Effective use gives patients a sense that they have been heard and allowed to express their major concerns, 17 as well as respect, 18 caring, 19 empathy, self-disclosure, positive regard, congruence, and understanding, 20 and allows patients to express and reflect their feelings 21 and relate their stories in their own words. 16Įffective use of the structural elements of the interview also affect the therapeutic relationship and important outcomes such as biological and psychosocial quality of life, compliance, and satisfaction. 15 Increasing data suggest that patients activated in the medical encounter to ask questions and to participate in their care do better biologically, in quality of life, and have higher satisfaction. It is the major influence on practitioner and patient satisfaction and thereby contributes to practice maintenance and prevention of practitioner burnout and turnover, and is the major determinant of compliance. The relationship therefore directly determines the quality and completeness of information elicited and understood. A patient who is anxious will not comprehend information clearly. For example, a patient who does not trust or like the practitioner will not disclose complete information efficiently. 14 These three functions inextricably interact. 13 The three functions are gathering information, developing and maintaining a therapeutic relationship, and communicating information. The interview has three functions and 14 structural elements ( Table 1). Most of the medical encounter is spent in discussion between practitioner and patient. The medical interview is the major medium of health care. We describe problems that exist and are said to exist, we promulgate principles for safeguarding what is good and improving that which requires remediation, and we finish with a brief discussion of practical ways that the doctor–patient relationship can be enhanced in managed care. 11, 12 We will first review data about the importance of the doctor–patient relationship and the medical encounter, then discuss moral features.
PUBLIC RELATIONS EXPERT CLIPART HOW TO
We know much about the average doctor's skills and knowledge in this area, and how to teach doctors to relate more effectively and efficiently. A robust science of the doctor–patient encounter and relationship can guide decision making in health care plans. The relationship between doctors and their patients has received philosophical, sociological, and literary attention since Hippocrates, and is the subject of some 8,000 articles, monographs, chapters, and books in the modern medical literature. This article examines the foundations and features of the doctor–patient relationship, and how it may be affected by managed care. But objective and theoretical bases for genuine concern remain. 6 – 10 Some such concerns represent a blatant backlash on the part of providers against the perceived or feared deleterious effects of the corporatization of health care practices. The rapid penetration of managed care into the health care market raises concern for many patients, practitioners, and scholars about the effects that different financial and organizational features might have on the doctor–patient relationship. 1 To managed care organizations, its importance rests also on market savvy: satisfaction with the doctor–patient relationship is a critical factor in people's decisions to join and stay with a specific organization. The doctor–patient relationship has been and remains a keystone of care: the medium in which data are gathered, diagnoses and plans are made, compliance is accomplished, and healing, patient activation, and support are provided.
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