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Gatot S Lawrence Department of Forensic Medicine and Medicolegal

Patient-Doctor Relationship. Gatot S Lawrence Department of Forensic Medicine and Medicolegal Faculty of Medicine, Hasanuddin University Makassar. Patient. Doctor. Health Status. Doctors do more talking than listening. 1

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Gatot S Lawrence Department of Forensic Medicine and Medicolegal

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  1. Patient-Doctor Relationship Gatot S Lawrence Department of Forensic Medicine and Medicolegal Faculty of Medicine, Hasanuddin University Makassar

  2. Patient Doctor Health Status

  3. Doctors do more talking than listening.1 Marvel KM et al in (JAMA) found that 72% of the doctors interrupted the patient’s opening statement after an average of 23 seconds. Patients who were allowed to state their concerns without interruption used only an average of 6 more seconds.2 Doctors often ignore the patient’s emotional health. A study of 21 doctors at an urban, university-based clinic found that when patients dropped emotional clues or talked openly about emotions, the doctor seldom acknowledged their feelings. Instead the conversation was directed back to technical talk.3 Doctor-Patient Relationship: What Evidence Show 1. Korsch, Barbara M. & Harding, C. The Intelligent Patients Guide To the Doctor-Patient Relationship (Oxford University Press, 1998) pg. 202. Marvel KM et al. Soliciting the patient’s agenda: Have we improved? JAMA 1999;281:283-2873. Suchman AL et al. A model of empathic communication in the medical interview JAMA 1997;277:678-682

  4. Doctors underestimate the amount of information patients want and overestimate how much they actually give. In one study of 20-minute office visits, doctors spent about 1 minute per visit informing patients but believed they were spending 9 minutes per visit doing so. 4 Doctors who can’t communicate are more likely to end up in court. An analysis of 45 malpractice cases found that many of the doctors being sued delivered information poorly and devalued the patient’s views. 5 Doctor-Patient Relationship: What Evidence Show 4. Waitzkin H Doctor-Patient Communication JAMA 1984;252:2441-24465. Beckman HB et al. The doctor-patient relationship and malpractice: Lessons from plaintiff depositions. Arch Intern Med 1994 Jun 27;154(12):1365-70

  5. Physician Attributes Contributing to Patient Satisfaction • Does not judge, understands, supports • Is always honest and direct    • Acts as partner in maintaining health   • Treats serious and non-serious conditions    • Attends to emotional and physical health   • Listens to me • Encourages me to lead healthier lifestyle    • Tries to get to know me • Can help with any problem • Stock Keister MC, Green LA, Kahn NB, et al: What people want from their family physician. Am Fam Physician 69:2310, 2004.

  6. KAIDAH DASAR MORALBeauchamp and Childress (1994) • AUTONOMY, the rights to self determination • BENEFICENCE, for the sake of the patients • NON-MALEFICENCE, “above all, do no harm”, prinsip moral yang melarang tindakan yang memperburuk keadaan pasien • JUSTICE, prinsip moral yang mementingkan fairness, impartiality

  7. Relationships based on openness, trust and good communication will enable you to work in partnership with your patients to address their individual needs. To ful-fil your role in the doctor-patient partnership you must: be polite, considerate and honest treat patients with dignity treat each patient as an individual respect patients’ privacy and right to confidentiality support patients in caring for themselves to improve and maintain their health encourage patients who have knowledge about their condition to use this when they are making decisions about their care. Good Medical Practice:The doctor-patient partnership – paragraphs 20-21

  8. Hillary Rodham Clinton and BarackObama : Making Patient Safety the Centerpiece of Medical Liability Reform (New Engl J Med 354;21 May 25, 2006) Malpractice suits often result when an unexpected adverse outcome is met with a lack of empathy from physicians and a withholding of essential information

  9. ALASAN MENINGKATNYA KETIDAKPUASAN PASIEN • MENINGKATNYA PENDIDIKAN DAN KESADARAN ATAS HAK : ASERTIF • MENINGKATNYA PENGHARAPAN ATAS HASIL TINDAKAN MEDIS • KOMERSIALISASI & DEPROFESIONALISASI UPAYA LAYANAN KEDOKTERAN • PENINGKATAN BIAYA LAYANAN : INTOLERANSI TERHADAP KETIDAKSEMPURNAAN • PROMOSI AHLI HUKUM & UUPK TAN S Y, 1997

  10. medical meltdown Washburn identifies 5 trends that brought us to the brink of a “medical meltdown” • Excessive business and legal complexity in the provision of medical care. • Decreased medical spending without reduced demand for medical services. • The increasing role of for-profit corporations in changing the traditional emphasis on patient care into concern for shareholder equity. • A growing population of uninsured patients adding to the financial stresses on physicians and health care institutions. • Provider demoralization. Washburn ER. The coming medical apocalypse. The Physician Executive, 1999:34–38

  11. Elements of Professionalism • Altruism is the essence of professionalism, i.e. for the best interest of the patients, not self-interest. • Accountabilityis required at many levels - to individual patients, society and the profession. • Excellence a conscientious effort to exceed normal expectations and make a commitment to life-long learning.

  12. Elements of Professionalism • Duty is the free acceptance of a commitment to service. • Honour and integrity are the consistent regard for the highest standards of behaviour and refusal to violate ones personal and professional codes. • Respect for others (patients and their families, other physicians and professional colleagues such as nurses, medical students, residents, subspecialty fellows, and self) is the essence of humanism"

  13. Influenced by • Pts experience • Pts knowledge • Pts education Scientific -Formal Med-edu -NonFormal Med-edu -EBM -CPD/ CME Non-Scientific -Casual info -Over the Café -’A though of idea’ • Media Information • Professional • Unprofessional • Wrong/ Fraud Profit Taker Business Co Pharmaceutical Doctor Laboratory Me ‘company’ etc Biethics GMP The New Doctor Autonomy Beneficence Non-Maleficence Justice Patient’s Autonomy Patient Doctor Health Status The professional bodies (doctor, media, businessman) and government should constantly ‘keep an eye’ on their companies.

  14. Patient Doctor Health Status Makassar, 11 November 2008 • Professional • Love • Care • Beneficence • Non-Maleficence • Justice • Autonomy

  15. KESIMPULAN • Hubungan Dokter-Pasien yang prima dapat dijalankan dengan: • P rofesional • Love (penuh kasih) • Care (penuh perhatian) P L C Gatot S Lawrence 2008

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