The Evolution of the Doctor-Patient Relationship: Humanizing Healthcare

Introduction

Medicine is of great significance for mankind. It deals with the most fundamental aspects of the human condition: birth, life, physical functioning, vulnerability, loss, and death. Estimates show that health and medical care contribute to life expectancy over several years. Moreover, they contribute to improving people’s functional ability and quality of life. However, scientific knowledge and technical abilities are not only requirements of the medical field, but also an understanding of the human nature. As the patient is a human being with own worries and hopes, not just a group of symptoms. Therefore, an intimate patient-physician relationship is stated at true importance in medical practice. It is the medium through which data is gathered from the patient. A decent relation is necessary to provide a successful medical diagnosis and treatment.

This essay explores the importance of the doctor-patient relationship in medical practice, emphasizing that physicians must recognize the patient as a human being with their worries and hopes, not just a group of symptoms. The text outlines various models of doctor-patient relationships, including Szasz and Hollender’s Active-Passive, Guidance-Cooperation, and Mutual Participation models, as well as Emanuel’s Paternalistic, Informative, Interpretive, and Mutual Participation models. The essay discusses the historical evolution of the doctor-patient relationship over five-time frames, starting from Ancient Egyptian times to modern-day practices, including initiatives such as telehealth video consultations and physician participation in funding programs to improve doctor-patient relationships.

Doctor-patient relationship

A constant encounter between a patient and a healer exists in all countries at all times which is named doctor-patient relationship. The relationship among doctor and patient is a moving and meaningful experience that can be defined as a mutual relationship where one person i.e. the patient, knowingly seeks the help of another i.e. the doctor, who in return knowingly grants him as a patient and provides assistance. Basically, doctor-patient interaction reflects a kind of guardianship or trustee in which the patient’s autonomy and confidentiality is preserved by the physician, simultaneously under the oath (Fallon et al. 2015). A physician must never forget that patients are not just a group of symptoms or “cases”, but helpless human seeking for relief, help, and trust. A successful consultation with a trusted doctor will have beneficial effects irrespective of any other therapy given. In addition, it is the base of an accurate diagnosis, just as effective treatment.

The essence of doctor patient relationship has been examined in various clinical and culturally responsible settings such as breast cancer; individuals living with HIV/AIDS; and people with chronic hepatitis B virus infections; to gain insight from clinicians into the patient’s expectations throughout their therapy. Also, particularly in the case of chronic lifestyle related conditions, many people still favor a long term relationship with their relating physician, because the physician is well concerned of the whole background and record, and the patient gets fully adapted to the relaxing environment.

A number of interesting initiatives have been formulated worldwide to improve doctor-patient relationship, include the utilization of placebo; the advancement of tele-health video consultations; particularly for patient with chronic diseases, requiring substantial self-care at home. Even additional steps are suggested such as physician’s participation in funding programs. It was also proposed that the doctor-patient relationship be applied to a new form of partnership, where many doctors treat a certain patient as a team.

Evolution through time

Throughout the course of history, the domain of doctor-patient relationship has been evolving alongside social scenario, society’s intellectual capacity, and the particular time’s ailments. The chronological overview of the interaction between doctor and patient includes five time frames of Ancient Egyptian, Greek Civilization, Medieval Europe, revolution of Europe and from 1700 onwards. It was these different time frames that resulted in the construction of various models of doctor-patient relationships at the time, and the various types we know of the present time.

Models of Doctor-Patient Relationship

1. Szasz T and Hollender M (Szasz 1956) proposed 3 basic models: a.Active-Passive model b.Guidance-Cooperation model c.Mutual participation model
2. On the contrary, Emanuel gave 4 models: a. Paternalistic model b. Informative model c. Interpretive model d. Mutual participation

Looking at the basics, these two models could be unified into a single model, which is close to the present time’s illustration, but it is beyond the scope of this paper so only the latest update of doctor-patient relationship is elucidated.

Types of doctor-patient relationship

Various types of doctor-patient relationship arise from the contrast in doctor and patient relative power and control. In reality, such various models may not necessarily exist in pure form, but most consultations nevertheless tend towards a one kind.

1) Paternalistic Relationship

“Guidance-cooperation” or paternalistic relationship , with high doctor control and low patient control, where the doctor predominates and functions as a ‘parent’ figure who determines what he or she considers to be in best interest of the patient ’infant’ and the expression actually originates from Latin term of ‘father’. Such type of relationship has been identified historically in medical consultations. Nevertheless, health consultations at the present time are generally distinguished by greater supervision of the patient and mutual-based interactions.

Patients in paternalistic relationship might gain great comfort at certain stages of the illness, for being able to depend on the doctor in these lines and being soothed of the stressful concern and decision making. Furthermore, it is indeed absolutely justified in the serious emergency framework, as either the timeframe taken to acquire informed consent or involve the patient in decision-making would obviously endanger the safety of the individual. There is additional argument that this paternalistic model is not an interaction since the individual operating on is incapable dynamically participate, an appropriate answer would be that the person is considered ‘powerless’ seeking the doctors special expertise as justified in emergency cases.

2) Mutuality Relationship

A relationship of mutuality is categorized by the active patient association as more progressed, equivalent partners in the consultation and has been depicted as a ‘meeting between experts’, in which the two parties take an interest as a joint venture and collaborate in an exchange of thoughts, ideas and sharing of belief framework. The doctor brings his or her clinical abilities and knowledge to the consultation in terms of diagnostic techniques, information of the causes of malady, prognosis, and preventive strategies, and patients bring their own skill in terms of their encounters and clarification of their illness, and information of their specific social circumstances, perspectives to risk, values and inclinations. Chronic diseases such as diabetes, heart disease, cystic fibrosis, dementia, Parkinson disease reveal the effectiveness of this relationship, as these need lengthy regulations and interpretive, comprehensive interactions.

3) Consumerist Relationship

A consumerist relationship characterizes a situation in which power correlations are switched, the patient acts the active role and the doctor adopts a genuinely passive role, follows the patients’ demands for a subsequent opinion, referral to emergency department, a sick note, and so on. This type has been defined since the boosting of upper class, wealthy patients from the revolution of industry on.

4) Default Relationship

A default relationship can occur if patients keep on adopting a passive role even if the doctor lessens a portion of his or her control, thus lacking adequate and sufficient direction for the consultation. This may emerge if patients are not aware of alternatives to a passive role for the patient or are reluctant to pursue an increasingly collaborative relationship.

* Distinct types of relationships, and primarily those marked by paternalism and mutuality, can be considered ideal for specific situations and stages of ailment. For instance, it is commonly necessary for the doctor to be authoritative in emergency cases, while in other circumstances patients should be more actively engaged with their own treatment choices.

Modern patient-centered medicine

A massive debate has emerged over the last decades which asserted a patient-centered approach to healthcare. Patient-centered medicine is the latest addition to the physician patient interaction, as a fresh concept of medical system in the 21st century. Doctors in this model, each with own skill and strategy collection construct a conceptual framework wherein the patient contributes as a companion while making choices about his or her own care.

Certain doctor-patient related aspects

Illness Behavior

Illness behavior describes the ways people react to bodily indications and the conditions under which they view them as irregular. The concern with illness behavior and the delay in seeking medical help has prompted to a large body of research since the center of the last century. One of the most punctual studies was conducted by Kutner, Makover, and Oppenheim (1958). In 1961, it was Mechanic and Volkart who identified illness behavior as a precedent for seeking clinical help. They gave one of the earliest descriptions of it stating that it is“the manner in which symptoms are thought to be, interpreted, and acted upon by a person who recognizes any pain irritation or other signs of organic failure” (1961,52).

The analysis of health related behavior is more accurate when it takes into account its trajectory in the context of individuals’ personal history. The illness trajectory contains three steps: 

1. preventive health behavior that includes the actions and attitudes of individuals who believe themselves healthy toward disease prevention.
2. illness behavior, the behavior of an individual who feels ill trying to define the problem and find a cure.
3. sick-role-behavior, what individuals do as patients after they have been diagnosed with a specific disease or disability.

As interpreted the timespan between one’s first awareness of symptoms and his or her decision to seek expert help is encompassed as illness behavior, and when the individual accepts a diagnosis by an expert, he or she enters a third stage of sick-role and becomes a “patient”. Upon the perception of symptoms, the individual typically accepts a wait-and-see stance, hoping the symptoms go away. If the symptoms persist or increase, the individual attempts to solve the problem with self-medication, searching for information, and talking about the problem with family and close friends. Eventually, the symptomatic individual may seek medical help. Mechanic appropriately considers illness behavior as the key phenomenon clarifying “why the need for care imperfectly predicts use of services”

One of the most clear illustrations for symptom neglect and its outcomes is the case of stroke warnings called “transient ischemic attacks” or TIAs, The American Heart Association clarified, in its 2011 website page on stroke, that TIAs are “warning strokes that produce stroke like symptoms, yet not lasting damage”, but are “powerful predictions of stroke”. The most common five stroke manifestations are sudden numbness or weakness of the face, arm, or leg, particularly on one side of the body, abrupt confusion, trouble talking or understanding, unexpected trouble seeing in one or the two eyes, unexpected trouble walking, dizziness, loss of coordination or balance, and sudden, extreme and severe headache with no known reason. Contrast between a TIA and a stroke is that a TIA is transient and may just last one to five minutes, leaving no changeless or permanent injury. The briefness of the TIA leads people to disregard the signs and carry on their usual daily routine without looking for medical attention. Specialists recommend that any individual experiencing one or more of those five stroke manifestations should look for medical consideration right away. Unfortunately, people in general either do not know how to recognize TIAs or tend to disregard them.

Indeed, evidence from hospital data on coronary artery diseases, thrombolysis, myocardial infarction, and other different infections demonstrates that people with chest pains and other clear symptoms in general consider the problem to be as not serious enough to call an ambulance.

In any case, the damage inflicted could have been kept away or minimized if the person or a relative, friend, or associate had taken symptoms seriously and looked for clinical consideration earlier.

Other illustrations of illness behavior come from the colorectal cancer (symptoms involve blood in stools), stomach cancer (symptoms involve consistent digestive problems) and mental illness. Onset of Alzheimer’s disease illustrates vividly the challenges and significance of recognizing early symptoms during the illness behavior course. The initial phase of Alzheimer’s disease proposes that a family member might be the first person to observe symptoms. The family caregiver who initially gets aware of the symptoms may postpone seeking clinical help, yet searches for information, talks about the issue with other family members, and may need to sort out family disagreements on the best action plan before contacting a specialist. This process and the procrastination by the family might take months even years.

Medical Jargon

Medical jargon is described as the technical terms used by members of a particular profession, healthcare professionals in this case, commonly not understood by a lay person. This medical terminology is used by the entire health community so that it could be understood globally and better aid in transfer of idea; for instance, if you have an emergency situation while on vacation, it is nice to know that your doctors back home can understand what happened to you quickly and easily. Many schools teach this language throughout training physicians, assistance, nurses, x-ray technicians, and even front desk staff. However, in professions that center on interaction with the diverse public, jargon-based communication could be counterproductive. As effective communication is the keyway to building doctor-patient relationships and open, simple communication is a central clinical function that can not be delegated considering vast majority of essential diagnostic information arises from the interview. It is progressively significant for the physician to use the correct language.

An investigation by Koch-Weser, Dejong and Rudd (2009), noticed that for certain patients, scientific terms either show up distance or frighten them altogether. Incidentally, complex medical terms are not understood even by medical specialists or understudies. Despite the fact that some healthcare terms are very common they are interpreted incorrectly, prompting patient confusion. Moreover, Castro el at. (2007) revealed that 81% of interviews included the utilization of at least one jargon not understood by patients.

Worldwide research suggests scientific terminology to be prevented throughout discussions with patients and family members. Conversely, a rise in the amount of e-patients (online patients) has assisted patients gain information about medical terminology from Fage Butler er al. (2015). People also utilize the internet to learn about biomedical language, prescribed medication, and phrases related to healthcare. Facilitating this health literacy is critical so that many more people are able to get superior healthcare. Just to be mentioned, in advance electronic revolution could go to an extent that telemedicine substitutes the face to face doctor patient interaction.

Conclusion

In conclusion, this essay on the doctor-patient relationship highlights their as a vital aspect of medical practice as it ensures the collection of accurate data, successful diagnosis, and treatment. Physicians must recognize the patients' humanity with their hopes and worries and not view them as a group of symptoms. The evolution of the doctor-patient relationship over time has led to the development of various models that allow doctors and patients to interact and collaborate in their decision-making process. The current trend emphasizes mutual participation and power-sharing between the doctor and the patient. To further enhance this relationship, innovative initiatives such as telehealth video consultations and physicians' participation in funding programs have been formulated. In conclusion, the doctor-patient relationship is fundamental, and health practitioners must continue to develop strategies to improve it further.