Doctor-Patient Communication: A Review
Doctor Quotes from BrainyQuote, an extensive collection of quotations by famous If the disease is precisely identified, a good resolution is far more likely. I saw too many patients who had poor health because of their decisions, but too. The good physician treats the disease; the great physician treats the patient who diagnosis usually means a bad outcome, no matter how skilled the physician. . A physician's physiology has much the same relation to his power of healing. Quotations about medical subjects, from The Quote Garden. medical professor for a patient who persisted in treating himself by means of the.
The relationship need not involve a difference in power but usually does, 30 especially to the degree the patient is vulnerable or the physician is autocratic. United States law considers the relationship fiduciary; i. Thus, providing health care, and being a doctor, is a moral enterprise.
Physician Quotes - BrainyQuote
An incompetent doctor is judged not merely to be a poor businessperson, but also morally blameworthy, as having not lived up to the expectations of patients, and having violated the trust that is an essential and moral feature of the doctor—patient relationship.
Deception or other, even minor, betrayals are given weight disproportional to their occurrence, probably because of the vulnerability of the trusting party R. Thus, a single organization may both provide and pay for care. Organizations as providers have duties such as competence, skill, and fidelity to sick members.
Organizations as payers have duties of stewardship and justice that can conflict with provider duties. Managed care organizations thus have conflicting roles and conflicting accountability.
An organization's accountability to its member population and to individual members has a series of inherent conflicts. Is the organization's primary accountability to its owners, to employer purchasers, to its population of members, or to individual, sick members? If these constituents somehow share the accountability, how are conflicting interests resolved or balanced? For example, the use of the primary care clinician to coordinate or restrain access to other services involves the primary care clinician in accountability for resource use as well as for care of individual patients.
Although unrestricted advocacy for all patients is never really achievable, the proper balance and the principles of balancing between accountability to individual patients, a population of patients, or an organization need to be made explicit and to be negotiated in new ways.
All mechanisms for paying physicians, including fee-for-service reimbursement, create financial incentives to practice medicine in certain ways. We still lack a calculus to minimize or even describe in fine detail how such conflicts affect our ability to justify trusting relationships. Even-handed social attention seems appropriate to all the different mechanisms of payment. Balanced assessment of how the details of remuneration systems influence doctor's willingness to act on behalf of patients will best protect both the health of the public and the health of doctor—patient relationships.
This is a priority for a new form of empirical, ethical research. Patients correctly wonder if doctors are caring for them, the plan, or their own jobs or incomes the latter is equally problematic in fee-for-service care.
This ambiguity erodes trust, promotes adversarial relationships, and inhibits patient—centered care. The recent controversy over gag rules has only confirmed this set of fears in the mind of the public which is now seeking regulation of the managed care industry through the political process.
As illustrated in Figure 1the interests of patients, plans, and doctors can overlap to a greater or lesser extent.
Professional ethics dictate that physicians attempt, as individuals and as a profession, to ensure that their interests and those of their patients are congruent in clinical practice. Plan interests, however, can pull physicians away from this goal, as the organization's values and their implementation inevitably influence attitudes, behavior, and experiences.
Alternatively, plans could promote patient-centered care by trying to maximize the extent to which patient, doctor, and plan interests overlap. For example, promoting continuity, communication, and prevention can further all three interests so long as value and not cost alone is seen as the plan's product.
Similarly, resource stewardship can be honestly promoted as a way to ensure that quality care is available for future patients. Einhorn [his oncologist], that's someone to believe in, I thought, a person with the mind to develop an experimental treatment 20 years ago that now could save my life. I believed in the hard currency of his intelligence and his research. Beyond that, I had no idea where to draw the line between spiritual belief and science. But I knew this much: I believed in belief, for its own shining sake.
To believe in the face of utter hopelessness, every article of evidence to the contrary, to ignore apparent catastrophe--what other choice was there? We do it every day, I realized. We are so much stronger than we imagine, and belief is one of the most valiant and long-lived human characteristics.
To believe, when all along we humans know that nothing can cure the briefness of this life, that there is no remedy for our basic mortality, that is a form of bravery. To continue believing in yourself, believing in the doctors, believing in the treatment, believing in whatever I chose to believe in, that was the most important thing, I decided.
It had to be. Without belief, we would be left with nothing but an overwhelming doom, every single day.
And it will beat you. I didn't fully see, until the cancer, how we fight every day against the creeping negatives of the world, how we struggle daily against the slow lapping of cynicism. Dispiritedness and disappointment, these were the real perils of life, not some sudden illness or cataclysmic millennium doomsday.