Medical Ethics 4 - Doctor - Patient Relationship

Summary

Dr. Hart Pinto discusses four models of the doctor-patient relationship: the deliberative, interpretive, paternalistic, and informative models. Each model highlights different levels of doctor involvement in patient decision-making, from guiding patient views (deliberative) to providing information for independent choices (informative). The lecture also covers when doctor-patient relationships may need to be terminated, such as in cases of violence or theft. The importance of clear communication and transferring care to another professional is emphasized, ensuring continuity for the patient. The talk aims to assist with medical ethics exam preparation.

Takeaways

• 😀 There are four primary models of doctor-patient relationships: deliberative, interpretive, paternalistic, and informative.
• 😀 The deliberative model involves the doctor challenging the patient's views to help them adopt values the doctor believes are in their best interests.
• 😀 The interpretive model emphasizes the doctor clarifying the patient's views and promoting understanding, respecting patient autonomy.
• 😀 The paternalistic model is where the doctor overrides the patient's decision, acting like a parent to protect the patient's best interests, often in emergency situations.
• 😀 The informative model promotes patient autonomy by giving patients all the facts and letting them decide on their treatment, though it can sometimes reduce beneficence.
• 😀 Doctor-patient relationships can break down due to violence, abuse, unreasonable behavior, or theft, warranting possible termination of the relationship.
• 😀 A doctor cannot terminate a relationship due to a patient’s complaint, shortage of staff, or differences in political/social views.
• 😀 When terminating a doctor-patient relationship, a doctor must ensure the patient is informed and that the reason for termination is justifiable.
• 😀 It is essential that when a doctor ends a relationship with a patient, they provide the patient with alternative care through a suitable colleague to maintain continuity.
• 😀 The doctor must provide written notice when terminating the relationship, clearly stating the reasons behind the decision.
• 😀 These concepts of doctor-patient relationships are crucial for medical professionals to understand in order to navigate ethical situations and maintain trust with patients.

Q & A

What are the four models of the doctor-patient relationship mentioned in the lecture?

The four models of the doctor-patient relationship discussed are the deliberative model, the interpretive model, the paternalistic model, and the informative model.

How does the deliberative model of the doctor-patient relationship function?

In the deliberative model, the doctor engages in a discussion with the patient to clarify and challenge their views, aiming to steer the patient toward values the doctor believes are in their best interests. The doctor is seen as a friend in this model.

What is the key difference between the deliberative model and the interpretive model?

The interpretive model focuses on helping the patient understand the consequences of their actions by informing them, rather than manipulating their views. It respects patient autonomy more than the deliberative model, where the doctor actively challenges the patient's views.

What does the paternalistic model of the doctor-patient relationship emphasize?

The paternalistic model is based on the idea of a doctor as a father figure, where the doctor overrides the patient's decisions for their own good, particularly in situations where the patient cannot communicate their wishes, such as in emergencies.

What ethical principle is challenged by the paternalistic model?

The paternalistic model challenges the ethical principle of autonomy, as it involves the doctor making decisions on behalf of the patient, even if those decisions go against the patient's wishes.

How does the informative model of the doctor-patient relationship operate?

In the informative model, the doctor provides the patient with all necessary facts about their treatment, allowing the patient to make an informed decision. The doctor then follows through on the patient's choice, promoting patient autonomy.

What are the main ethical concerns with the informative model?

The main concern with the informative model is that, while it promotes autonomy, it may lead to decisions that are not in the patient's best interest, as patients might lack the expertise to fully understand the consequences of their choices.

Under what circumstances can a doctor decide to terminate the doctor-patient relationship?

A doctor can terminate the relationship if the patient becomes violent or abusive, acts unreasonably, or is involved in theft. However, a complaint against the doctor or differences in political/social views are not valid reasons for termination.

What steps must a doctor take when terminating the doctor-patient relationship?

When terminating the relationship, the doctor must provide a justifiable reason, inform the patient about the termination and its reasons (preferably in writing), and ensure the patient's care is transferred to a suitable colleague to maintain continuity.

How does the termination process help maintain patient care?

By transferring the patient's care to another suitable colleague, the doctor ensures continuity of care and avoids leaving the patient without the necessary medical attention, which helps uphold ethical standards in patient treatment.