Sunday, 6 March 2016

Doctor Patient Encounter : Paternalistic versus Mutualistic

A doctor patient encounter in out patients is the consultation.A consultation has to be used as a means to understand patients ideas,concerns and expectations about their illness.This is called Concordance.Concordance is the quality of consultation.


The old fashioned paternalistic approach is no more accepted by many patients. The free availability of information about medical conditions on the internet means patients can now arrive at a consultation with sheaves of paper to challenge the doctors authoritative knowledge.
Mutualistic Approach is the way forward.


Unlike the words Compliance or Adherence we use for the patients.Better concordance leads to compliance and adherence to treatment.
If we do not involve them in this way,there are bound to be misunderstanding and dissatisfaction.

Usually any doctor spends time in a consultation to reach a diagnosis after listening to patient symptoms and clinical examination.
However once in a while you meet a patient who believes that the doctor has not spent enough time with them.What causes this confusion or misunderstanding?

How do we decide with whom to spent how much time?
It appears that the time of interaction is decided by presenting symptom OR rather how quickly the patient comes to the main complains.
Simple example is that if someone has an acute infection,it's a simple and short consultation within allotted 15-20 minutes.(with an average consultation time of 8 minutes)
Versus if someone has a chronic illness or a disability,then doctor needs to spend more time.

We come across patients who are having simpler diagnosis complaining about spending less time with them ( well precisely that's whats its going to be) I understand the patients perspective that for him/her illness is illness or grave for some.

As a doctor I feel that they can make a list of questions or concerns before visiting the doctor(especially since internet gives a lot of info) and get them answer promptly.Rather than quoting internet or what they have read or other specialists have told them.

Mutualistic Approach brings benefits to both patients and doctors....



1 comment:

Rajeev said...

I personally feel that patients should not refer too much to the internet in the initial stages because going by all the information in the internet, any symptom can be caused by almost any ailment, each medical website will have a slightly different list of possible causes, it just creates more panic.

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