Patients recording their clinical consultations: A new challenge for medical ethics

2020 ◽  
Vol 13 (5) ◽  
pp. 306-310
Author(s):  
Dan P Turley ◽  
Neil H Metcalfe
Keyword(s):  
General Practice ◽  
Medical Ethics ◽  
Individual Rights ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Advantages And Disadvantages ◽  
Video Recordings ◽  
The Future ◽  
The Individual

Patients can and do record their consultations in general practice. Data suggests that 19% of doctors have reported being recorded, with 40% of these being unaware at the time. Due to rapid advancements in technology in recent years, over three quarters of patients that attend clinical consultations have the ability to take audio or video recordings using internet-connected smartphones. This paper will look at the individual rights of both the doctor and the patient with regard to recording clinical consultations, assess the advantages and disadvantages that can result and ask whether the future of the doctor–patient relationship is threatened by this modern behaviour.

The Doctor-Patient Relationship as a Diagnostic Tool

1972 ◽  
Vol 3 (4) ◽  
pp. 343-355 ◽  
Author(s):  
Max B. Clyne
Keyword(s):  
General Practice ◽  
Structure And Function ◽  
Diagnostic Process ◽  
Abstract Concept ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Statistical Probability ◽  
Objective Observer ◽  
The Individual ◽  
And Function

Diagnosis is possible on a number of levels. Traditional, overall, and interrelationship types of diagnosis are differentiated. The effectiveness of the traditional diagnosis, which is used to indicate etiology of disease, to assess the effect of the disorder on structure and function, and to classify the illness, is questioned, since it usually leads to a general prognosis based on statistical probability rather than to a unique prognosis indicating specific predictions and treatments for the individual patient. The doctor, when making this kind of diagnosis, acts as an objective observer and assesses an abstract concept, the illness rather than a person, so that the traditional diagnosis is illness-centered. By including features of the patient's personality and his relationships with others, the overall diagnosis provides a more embracing overview of the individual's physical and emotional conditions. It has greater ongoing validity in description and of usefulness for treatment by centering upon the patient as an individual whose conflicts and sufferings are felt and understood. It may require lengthy interviewing, but this may be shortened in practice by focusing upon the particular aspect of the patient's world which seems central to the pathology. This focal area is often determined spontaneously through a “flash,” the mutual intuitive recognition of an important understanding between doctor and patient, leading to further diagnostic and therapeutic work. The flash establishes a climate of high emotional charge and involves both patient and doctor intrinsically in the diagnostic process and its outcome. It is one of the means by which an interrelationship diagnosis, centered on the doctor-patient relationship, may be arrived at. Truly successful treatment in general practice, and perhaps in most branches of medicine, is probably based on some form of interrelationship diagnosis, even though this diagnosis may not have been verbalized or properly conceptualized by the doctor. Case material illustrates the effectiveness of each type of diagnosis for the physician and for his patient.

Medical Ethics and Learning

2016 ◽  
Author(s):  
Samuel Hellman
Keyword(s):  
Clinical Trials ◽  
Medical Ethics ◽  
Randomized Clinical Trials ◽  
Inductive Reasoning ◽  
Medical Knowledge ◽  
Individual Rights ◽  
Patient Relationship ◽  
Medical Learning ◽  
Helsinki Declaration ◽  
The Individual

Randomized clinical trials have become the preferred method of medical learning, but the author believes that they are often in conflict with an appropriate doctor-patient relationship. The physician’s primary obligation is to the individual patient rather than patients in general. Medical knowledge, by being gained by inductive reasoning, is always conditional and subject to being disproved. Medicine must be practiced with awareness of this uncertainty; while learned for patients as a group, it must be modified for the particular patient. From Tuskegee and Willowbrook to the Helsinki Declaration, medical ethics continues to evolve to favor individual rights rather than utilitarian benefit, and this trend should and will continue.

PRELIMINARY ASSESSMENT OF GPS' KNOWLEDGE AND ATTITUDE ABOUT PERSON CENTRED CARE

2018 ◽  
Vol 28 (2) ◽  
pp. 567-570
Author(s):  
Radost Assenova ◽  
Levena Kireva ◽  
Gergana Foreva
Keyword(s):  
General Practice ◽  
Patient Empowerment ◽  
Patient Relationship ◽  
Preliminary Assessment ◽  
Doctor Patient Relationship ◽  
Patient Centered ◽  
Term Care ◽  
Family Doctors ◽  
Person Centered Care ◽  
Centered Care

Introduction: The European definition of WONCA of general practice introduces the determinant elements of person-centered care regarding four important, interrelated characteristics: continuity of care, patient "empowerment", patient-centred approach, and doctor-patient relationship. The application of person-centred care in general practice refers to the GP's ability to master the patient-centered approach when working with patients and their problems in the respective context; use the general practice consultation to develop an effective doctor–patient relationship, with respect to patient’s autonomy; communicate, set priorities and establish a partnership when solving health problems; provide long-lasting care tailored to the needs of the patient and coordinate overall patient care. This means that GPs are expected to develop their knowledge and skills to use this key competence. Aim: The aim of this study is to make a preliminary assessment of the knowledge and attitudes of general practitioners regarding person-centered care. Material and methods: The opinion of 54 GPs was investigated through an original questionnaire, including closed questions, with more than one answer. The study involved each GP who has agreed to take part in organised training in person-centered care. The results were processed through the SPSS 17.0 version using descriptive statistics. Results: The distribution of respondents according to their sex is predominantly female - 34 (62.9%). It was found that GPs investigated by us highly appreciate the patient's ability to take responsibility, noting that it is important for them to communicate and establish a partnership with the patient - 37 (68.5%). One third of the respondents 34 (62.9%) stated the need to use the GP consultation to establish an effective doctor-patient relationship. The adoption of the patient-centered approach at work is important to 24 (44.4%) GPs. Provision of long-term care has been considered by 19 (35,2%). From the possible benefits of implementing person-centered care, GPs have indicated achieving more effective health outcomes in the first place - 46 (85.2%). Conclusion: Family doctors are aware of the elements of person-centered care, but in order to validate and fully implement this competence model, targeted GP training is required.

Migrating Meanings

2019 ◽  
Author(s):  
James W. Underhill ◽  
Mariarosaria Gianninoto ◽  
Mariarosaria Gianninoto
Keyword(s):  
Mandarin Chinese ◽  
Historical Narratives ◽  
Individual Rights ◽  
Lingua Franca ◽  
Broad View ◽  
European Languages ◽  
The People ◽  
The Future ◽  
The Individual ◽  
Historical Accounts

Exploring the roots of four keywords for our times: Europe, the citizen, the individual, and the people, Mariarosaria Gianninoto’s and James Underhill’s Migrating Meanings (2019) takes a broad view of conceptualization by taking on board various forms of English, (Scottish, American, and English), as well as other European languages (German, French, Spanish & Czech), and incorporating in-depth contemporary and historical accounts of Mandarin Chinese. The corpus-based research leads the authors to conclude that the English keywords are European concepts with roots in French and parallel traditions in German. But what happens to Chinese words when they come into contact with migrating meanings from Europe? How are existing concepts like the people transformed? This book goes beyond the cold analysis of concepts to scrutinize the keywords that move people and get them excited about individual rights and personal destinies. With economic, political and cultural globalisation, our world is inseparable from the fates of other nations and peoples. But how far can we trust English to provide us with a reliable lingua franca to speak about our world? If our keywords reflect our cultures and form parts of specific cultural and historical narratives, they may well trace the paths we take together into the future. This book helps us to understand how other languages are adapting to English words, and how their worldviews resist ‘anglo-concepts’ through their own traditions, stories and worldviews.

Duties of Behavior Toward Patients

2020 ◽  
pp. 118-137
Author(s):  
Rosamond Rhodes
Keyword(s):  
Medical Ethics ◽  
Medical Information ◽  
Common Morality ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Case Examples ◽  
Medical Needs ◽  
Numerous Case ◽  
Patient Interactions ◽  
Treatment Plans

This chapter explains three central physician duties that clearly set medical ethics apart from common morality: nonjudgmental regard, nonsexual regard, and confidentiality. Because patients will not trust doctors when they are not confident in the doctor’s devotion and commitment to meeting their medical needs, doctors must avoid any intimation of judging a patient unworthy of care. Because doctors need their patients to trust that the intimacy of the doctor-patient relationship has no sexual overtones in spite of the revelation, nudity, and touching, doctors must maintain nonsexual regard in their patient interactions. Because doctors need patients to divulge intimate personal details about their behavior and history in order to make accurate diagnoses and develop treatment plans, patients must be able to trust their doctors to uphold confidentiality and only share medical information with other professionals on a need-to-know basis. These duties are explained and illustrated with numerous case examples.

Handle With Care

2013 ◽  
Vol 3 (4) ◽  
pp. 84-88
Author(s):  
Ranjana Srivastava
Keyword(s):  
Case Studies ◽  
Future Generation ◽  
Illness Narratives ◽  
Reflective Writing ◽  
Struggling Students ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
The Individual

Reflective writing helps people to explore the larger context, the meaning, and the implications of an experience and action. When used well, it promotes the growth of the individual (William, 2002). Just as personal illness narratives help patients understand their illnesses and help in healing similarly reflective writing by physicians can help them see and understand illness, pain and loss from a larger perspective. At the same time reflection on one's lapses or inadequacies can help in one's own healing. They also help people evolve into more empathic and self-aware practitioners (Sayatani, 2004). Here are two case studies which can be used to make future generation of doctors more human. The first raises the issue of the inadequate training and courage to admit one's mistakes. Whenever this happens people are the first casualty for one carries the burden for years when simple disclosure would have helped in the healing and helped in improving the doctor patient relationship by making doctors appear more human. The second advises struggling students and residents trying to find answers and develop reactions to deal with a situation when they can do nothing for patients (Lisa, 2011)—the answer is communication: engage with patients, simply listen to their stories and keep learning by listening.

scholarly journals The Duty of the Patient to Cooperate

2017 ◽  
Vol 21 (1) ◽  
Author(s):  
Jörg Löschke
Keyword(s):  
Medical Ethics ◽  
Moral Dilemma ◽  
Patient Relationship ◽  
Moral Obligations ◽  
Doctor Patient Relationship ◽  
Moral Duties ◽  
Normative Dimension ◽  
Normative Implications

AbstractIn discussing the normative implications of the doctor-patient relationship, medical ethics has mostly focused on the duties of doctors to their patients. This focus neglects an important normative dimension of the doctorpatient- relationship, namely the duties of patients to doctors. Only few authors have discussed the content and ground of the moral duties of patients, and each of these accounts are wanting in some way. This paper discusses patients’ duties and argues that patients have a relationship-dependent obligation to cooperate with the doctor, because doctors have a morally justified interest in fulfilling their moral role obligations as doctors, and by not cooperating, patients make it more difficult for doctors to fulfill their moral obligations. In some cases, failing to cooperate might even create an avoidable moral dilemma for the doctor.

Boundaries of reasoning in cases: The visual psychoanalysis of René Spitz

2020 ◽  
Vol 33 (3-4) ◽  
pp. 66-84
Author(s):  
Rachel Weitzenkorn
Keyword(s):  
Experimental Psychology ◽  
Developmental Psychology ◽  
Patient Relationship ◽  
Visual Displays ◽  
Doctor Patient Relationship ◽  
Interpersonal Emotions ◽  
The Individual ◽  
Key Aspects

This article argues that the foundational separation between psychoanalysis and experimental psychology was challenged in important ways by psychoanalytic infant researchers. Through a close examination of American psychoanalyst René Spitz (1887–1974), it extends John Forrester’s conception of reasoning in cases outside classic psychoanalytic practices. Specifically, the article interrogates the foundations of reasoning in cases—the individual, language, and the doctor–patient relationship—to show how these are reimagined in relation to the structures of American developmental psychology. The article argues that the staunch separation of experimental psychology and psychoanalysis, reiterated by philosophers and historians of psychology, is flimsy at best—and, conversely, that the maintenance of these boundaries enabled the production of a cinematic case study. Spitz created films that used little language and took place outside the consulting room with institutionalized infants. Yet key aspects of the psychoanalytic case, as put forth by John Forrester, were depicted visually. These visual displays of transference, failure, and interpersonal emotions highlight the foundations of what Forrester means by reasoning in cases. The article concludes that Spitz failed at creating classic psychoanalytic evidence, but in so doing stretched the epistemology of the case.

Confidentiality in medicine: how far should doctors prioritise the confidentiality of the individual they are treating?

2018 ◽  
Vol 94 (1116) ◽  
pp. 596-600 ◽  
Author(s):  
Jennifer L H Peterson
Keyword(s):  
Information Sharing ◽  
Genetic Diagnosis ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Significant Harm ◽  
Legal Position ◽  
Harm To Others ◽  
The Individual ◽  
Privacy And Confidentiality ◽  
Genetic Medicine

There is a premium placed on the maintenance of our privacy and confidentiality as individuals in society. For a productive and functional doctor–patient relationship, there needs to be a belief that details divulged in confidence to the doctor will be kept confidential and not disclosed to the wider public. However, where the information disclosed to the doctor could have implications for the safety of the wider public, for example disclosures with potential criminal implications, or have serious consequences for another individual, as is the case in genetic medicine, should doctors feel confident about breaching confidentiality? This essay firstly explores the legal rulings regarding cases in which confidentiality has been breached where there was risk of significant harm to others following the patient’s disclosure, and secondly, focusing on the evolving legal position with regard to confidentiality in contexts where information sharing would be beneficial to others, for example the evolving case of the implications of genetic diagnosis on families (eg, ABC v St George’s Healthcare NHS Trust; 2017).

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