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The Concept of Care. And eight models of physician-patient relationships. The Lady W ith the Lamp. A nurse Considered “curing”, the use of therapeutics, less important to patient outcome Assigned the task of “caring” to the nurse. “Doctors cure and nurses care”.
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The Concept of Care And eight models of physician-patient relationships
The Lady With the Lamp A nurse Considered “curing”, the use of therapeutics, less important to patient outcome Assigned the task of “caring” to the nurse
“Doctors cure and nurses care” • Does this paradigm still exist? • Ingrained into society • Patients influence professional self-perception • What are the implications? • Lack of clarity on the concept of care • Dissociates physicians from caring, and encourages a one-dimensional idea of nursing care
Producing the Dichotomy • Expectation of nurses to: • Follow procedures • Report incidents to supervisors • Organize wards/departments • Whereas physicians: • Order procedures • Make decisions • Lead wards/departments
Why Men in Medicine Tend to be MDs Project danger into intimacy More comfortable with personal achievement
Why Most Nurses are Women Project danger into situations related to personal achievement More comfortable in activities that involve closeness Medicine an objective science that denies subjectivity
Another suggestion Early 19th-century thinking shifted the female image from seductive to pure This prudery confined the social roles they were qualified to fill Seen as unfit for medicine based on the need to restrain natural sympathies
On the Contrary • Male nursing graduates • 1,694 in 1972 • 3,492 in 1981 • More likely to advance to higher positions
Historical Case • Pre-1870 • “Nurses” were housewives/daughters • “Domestic Medicine” advised to rarely consult with physicians • In physician’s presence, nurses act as assistants
Professionalizing the Physician Involved a separation from laypersons Requires emphasis on special skills At odds with empathy and caring
Concept of Care • Distinction between “care” and “cure”? • “Cure” from “curare” – to care for • Therefore cure a part of caring • Possible to cure without caring?
Caring For versus Caring About • Two definitions for care: • “A burdened state of mind arising from... Concern about anything... Mental perturberation • Caring about • “Oversight with the view to protection, preservation, or guidance: hence to have the care of” • Caring for
Care-based Interaction Caring For and About a Patient Caring For, but Not About a Patient Caring About, but Not For a Patient Caring Neither For nor About a Patient
Four Models of the Physician-Patient Relationship Goals Physician obligations Role of patient values Conception of patient autonomy
Paternalistic Model Aka Parental or Priestly Goal to promote patient’s well-being despite preference Assumes shared objective values Little/no autonomy “You’ll thank me later” Guardian
Informative Model Aka Scientific or Engineer Goal to provide extensive information and let patient decide intervention Assumes patient values are known and fixed Full autonomy Technical expert
Interpretive Model Goal to elucidate patient values and help find a suitable intervention Patient values are unclear Autonomy in self-understanding Counselor or Advisor
Deliberative Model Goal to support admirable values and providing relevant information Open to development through moral discussion Self-development Friend or Teacher
Connecting the Models For/AboutFor/AboutFor/AboutFor/About Paternalistic Informative Interpretive Deliberative
Sources E. Emanuel& L. Emanuel, Four Models of the Physician-Patient Relationship. In E. Boetzkes & W. Waluchow (Eds.), Readings in Health Care Ethics (pp.39-49). Toronto: Broadview Press. N. Jecker & D. Self, Separating Care and Cure: An Anaylysis of Historical and Contemporary Images of Nursing and Medicine. In E. Boetzkes & W. Waluchow (Eds.), Readings in Health Care Ethics (pp.57-68). Toronto: Broadview Press.
