Doctor-patient relationship

from Wikipedia, the free encyclopedia
Conversation between doctor and patient

The doctor-patient relationship or doctor-patient relationship (also known as the patient-doctor relationship and doctor-patient relationship ) is the relationship between a doctor or dentist and the patient who is advised or treated by him. Because of the differences in information and skills in terms of training, the professional relationship is usually asymmetrical . In view of the greater chances of healing success in cooperation with the mature and more critical patient, today's medical education strives for a symmetrical doctor-patient relationship in the common interest in recovery. The so-called paternalistic thinking that is still often practiced in the doctor-patient relationship is therefore now considered outdated.

Essential places in the doctor-patient relationship are anamnestic and therapeutic discussions as well as interactions during diagnosis or therapeutic measures. There is a relationship with non-medical therapists such as psychological psychotherapists , psychologists , healing therapists , alternative practitioners , health workers and nurses that is similar to the doctor-patient relationship. This often has features of so-called reparenting .

Characteristics of the doctor-patient relationship

General legal provisions, etc. a. with regard to the treatment order that the patient gives the doctor (also the service provider ), are the basis of the relationship between patient and doctor. Medical confidentiality is intended to ensure that the relationship takes place in a protected space. Rules for the doctor-patient relationship are also in the Hippocratic Oath , in the Declaration of Geneva (Geneva vow) and ethical or professional regulations specified guidelines.

Ideally, all of the factors that are important for the doctor-patient relationship should be designed in such a way that the patient and doctor trust each other , the patient receives competent professional advice, receives the best possible treatment and is satisfied with the treatment . This requires medical as well as psychosocial and linguistic and communicative competence from the doctor. The English doctor Michael Balint has developed a psychoanalysis- oriented method that is practiced in Balint groups and can help the doctor to better understand the doctor-patient relationship and its effects on the success of treatment.

A good doctor-patient relationship is ascribed an important influence on the course of the disease , the will to recover and the success of the treatment. Without it, therapeutic measures can be unsuccessful because the patient does not cooperate. The main reasons for the so-called non- compliance or non- adherence see Ronald M. Epstein u. a. The fact that the patient does not understand the poorly communicated medical advice or, due to a lack of persuasiveness, does not follow it and does not take prescribed medication .

A very good and close doctor-patient relationship can be both an advantage and a disadvantage. If in doubt, it may be advisable to get a second opinion or to change doctor.

Legally, the relationship between patient and doctor is regulated in order law and medical law in general and in medical liability law in particular.

Conversation between doctor and patient

Even if doctors are medically trained, they may lack dialogical and psychosocial competence. Studies in Germany and Austria have shown that when the patient visits a doctor, the patient's introductory report is interrupted after an average of 15 seconds by questions from the doctor, or that in 50% of the cases - often averted - the doctor simultaneously carries out small secondary activities (reading card, operating computer, etc.) executes. As a result, essential aspects of the anamnesis (e.g. about diets or diabetes) can be overlooked and trust in the doctor is disturbed. In the case of the chronically ill, the conversation lasts an average of only 7 seconds (as of 2006). A field trial in Vienna tested whether the doctor could initially listen for a minute . If this is the case, the patient's later satisfaction increases significantly.

Similar studies have shown that only a third of patients feel adequately informed. Furthermore, only about 50% of the medical information on diagnosis and therapy is medically correctly understood, of which half is forgotten after 30 minutes. In addition to the desire for healing , one of the main concerns of patients is to be taken seriously by the doctor. If the patient's initial willingness to provide information is interrupted too early, trust can only be created with difficulty and an appropriate anamnesis cannot be taken - with correspondingly negative consequences for the state of mind, the doctor-patient relationship and the course of treatment. In the absence of attentive listening on the part of the doctor, premature anamnesis-alien projections creep in, which can lead to incorrect diagnoses and incorrect treatments.

In studies, the poor communication in an incomprehensible medical language and the resulting low persuasiveness are primarily responsible for the patients' inadequate adherence to therapy (less than 50%), which is often complained about by doctors . Obviously, many doctors in everyday medicine are still not able to translate the specialist vocabulary they have learned into a patient-friendly, generally understandable language, like teachers or judges. According to Ronald M. Epstein, the reasons for this range from the desire for professional demarcation to medical vanities of self-expression to the need to hide behind mysterious terms. In addition, the doctor-patient relationship according to RM Epstein is still characterized by an outdated, paternalistic way of thinking in a considerable part of the doctors (43%) , which relied on blind trust in the doctor, whereas a prescription based on authority is not the case with patients who are generally internet-informed today more is enough.

Contemporary medicine is geared towards the responsible patient as a partner in his recovery and a corresponding symmetrical relationship that is oriented towards the patient's autonomy . In this respect, the standard work of medicine, the Pschyrembel , describes the appropriate language finding in dealing with the patient as an essential characteristic of a good doctor.

The more recent medical training has now recognized the deficits of the old training and has responded to the demands for an improvement in the communication skills of prospective doctors through appropriate curricula and textbooks.

In addition to a training focus on conducting discussions , the aim is to promote emotional understanding .

However, it is objected from medical circles that doctors, therapists and nurses must not be too emotionally affected in order not to endanger the professional quality of treatment and to prevent personal overload . The most important measure would be to extend the time available per patient, which has previously been less than 10 minutes on average. This measure, which has been required for a long time, is opposed to the financial and organizational bottlenecks in the health system . This restriction, which becomes clear in doctors' offices , outpatient departments and during hospital stays, is found, somewhat less severe, also during spa stays and is reduced in private patients .

A draft law of the German federal government from 2016 for a fourth law amending pharmaceutical law and other regulations provides that the dispensing of medicinal products for human medicine requires direct contact between the patient and the doctor or dentist, except in justified exceptional cases.

Improper behavior

For ethical as well as therapeutic reasons it is forbidden for the doctor to enter into an overly close personal or sexual relationship with a patient . Society and professional representatives expect a doctor not to allow such relationships in order not to take advantage of the patient's existing relationship of dependency. If the doctor registers that the relationship is getting an erotic part from the patient's side or from him , he must address this to the patient and try to deal with it therapeutically in the conversation as a transference . If necessary, a change of doctor is recommended to the patient.

See also

literature

  • AOK Federal Association (ed.): Success factor communication. Potential for an improved doctor-patient relationship . (Documentation of a conference on February 17, 2007 in Frankfurt am Main), Bonn 2007.
  • Sascha Bechmann: Medical communication: Basics of medical conversation . University paperbacks UTB, Tübingen 2014, ISBN 978-3-8252-4132-2 .
  • Edlef Bucka-Lassen: The difficult conversation. Communicate drastic diagnoses in a human way. Deutscher Ärzte-Verlag, Cologne 2005, ISBN 978-3-7691-0501-8 .
  • Andrew Elder, Oliver Samuel (Eds.): 'What else I wanted to say ... Significance and change in the doctor-patient relationship. Springer-Verlag, Berlin 1991, ISBN 978-3-540-53844-8 .
  • Linus Geisler : Doctor and patient - meeting in conversation. Reality and ways. 5th updated edition. Pmi-Verlag, Frankfurt am Main 2008, ISBN 978-3-89786-076-6 .
  • M. Härter, A. Loh, C. Spies (Eds. :) Decide together - treat successfully . Deutscher Ärzte-Verlag, Cologne 2005, ISBN 978-3-7691-3250-2 .
  • Ernest WB Hess-Lüttich and Jan CL König: Medical communication . In: Gert Ueding (Hrsg.): Historical dictionary of rhetoric . WBG, Darmstadt 1992 ff., Vol. 10 (2011), Col. 660-669.
  • Karl Huth (Ed.): Doctor - patient. On the history and meaning of a relationship . Attempto-Verlag, Tübingen 2001, ISBN 3-89308-339-1 .
  • David Klemperer: Shared Decision Making and Patient Centering - from Paternalism to Partnership in Medicine, Part 1: Models of the doctor-patient relationship. In: Balint. No. 6/2005, pp. 71-79.
  • Philip R. Myerscough, Michael Ford: Communicating with Patients. Huber, Bern / Göttingen 2001.
  • S. Theisel, T. Schielein, H. Spießl: The 'ideal' doctor from the perspective of psychiatric patients . In: Psychiatrische Praxis , No. 37, 2010, pp. 279–284.
  • This is how doctor and patient understand each other: 5 tips for the next consultation. (Cover story) In: AOK Bayern Magazin. No. 3, 2018, pp. 8–12.

Web links

Individual evidence

  1. ↑ a b c d Linus Geisler : Doctor-patient relationship in transition. Strengthening the dialogical principle. In: Final report of the Enquête Commission “Law and Ethics of Modern Medicine”, May 14, 2002, pp. 216–220.
  2. ^ A b c Ronald Mark Epstein: Physician self-disclosure in primary care visits . In: Archives of Internal Medicine . 167th vol., No. 12, June 25, 2007, PMID 17592107 , pp. 1321-1326.
  3. ↑ LE Rose, MT Kim, CR Dennison, MN Hill: The contexts of adherence for African Americans with high blood pressure. In: Journal of advanced nursing. Volume 32, No. 3, September 2000, pp. 587-594, PMID 11012800 .
  4. ^ Eduardo Sabaté: WHO Adherence to Long Term Therapies Project. Global Adherence Interdisciplinary Network. World Health Organization. Dept. of Management of Noncommunicable Diseases. (2003). Adherence to long-term therapies: evidence for action. Geneva: World Health Organization.
  5. ↑ According Ö1 -Radiokolleg, March 13 of 2006.
  6. ↑ The spontaneous conversation time of patients at the beginning of the doctor's consultation in the general practitioner's practice. Dissertation, Charité.
  7. ^ Keyword doctor-patient relationship. In: Pschyrembel Clinical Dictionary 2014 . Founded by Willibald Pschyrembel. Edited by the publisher's Pschyrembel editorial team. 265th edition. De Gruyter, Berlin 2013.
  8. ↑ Sascha Bechmann: Medical communication: Basics of medical conversation. University paperbacks UTB, Tübingen 2014.
  9. ↑ M. Härter, A. Loh, C. Spies (Eds. :) Decide together - treat successfully. Deutscher Ärzte-Verlag, Cologne 2005.
  10. ↑ Christiane Link : Online house doctors: Online doctors soon offline? In: time online. September 26, 2016. Retrieved September 27, 2016 .