inflation.

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The Impact of Health Care Costs on the
Relationship

• Consumers face increasing costs, co-payments and
  coinsurance
• The cost of prescription drugs is becoming
  unaffordable.
• Payers ,the government, insurance companies,
• Employers and private individuals believe that
  health care has become unwieldy and increasingly
  unaffordable.

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The Physicians Obligation

• Commits full attention to the patient
• Creates an environment that preserves the
  patients dignity
• Fosters candor in the disclosure of
  confidential and intimate information
• Conveys genuine concern for the patients well
  being and
• Respects the role of the patient advocate
  and/or caregiver.

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The Physicians Obligation

• Improved capacity for physicians to see
  patients as whole persons, rather than diseases
  or organ systems
• Improved patient adherence to recommended
  therapies
• Improved patient self-care
• Increased patient satisfaction and more
  word-of-mouth referrals from happy,

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foundation of mutual responsibilities

• The intimacy of emotions and the private, often
  uncomfortable sharing of information
• between patient and physician require a that
  include
• Open and honest communication
• Compassion
• Trust and Respect

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The Physicians Obligation

• Improved patient recognition of important
  symptoms
• More informed decisions by patients
• Positive patient behavior changes
• Patients taking a more active role in their
  care
• A strong foundation to facilitate self-care
• Improved clinical outcomes

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The Patients Obligation

• Prepare a list of questions and concerns they
  wish the physician to address
• Make the physician aware of these questions and
  concerns at the beginning of the visit
• Share their medical histories as completely and
  accurately as possible
• .

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Principal elements that are essential to the
relationship

• 1-COMMUNICATION
• 2-OFFICE EXPERIENCE
• 3-HOSPITAL EXPERIENCE
• 4-EDUCATION
• 5-INTEGRATION
• 6-DECISION-MAKING
• 7-OUTCOMES

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C o m m u n i c a t i o n

• Exchange information
• Reach mutually satisfying decisions
• Develop a common understanding and
• Build trust.

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Drug of choice

• Patient Education is the "drug of choice" for
  prevention and treatment of every medical
  condition.
• The educational process is continuous and
• requires regular assessment and/or update.

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Education to change behavior

• Education must occur in each element of the
  patient-physician relationship.
• Its main goal is to achieving optimal health by
  "Behavior change"
• includes both therapeutic lifestyle changes and
  adherence to treatment recommendations.

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E d u c a t i o n

• Patients and physicians must work as
• partners to create an ever-evolving self-care
• Program
• Education should address physician/patient
  knowledge differences, culture and language Each
  patient should receive a tailored education
  package.
• Physicians should be open to education ,

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O f f i c e E x p e r i e n c e

• Telephone communication between patients and
  office can be a very effective and efficient tool
• Assuring flexible access is essential to a
  successful patient-physician relationship
• Physicians should continually evaluate their
  scheduling systems for effectiveness

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O f f i c e E x p e r i e n c e

• Office visits should be used as opportunities to
  review care plans, including illnesses,
  pharmacologic therapies, potential drug-to-drug
  interactions and any new medications added by
  other physicians.
• Patients and physicians should project mutual
  respect for each other by making every effort to
  be on time for appointments.

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O f f i c e E x p e r i e n c e

• A responsive, effective system for referrals and
  pre-authorizations is essential to an effective
  patient-physician relationship
• Physicians should communicate to patients the
  value of regular, face-to-face medication reviews

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H o s p i t a l E x p e r i e n c e

• The health care team members should
• attempt to personalize care in the hospital Which
  physician is in charge of care
• Physicians role should be clearly defined to the
  patient
• Effective communication is imperative to avoid
  errors

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H o s p i t a l E x p e r i e n c e

• Prior to procedures, an appropriate member of the
  hospital staff must educate patients about what
  to expect and answer their questions
• Communication with family, as approved by the
  patient, should be coordinated by a designated
  family member or advocate

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I n t e g r a t i o n

• Patient-physician-developed strategies that offer
  opportunities for empowered patients to
• take a more active role in choosing treatment
  options and developing desired outcomes.
• Patient and physician recognition of the
  important medicinal value of a therapeutic
  rapport.

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I n t e g r a t i o n

• Physicians continually recommending health
  promoting lifestyle changes.
• Patients working to understand the importance of
  managing their diseases and taking responsibility
  when their lifestyles negatively impact their
  diseases and health outcomes.

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D e c i s i o n - M a k i n g

• In the decision-making process,
• Physicians should consider personal, religious,
  economic and psychosocial factors
• Physicians are obliged to see that patients
• receive sufficient information
• Patients are obliged to educate themselves
  sufficiently to ask questions and participate in
  the decision goals regarding testing and
  treatment.

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OUTCOMES

• Physicians viewing patients as whole persons, not
  just as diseases or organ systems.
• Likewise, patients viewing physicians as
  individuals who need
• Trusting, honest and respectful relationships
  with their patients.

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An effective patient-physician relationship
creates

• The patient-physician relationship is the very
  heart of health care delivery.
• At its best, the physician-patient relationship
  not only gives patients access to health care but
  also can promote healing.
• In the scientific realm, mounting evidence
  demonstrates that the effectiveness of the
  patient-physician relationship directly relates
  to health outcomes.

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An effective patient-physician relationship
creates

• This healing relationship often includes friends
  and family members, patient advocates and other
  health care professionals.
• The relationship works best when physicians
  acknowledge the roles of these individuals and
  fully integrate them into the care of the patient.