The Effectiveness of the Physician-Patient Relationship Crisis Communication Strategy

AbstractMany individuals develop a temporary state of cognitive and emotional impairment after being diagnosed with catastrophic illness. Thus, when crucial decisions about medical treatment are required, they are unable to assimilate information; or worse, the legal need to be informed can rival a psychological desire to not be informed. The Canadian informed consent doctrine is unresponsive to crisis and clinically impracticable, and so paradoxically compromises the integrity and autonomy it was designed to protect. Many aspects of the physician-patient relationship and clinical setting also undermine the philosophical values enshrined in this doctrine. This further jeopardizes the individual's integrity. The Article explores proposals for change such as delaying the informing and consenting, improving the concept of consent, and improving the role of the physician.

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Physicians’ views on the usefulness and feasibility of identifying and disclosing patients’ last phase of life: a focus group study

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002764 ◽

2021 ◽

pp. bmjspcare-2020-002764

Author(s):

Catherine Owusuaa ◽

Irene van Beelen ◽

Agnes van der Heide ◽

Carin C D van der Rijt

Keyword(s):

Palliative Care ◽

Organ Failure ◽

Care Quality ◽

Patient Relationship ◽

Physician Patient Relationship ◽

Focus Group Study ◽

Timely Initiation ◽

Care Services ◽

Palliative Care Services ◽

Physician Patient

ObjectivesAccurate assessment that a patient is in the last phase of life is a prerequisite for timely initiation of palliative care in patients with a life-limiting disease, such as advanced cancer or advanced organ failure. Several palliative care quality standards recommend the surprise question (SQ) to identify those patients. Little is known about physicians’ views on identifying and disclosing the last phase of life of patients with different illness trajectories.MethodsData from two focus groups were analysed using thematic analysis with a phenomenological approach.ResultsFifteen medical specialists and general practitioners participated. Participants thought prediction of patients’ last phase of life, i.e. expected death within 1 year, is important. They seemed to find that prediction is more difficult in patients with advanced organ failure compared with cancer. The SQ was considered a useful prognostic tool; its use is facilitated by its simplicity but hampered by its subjective character. The medical specialist was considered mainly responsible for prognosticating and gradually disclosing the last phase. Participants’ reluctance to such disclosure was related to uncertainty around prognostication, concerns about depriving patients of hope, affecting the physician–patient relationship, or a lack of time or availability of palliative care services.ConclusionsPhysicians consider the assessment of patients’ last phase of life important and support use of the SQ in patients with different illness trajectories. However, barriers in disclosing expected death are prognostic uncertainty, possible deprivation of hope, physician–patient relationship, and lack of time or palliative care services. Future studies should examine patients’ preferences for those discussions.

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Ethics of Drug Giving and Drug Taking

Journal of Drug Issues ◽

10.1177/002204268801800206 ◽

1988 ◽

Vol 18 (2) ◽

pp. 195-200 ◽

Cited By ~ 2

Author(s):

Albert R. Jonsen

Keyword(s):

Ethical Principles ◽

Patient Relationship ◽

Physician Patient Relationship ◽

Ancient Greek ◽

Therapeutic Application ◽

Therapeutic Drugs ◽

Physician Patient ◽

Technical Terms

The activity of prescribing therapeutic drugs is one of the most significant features of the physician-patient relationship. This activity must be understood in moral, as well as technical terms. The ancient Greek word for drug had three meanings, providing the outline for an ethics of medication: remedy, poison and magical charm. Corresponding to these three meanings are three ethical principles: competence in therapeutic application, avoidance of harm and honesty.

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