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.

‘Is it alright if I-um-we unbutton your pyjama top now?’ Pronominal use in bedside teaching encounters

2009 ◽  
Vol 5 (2) ◽  
pp. 171-182 ◽  
Author(s):  
Charlotte Rees ◽  
Lynn Monrouxe
Keyword(s):  
General Practice ◽  
Healthcare Professionals ◽  
Bedside Teaching ◽  
Patient Relationship ◽  
Doctor Patient Relationship ◽  
Younger Patients ◽  
Multiple Functions ◽  
Full Diversity ◽  
And Function

Individuals’ pronominal talk can signify how they conceptualize themselves, others and their relationships. Although studies have analysed healthcare professionals’ use of pronouns within the doctor– patient relationship, none have explored this within the ‘learning triad’ of the bedside teaching encounter (BTE). We aim to address this gap in the literature by considering the functions of pronouns in the talk of physician tutors, students and patients during BTEs. We analysed the use and function of pronouns (I, we, you and they), pronoun shifts and the collocate ‘think’ in the talk of five tutors, ten students and six patients within six BTEs. Our analysis suggested that participants’ pronominal talk served multiple functions. We discuss the varied functions of BTE participants’ pronominal talk and consider what their pronouns reveal about their understanding of each other and their relationships. Further research is needed with a more diverse sample, including younger patients, and across different settings like general practice, to explore the full diversity of pronominal talk within BTEs. Keywords:

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.

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.

Effect of EPS on biofilm structure and function as revealed by an individual-based model of biofilm growth

2001 ◽  
Vol 43 (6) ◽  
pp. 135-135 ◽  
Author(s):  
J.-U. Kreft ◽  
J. W. Wimpenny
Keyword(s):  
Dimensional Space ◽  
Three Dimensional ◽  
Structure And Function ◽  
Individual Based Model ◽  
Biofilm Growth ◽  
Rate Dependent ◽  
Binding Forces ◽  
The Individual ◽  
And Function ◽  
Biofilm Structure

We have simulated a nitrifying biofilm with one ammonia and one nitrite oxidising species in order to elucidate the effect of various extracellular polymeric substance (EPS) production scenarios on biofilm structure and function. The individual-based model (IbM) BacSim simulates diffusion of all substrates on a two-dimensional lattice. Each bacterium is individually simulated as a sphere of given size in a continuous, three-dimensional space. EPS production kinetics was described by a growth rate dependent and an independent term (Luedeking-Piret equation). The structure of the biofilm was dramatically influenced by EPS production or capsule formation. EPS production decreased growth of producers and stimulated growth of non-producers because of the energy cost involved. For the same reason, EPS accumulation can fall as its rate of production increases. The patchiness and roughness of the biofilm decreased and the porosity increased due to EPS production. EPS density was maximal in the middle of the vertical profile. Introduction of binding forces between like cells increased clustering.

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 Idiosyncratic cleavage and ligation activity of individual hammerhead ribozymes and core sequence variants thereof

2007 ◽  
Vol 388 (7) ◽  
pp. 737-741 ◽  
Author(s):  
Rita Przybilski ◽  
Christian Hammann
Keyword(s):  
Small Rna ◽  
Plant Pathogens ◽  
Hammerhead Ribozyme ◽  
Structure And Function ◽  
Sequence Variants ◽  
Hammerhead Ribozymes ◽  
Satellite Dnas ◽  
Cleavage Reactions ◽  
The Individual ◽  
And Function

AbstractThe hammerhead ribozyme is a small RNA endonuclease found in sub-viral plant pathogens, in transcripts from certain animal satellite DNAs and encoded at distinct loci ofArabidopsis thaliana. Kinetic analyses of tertiary stabilised ribozymes from peach latent mosaic viroid (PLMVd),Schistosoma mansoniandA. thalianarevealed a ten-fold difference in cleavage rates. Core nucleotide variations affected cleavage reactions least in theA. thalianaribozyme, and most in theS. mansoniribozyme. The reverse ligation reaction was catalysed efficiently by the PLMVd andA. thalianaribozymes. The different behaviour of the individual hammerhead ribozymes is discussed in terms of structure and function.

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.

Structure and function of the skin

2020 ◽  
pp. 3-14
Keyword(s):  
Barrier Function ◽  
Individual Cell ◽  
Normal Skin ◽  
Cell Types ◽  
Structure And Function ◽  
Hair Follicles ◽  
Sweat Glands ◽  
Dermoepidermal Junction ◽  
The Individual ◽  
And Function

The structure and function of the skin details the individual components of the epidermis, dermis, and their roles in normal skin health. The individual cell types in the epidermis, the different epidermal layers, and the roles of the keratinocyte are explained. The epidermis and dermis, and their important relation to each other through the dermoepidermal junction are described. The dermal adnexal structures of hair follicles (pilosebaceous units), sweat glands, and nerves are all considered. The functions of skin and barrier function are also listed. Rare but important causes of disordered sweating (hyperhidrosis and hypohidrosis) are described. In addition, presentations of hyperhidrosis are discussed.

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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