Doctor-Patient+Relationships

Student Name: Julianne HolbeckStudent number: n7497989Tutor name: Kate Page

A sarcastic and over-exaggerated interpretation of doctor-patient relationships can be seen in the above image (A.Bacall 2011). It conveys the message that although a Doctors verbal communication is vitally important, they often lack empathy and emotional understanding of their patients; particularly those from a culturally different background. Issues within these relationships often arise when Doctors lack an understanding of certain barriers patients may experience, such as cultural differences and communication difficulties. In order to overcome these issues we must understand how culturally ‘clued in’ our Primary and Emergency Service Providers are to their patients.

**PUBLIC HEALTH ISSUE**

Like any relationship, it is likely that numerous issues may arise. The Public Health Issues that occur within the doctor-patient relationships will be discussed in detail throughout this analysis. Issues include physician superiority, the importance of high quality communication/relationships, as well as the implications of miscommunication and misunderstanding of ones culture and personal values. These issues become highly significant to the Australian population and Healthcare system due to our ever-growing multicultural society. Improving on these issues will aid patient satisfaction, encourage continued prognosis adherence and improve overall disease outcomes (Cartwright, 1964, 1967; Locker and Dunt, 1978). Relevant literature supports these findings.

**LITERATURE REVIEW**

The current research surrounding Doctor-Patient relationships focuses on patient satisfaction. “Evaluation of health care is regarded by many asthe most important function of patient satisfaction research” (Sitzia & Wood. 1997). The issues previously mentioned can be improved and/or rectified by looking at the foundation of a solid relationship. Three components that form the basis of most relationships are trust, communication and empathy (Finset, A. Hjortdahl, P. Middlethon, A. Skirkbekk, H. 2011).

Patient trust has an impact on patient satisfaction, adherence to medical prescription, and continued enrollment. What affects a patient’s trust the most is the initial rapport building a general practioner is first able to establish with their patient. Stavropulou findings support the opinion that, irrespective of the disease characteristics or the specific circumstances of a consultation, a patients perception of the doctor–patient relationship is a key issue in the problem of non-adherence. These findings support further and even more strongly the need for better doctor–patient relationships as the basis of any intervention that intends to help patients follow recommendations.

According to Finset (2011), it not often that trust is explicitly mentioned between doctors and patients, instead a mutual understanding of trust is understood. The competency of one’s physician is integral in forming a strong relationship with their doctor as it encourages the patient to confide in them. ** The Australian Medical Association (2011) ** states that the doctor-patient relationship involves the doctor acting in the patient’s best interest, establishing this mutual trust and then maintaining it. Good rapport building is considered important particularly in the initial consultation. A study completed by Cape (2000) said “The results indicate an association between patient perceptions of how GP and patient related in the consultation and reduction in symptom severity 3 months later.”

Something that is best able to establish trust is ones ability to communicate. Kurtz (1989) outlines 5 principles of effective communication that encourages interaction, reduces uncertainty, shows ‘dynamism’ and creates a positive communication build-up between the doctor and patient. “ To provide appropriate care, doctors must possess the appropriate skills to communicate sensitively with people, irrespective of cultural, social, religious or regional differences” (BMA 2004). Good communication skills are also an integral component of empathy (Cape, J. 2000).

When observing the doctor-patient relationship we can also see that there is a power imbalance. Goodrich & Wang (1999) state that although there may be a difference in power, it is necessary in order to be able to establish proper rapport building and show the patient that they are professional and their knowledge can be trusted. In regards to a “power-in-relation model proposed by Candib in Medicine and the Family, which directs physicians to acknowledge their power, use it to enhance the patient's power, and to do so in areas far beyond treatment decisions.” (Goodrich, T., & Wang, C. M. 1999).

Lifespan.org outlines the ethics of this relationship and the patience rights. The website discusses how your doctor can/or is unable to help you and the final decisions made about treatment. A doctor can identify the treatments available to their patience; however they cannot force a treatment upon them that may conflict with their personal values (Lifespan 2011). In saying that, doctors are unable to be forced to give a treatment that is deemed ‘medically inappropriate’ (Lifespan 2011).

A pressing issue that is more apparent in Australia than before, due to an ever-growing multi-cultural society, is the importance of inter-cultural communication. In the 1970s the population of people born overseas was 20% and fast track to June 2010 and that number has increased to 27% (ABS 2011). This occurs when doctors must deal with a patient from a differing cultural background to theirs. There are many difficulties that may arise due to inability to properly communicate (both verbally and physically) as well as the sensitivity to certain cultural attitudes, behaviours and beliefs. According to the //Journal of Ethnic & Cultural Diversity in Social Work//, patients from other countries experience culture shock, language difficulties, and systemic discrimination. Being in a new country also means fewer resources and less social support to cope with the stress. These issues create cultural and structural barriers to usage of mental health services (Chen, S., Sullivan, NY., Lu, YE., & Shibusawa, T. 2003 ; Lo, M. 2010 ).

Health care professionals are expected to be culturally competent. According to the National Center for ** Cultural ** Competence (2004; as cited by [|Gallardo, 2009]) they identify those that are culturally responsive as those that “have the capacity to value diversity, conduct self-assessment, manage dynamics of difference, institutionalize ** cultural ** knowledge, and adapt to diversity and ** cultural ** contexts of the communities they serve”. So not only must they have a cultural understanding of the patient, they must also be able to understand the cultural context by expressing sensitivity of the patients’ situation (Matar, S. 2011; Lo, M. 2010).

By expanding our understanding on efficient ways to connect with diverse populations, health care professionals being culturally competent can improve patient satisfaction (Sitzia & Wood. 1997). As stated by Mater & Finset //et al// (2011) the importance of intercultural communication shows that Health care professionals are able to engage and retain clients from diverse backgrounds, there is a lesser risk of under and/or over diagnosis, the appropriate level of empathy is provided to the patient and an adherence to medical prognosis is better maintained.

**CULTURAL AND SOCIAL ANALYSIS**

As mentioned in the literature above, we are able to see how culture and society are crucial to consider when understanding and addressing Doctor-patient relationships. Due to the rapid advances of technology such as computers and the Internet, access to medical information is now readily available to the public with the simple click of a button. This empowers the public to gain knowledge that was previously only accessible by medical professionals. This increases the power-imbalance issue. Access to this knowledge creates a sense of arrogance in patients thinking they know better than their doctor which can then cause patients to become distrusting of the doctors validity and a failure in compliance of prognosis is then evident.

Cultural competency is an integral issue in doctor-patient relationships. The term “cultural competency” was only created in the early 1990s, which is consistent with the ABS statistics showing an increase of people born overseas between 1970-2010. Research by Chen //et al// (2003) shows that dealing with culturally diverse populations can create an increased gap within doctor-patient relationships. The bigger the gaps in this relationship, the more issues arise creating more tension in the health care system. Those from culturally differing backgrounds are the most prominent group affected.

Lo (2010) identifies bridging this gap in the title of her studies as “cultural brokeage”. In order for this relationship to improve, a fundamental element of culturally competent healthcare requires patient-centered communication which focuses on the individiual demands of each patient ( Saha, S., Beach, M.C., Cooper, L.A, 2008). Saha //et al// discusses how the integration of these two frameworks, cultural competence and patient centeredness, can dramatically improve patients satisfaction by treating those of differing cultural backgrounds as individuals rather than minor racial or ethnic groups. This avoids incorrectly stereotyping and observing the diversity in each patients values and viewpoints.

**ANAYLISIS OF THE ARTEFACT AND LEARNING REFLECTIONS**

After researching this public health issue I was surprised to discover the complexity behind doctor-patient relationships. Health practitioners must have a substantial amount of background knowledge on culture, patient-empowerment through authority and effective communication skills. My cultural artefact represents what can happen when these integral components of an effective doctor-patient relationship are misinterpreted. It is one thing to ‘say’ you understand your patients needs, however demonstrating your understanding is another.

Coming from a culturally diverse background myself and working as a health care professional with varying cultures of differing values, communications and beliefs; I can easily understand the difficulties health-care professionals must face and the implications of misunderstandings.

I experienced first-hand the difficulty adjusting my western cultured views of practice from to a vastly different culture when I volunteered as a Physiotherapist at a disabled school in Nepal. In their culture it is understood that you must always be humble; if you don’t know the answer you just agree, or if you feel pain you pretend that you don’t. They believe it is disrespectful towards someone if they feel they are becoming a hindrance to your daily living.

Even when communicating with my mum who is Filipino, I need to consider all the factors of a doctor-patient relationship. If she doesn’t understand what I’ve said to her and I don’t provide the correct level of empathy towards her, then she feels threatened and becomes very upset and angry towards me.

This assignment has helped to better isolate the issues I have previously experienced and has given me the tools to be able to better educate those around me during my medical profession as a personal trainer/coach/sports trainer.

**REFERENCES**

Australian Bureau of Statistics – ABS (2011). HISTORY OF OVERSEAS-BORN IN AUSTRALIA. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Products/1197BC920F1A28E5CA2578B00011976A?opendocument

Australian Medical Association - AMA (2011). Role of the Doctor. Retrieved from http://www.ama.com.au/node/6569

Bacall, A. (2011). '...Don't you see me making eye contact, striking an open posture, leaning towards you and nodding empathetically?' [image] Retrieved 27 October 2011, http://www.cartoonstock.com/cartoonview.asp?catref=aba0445

British Medical Association - BMA (2004). Communication skills education for doctors: an update. //Board of medical edcuation, 16//(8), 30-32. Retrieved from www.bma.org.uk/images/communication_tcm41-20207.pdf

Cartwright, A. (1964) //Human Relations and Hospital Care.// Routledge and Kegan Paul, London.

Cartwright, A. (1967) //Patients and Their Doctors. A Study of General Practice.// Routledge and Kegan Paul,London.

Goodrich, T., & Wang, C. M. (1999). The doctor's power: Implications for training. //Families, Systems, & Health//, //17//(4), 447-457. doi:10.1037/h0089896

Lifespan. (2011). Ethics & Patient Rights: What Your Doctor Can and Can't Do. Retrieved from http://www.lifespan.org/services/ethics/sfyb/doc.htm

Locker, D. and Dunt, D. (1978) Theoretical and methodo- logical issues in sociological studies of consumer satis- faction with medical care. //Social Science & Medicine// 12, 283-292

Lo, M. (2010). Cultural brokerage: Creating linkages between voices of lifeworld and medicine in cross-cultural clinical settings. //Health: An Interdisciplinary Journal For The Social Study Of Health, Illness And Medicine//, //14//(5), 484-504. doi:10.1177/1363459309360795

Kurtz SM (1989) Curriculum structuring to enhance communication skills development. In: Stewart M & Roter D (eds) Communication with medical patients. Newbury Park, CA: Sage Publications.

Mattar, S. (2011). Educating and training the next generations of traumatologists: Development of cultural competencies. //Psychological Trauma: Theory, Research, Practice, And Policy//, //3//(3), 258-265. doi:10.1037/a0024477

Saha, S., Beach, Mary Catherine,M.D., M.P.H., & Cooper, Lisa A,M.D., M.P.H. (2008). Patient centeredness, cultural competence and healthcare quality. //Journal of the National Medical Association, 100//(11), 1275-1275-85. Retrieved from http://search.proquest.com/docview/214047321?accountid=13380

Sheying Chen PhD, Ning Yang Sullivan MS, MPhil, Yuhwa Eva Lu PhD & Tazuko Shibusawa PhD (2003): Asian Americans and Mental Health Services, //Journal of Ethnic And Cultural Diversity in Social Work//, 12:2, 19-42