Doctor-Patient Relationship

The doctor-patient relationship describes the interaction between medical practitioner and those being treated, and is a vital component of good health care and the diagnosis and treatment of disease, illness and injury. Medical practitioners have worked to a code of ethics for more than 2,500 years. Although methods vary, the core principles of the doctor-patient code of conduct have remained the same.

In its shortest form, the doctor-patient relationship involves maintaining a rapport with the patient, upholding their dignity, and respecting their privacy at all times. An obvious but vital factor is the constant need for effective communication between doctor and patient. Surveys show that satisfied patients perceive their doctor to demonstrate friendliness, understanding and an ability to carefully judge or listen to their concerns. Failure to communicate effectively is a common factor in complaints made against doctors. Dissatisfied patients criticize their doctor for not listening, for not providing adequate explanations, or for appearing uninterested.

Many issues can influence positive or negative communication between doctor and patient. Regular factors that can affect this include differences in age, sex, social class, level of education, and ethnic background; the experience of the doctor; the physical environment; time constraints; access to past records; variations in patients' attitudes and emotional responses to their illnesses, and the purpose of the examination.

Doctors must uphold their ethical principles as patients expect their doctor to be forthright when it comes to their health. Effective and positive medical practice requires the need for a combination of compassion, patience, and confidentiality, as well as good communication skills. Maintaining privacy and confidentiality of their patient's health and personal details is paramount to any doctor. Doctors cannot abandon their patients without making other arrangements for their care. Likewise doctors are explicitly prohibited from exploiting the doctor-patient relationship for sexual or improper purposes. When a doctor is listed as on call, they are required to attend any incident should an emergency arise, no matter what they are doing. Conflicts of interest can occur, but the patient is the priority at all times.

The medical profession places a serious emphasis on the importance of trust throughout the entire practice of medicine. Without trust, patients could easily be dissuaded from revealing their secrets, or to be examined and receive treatment. Serious offences which are likely to be subject to a formal hearing include: Sexual misconduct, gross negligence or incompetence, issue of fraudulent certificates, conviction for serious crimes or other serious offences including abuse of drink and drugs. The most serious breach of trust by a doctor is to seek or establish a sexual or improper relationship with a patient. Where this occurs, typically the patient is vulnerable, making the breach of trust more serious and potentially creating long-term harm to the patient. All doctors should be highly aware of medical profession's expectations in this regard.

Regulations regarding use of drugs are in place to protect the community and doctors. If doctors do misuse narcotics or tranquillizers, they are putting themselves and their patients at risk. Aside from drug dependence and impairment, the use of drugs such as alcohol and cannabis during work hours (including time on call) can also qualify as unprofessional conduct. Doctors have a personal and professional responsibility not to use illegal drugs and to ensure that the use of alcohol does not affect their ability to practise.

Those doctors who espouse alternative medicine methods, often as part of a holistic approach to patient care, have an ethical duty to fully inform patients about the unproven nature of these methods and products. To conceal information in order to promote alternative methods is unethical, and places the doctor at risk of disciplinary action.

Other factors which contribute greatly to a healthy doctor-patient relationship include: the adequacy of the waiting area, the attitude of reception staff, and the physical environment of the doctor's consulting room. Any negative aspect in these factors may exacerbate the patient's anxieties, causing the doctor-patient trust to elapse, which in turn may ruin any subsequent communication between patient and doctor. For many doctors, interruption to take essential telephone calls about clinical matters is unavoidable, but every attempt should be made to minimise this; when calls are taken, an explanation is made to the patient, with care taken to maintain confidentiality of the telephone call.

It is important that a doctor offers many qualities beside those adhered to within the code of conduct. While not absolutely essential for the satisfactory completion of any doctor-patient relationship, there are two characteristics which are vitally important to doctors in developing and maintaining effective relationships with their patients - compassion and discernment.

Compassion in the context of medical practice involves perceptivity and sensitivity to the needs of the patient, the opposite of which can include rudeness, shortness, and lack of sensitivity. Doctors can in some cases be excused these negatives if the circumstances require efficiency and effectiveness.

Selected full-text books and articles on this topic

Ethics, Law, and Medical Practice
Kerry J. Breen; Vernon D. Plueckhahn; Stephen M. Cordner.
Allen & Unwin, 1997
Librarian’s tip: Part A "The Doctor-Patient Relationship"
The Management of the Doctor-Patient Relationship
Richard H. Blum.
McGraw-Hill, 1960
The Person as Patient: Psychosocial Perspectives for the Health Care Professional
Elsa Ramsden.
W. B. Saunders Co., Ltd., 1999
Librarian’s tip: Chap. 11 "The Relationship between Health Practitioner and Patient"
Doctors Talking with Patients/Patients Talking with Doctors: Improving Communication in Medical Visits
Debra L. Roter; Judith A. Hall.
Auburn House, 1993
Behind Closed Doors: Gender, Sexuality, and Touch in the Doctor/Patient Relationship
Angelica Redleaf; Susan A. Baird.
Auburn House, 1998
Communication Skills for Medicine
Margaret Lloyd; Robert Bor; Geraldine Blache; Zack Eleftheriadou.
Churchill Livingstone, 1996
Librarian’s tip: Chap. 10 "Challenging Consultations: Special Problems in Doctor-Patient Communication"
Doctors and Their Feelings: A Pharmacology of Medical Caring
Benjamin Maoz; Stanley Rabinowitz; Michael Herz; Hava Katz Elkan.
Praeger Publishers, 1992
Librarian’s tip: Chap. 13 "Setting Boundaries in the Doctor-Patient Relationship"
Handbook of Health Communication
Teresa L. Thompson; Alicia M. Dorsey; Katherine I. Miller; Roxanne Parrott.
Lawrence Erlbaum Associates, 2003
Librarian’s tip: Part II "Provider-Patient Interaction Issues"
Psychosocial Treatment for Medical Conditions: Principles and Techniques
Leon A. Schein; Harold S. Bernard; Henry I. Spitz; Philip R. Muskin.
Brunner-Routledge, 2003
Librarian’s tip: "Doctor-Patient Relationship" begins on p. 57
The Doctor-Patient Breakdown: Trouble at the Core of the Medical Economy
Alper, Philip R.
Policy Review, April 2002
Applications of Nonverbal Behavioral Theories and Research
Robert S. Feldman.
Lawrence Erlbaum Associates, 1992
Librarian’s tip: Chap. 5 "Physician-Patient Relationships"
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