scholarly journals Post Covid-19 Doctor-Patient Relationship Model. Creation of Social Connection Contexts With Physical Distancing

2020 ◽  
Vol 1 (2) ◽  
pp. 15-19
Author(s):  
Jose Luis Turabian

The coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 1 has produced a significant change in the way general medicine is conducted. This shift has been remarkably quick towards telecare. The form of the clinical interview has changed, and with it communication and the doctor-patient relationship; Before COVID-19, all communication techniques and doctor-patient relationship, which were considered tried and true to establish a good relationship with patients, involved physical proximity 2. Now in many European countries and in the United States face-to-face consultations have been reduced to 10-20%, with most contacts now being provided remotely using symptom checkers, electronic messaging, and phone or video consultations 3.

2001 ◽  
Vol 7 (5) ◽  
pp. 257-265 ◽  
Author(s):  
E J Nordal ◽  
D Moseng ◽  
B Kvammen ◽  
M-L Løchen

We compared the diagnoses made by one dermatologist via telemedicine with those of another dermatologist made in a face-to-face consultation. The patients first underwent a teledermatology consultation and then a face-to-face consultation. A general practitioner was present with the patient in the videoconference studio. Videoconferencing equipment connected at 384 kbit/s was used. The doctor-patient relationship and the satisfaction of the patients and dermatologists in the two settings were assessed, as well as technical conditions during the videoconferences. There were 121 patients, with a mean age of 40 years (range 17-82 years). There was a high degree of concordance between the two sets of diagnoses, with 72% complete agreement and 14% partial agreement between the two dermatologists. A total of 116 patients (96% of those included) completed a questionnaire. Both the patients and the dermatologists were in general satisfied with the videoconferences. Videoconferencing with a participating general practitioner may be useful in dermatology, but the technique should be used only for selected patients.


2019 ◽  
Vol 2 (1) ◽  
pp. 01-06
Author(s):  
Jose Luis Turabian

Practical work requires deepening in the theory. In this way, the intention of this article is to systematize the concept of "minimal interventions", as well as draw attention to the impact that this type of interventions of the general practitioner can have on the patient, however small and insignificant, their action may seem. The doctor-patient relationship creates contexts that act, in one way or another, on the patient. There is no absence of medical intervention, even when there is no conscious intervention of the doctor on the patient. Non-intervention is a type of intervention. Non-intervention is a bio-fiction. The different types of doctor-patient relationship give rise, naturally, perhaps imperceptibly, to different models of educational intervention. In this scenario, a conceptualization and systematization of the "micro-interventions" in general medicine is presented: minimal, imperceptible, briefs, low cost, zen, human size, opportunistic, small and mild, but continuous interventions. These micro-interventions are cost-effective no matter how small and insignificant their action seems. These minimal interventions of the general practitioner are of great importance and constitute an updated form of the "less is more" rationalist, they express the power of the minimum gesture in general / family medicine, and can transform health / disease on a large scale. In this way we can hypothesize a plausible relationship between the minimal but concentrated and powerful means, that is to say "contextualized", and the intensity of the effect in general medicine. The clarity of the reading of a message depends on the appreciation of the context; what counts is not what, but how. The context highlights or "pulls" the message. Many small people, in small places, doing small things, can change the world.


BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S259-S259
Author(s):  
Sudha Jain ◽  
Emma Adams ◽  
Alyson Lee

Aims1. To compare the experience of psychiatric trainees in Ireland of online Balint Groups (BG) in contrast to face to face groups.2. To assess the general attitudes of trainees to BG using the Psychological Medical Inventory (PMI) (Ireton and Sherman, 1988) scale.MethodAn online survey comprising two sections: 1. A questionnaire exploring participants experience, effectiveness and obstacles to attending the two formats of BG with a free text box response. 2. General attitude of trainees towards BG using PMI scale.An online cross-sectional survey using Survey Monkey. An invitation to participate in the survey was emailed to all trainees by the College of Psychiatrists in Ireland. All data were anonymised, and all data processing was conducted in line with GDPR. Statistical analysis was undertaken using Microsoft Excel. Thematic analysis was applied to the free-text box responses.Result16.49% (64/388) responded to the survey. Responses were uniform across all stages of training. 97% of respondents attended BG; 72% attended both formats, 25% attended only face-to-face and 3% online only. 65% of respondents preferred face to face compared to 18% online, whilst 11% stated no preference.On thematic analysis, trainees asserted a preference for face-to-face, describing better group cohesion, feeling safer to share, increased ease of interpreting non-verbal communication, and that conversation was more fluid. They described greater ease of engagement with the group/facilitator and preferred direct social interaction with peers.Conversely, most trainees acknowledged that online groups were convenient to attend, less time consuming & mitigated COVID risk associated with face-to-face meetings. Common themes against the use of online groups were: less psychotherapeutic in nature, technical issues, silences, unable to see participants faces and as though speaking “into the void”.Regarding trainees' attitudes to attending BG, most of the trainees found BG had been beneficial in developing more interest and confidence in dealing with the psychological aspects of patient care. Trainees agreed that skills improved in developing an excellent doctor-patient relationship, recognising patients under stress/ in distress, systemically obtaining psychological information and making treatment decisions based upon psychological needs and psychotherapeutic engagement. They agreed that they could better understand the influence of doctors' emotions on the doctor-patient relationship.ConclusionThis survey showed that most trainees find BG beneficial in developing better doctor-patient relationships, preferring face-to-face rather than online BG. However, they found online more convenient. A blended learning approach could provide trainees with the benefits of both formats of BG.


2009 ◽  
Vol 5;12 (5;9) ◽  
pp. 811-818
Author(s):  
Paul Ky

Background: Independent Medical Examinations (IMEs) have protected the rights of workers in the United States since the first laws protecting employees were established in the early 1900s. There have been many social advancements and a great collective struggle over the last 100 years that have ultimately lead to justice for the injured or disabled worker. Objective: We describe the origins of the IME as well as the evolution of both medical and social processes that have provided the legal framework for the correct practice of IMEs. This article will summarize the current medical principles, legal process, and social controversy embodying the modern IME. Discussion: Medical professionals must adhere to the same principles of impartial and ethical conduct that they uphold in general patient care when dealing with IMEs. Although previously controversial, it is now clear following successful litigation of many physician examiners that at least a ‘limited doctor-patient relationship’ is created during an IME. Limitations: The limitations of this manuscript include a paucity of the literature, lack of IME updates, and certain conflicts with guidelines by various organizations. Conclusion: IMEs represent a valuable mechanism for determining alleged impairment and/or disability. In the current economic environment of declining reimbursement to physicians, IMEs exist outside the scope of traditional payment methods and offer competitive compensation. Key words: Independent Medical Examination, disability, impairment, worker’s compensation, injured worker, disabled worker, doctor-patient relationship


2021 ◽  
Vol 33 (1) ◽  
pp. 182-188
Author(s):  
Anandaraj Rajagopal ◽  
Lalithambigai Chellamuthu ◽  
Premnath Dhasaram ◽  
Kavita Vasudevan ◽  
Prakash Mathiyalagen

Background: Patient satisfaction is a scale to assess the services offered by the healthcare system. Patient’s feedback is necessary to identify problems that need to be resolved in improving health services. Aim & Objective: Keeping this in view, the present study is an initiative to estimate the patient’s satisfaction in service provision among NCD patients at a tertiary care hospital of Puducherry. Settings and Design: A Facility-based descriptive cross-sectional study was conducted among NCD patients attending General medicine OPD of a tertiary care hospital of Puducherry between April-June 2019. Methods and Material: Assuming 50% satisfaction level among study participants and 5% non-response rate, the sample size was estimated as 404. The NCD register maintained at the General medicine OPD was considered as the sampling frame & systematic random sampling was applied, so that every 5th patient satisfying the inclusion criteria will be included. A standardized patient satisfaction questionnaire with 31-items (4 domains) which is validated for Indian setting (Cronbach’s alpha 0.96) was used. Statistical analysis used: Data capture was done using Epicollect-5 android application and analysed using SPSS version 16.0. Results: Among the 404 NCD patients, the mean age was 56 ± 11.8 (SD) years and 60.6% were females. One in four patients felt poor in reception, doctor-patient relationship and dispensary services. The overall satisfaction of study subjects categorized as good, satisfactory, poor was 6%, 86% and 8% respectively. Conclusions: Majority of the study participants were satisfied with the service provision of the health facility. Still, there is a scope for improvement in dispensary, doctor-patient relationship and registration services.


1998 ◽  
Vol 4 (2) ◽  
pp. 72-79 ◽  
Author(s):  
Ben Stanberry

Summary This paper reviews the difficulties raised by the need to obtain valid consent from telemedicine patients to the treatment that they receive and evaluates the legal principles that the courts will apply to an allegation of negligence brought against a teleconsultant or telemedicine service by a patient. While many of the processes that take place during a telemedical consultation will be unique, it is suggested that the legal principles that apply to the conventional, face-to-face, doctor-patient relationship are equally as valid in the context of the practice of medicine at a distance.


2019 ◽  
Author(s):  
Mark J. Yaffe ◽  
Richard B. Hovey ◽  
Charo Rodriguez

Abstract Background Positive doctor-patient relationship have been linked to some good patient outcomes. Different modalities have been used to study communication and behaviors within such encounters. Unsolicited writings from patients to doctors has rarely been reported on in this context; therefore this paper aimed to explore the content of such correspondence sent to a single family physician over a 4 decade period. Methods 107 of 140 pieces of correspondence contained content necessary to permit studying three research questions: (1) using univariate analyses, which patients or family members wrote personalized notes to the family doctor, when, and in what fashion; (2) using Hermeneutic exploration of each note, what words or sentiments were used to describe encounters with, and care received, from the doctor; (3) with similar Hermeneutic exploration, what words or phrases provided insight into the apparent motivations underlying the writing of the notes. Results The notes were mostly handwritten, predominantly by women, and frequently around personally relevant life span events. An iterative process generated six themes which summarized appreciated physician or relational attributes: (1) quality care; and physician (2) competence; (3) physical presence; (4) positive personal traits; (5) provision of emotional support; and (6) spiritual impact. A similar process identified six motivations for writing, which were to: (1) express appreciation for an established relationship; (2) acknowledge value / benefit experienced from continuity of care; (3) seek catharsis, emotional relief or closure; (4) reflect on termination of care; (5) validate care that extended beyond the Hippocratic tradition into that of Asklepian healing [17] ; and (6) share personal reflection, experience, or impact. Conclusions Unsolicited writings to a doctor provide a personalized, direct link from patient to physician that seems to allow for expression of thoughts difficult to convey face to face. They provide unique, real life testimonials that offer potential as a teaching tool on doctor-patient relationships. These particular patients seemed to value considerate, competent, quality care that was given in continuity fashion, with support for emotional and spiritual needs. In some communities this suggests that good care needs to go beyond rapid accessibility.


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