Relationships Between Patients and Professionals Flashcards Preview

ESA 4 - Health and Disease in Society > Relationships Between Patients and Professionals > Flashcards

Flashcards in Relationships Between Patients and Professionals Deck (16)
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1
Q

What is the patient-professional relationship?

A

A very important component of the experience of illness

Has become increasingly central to improving the delivery of health care

Not just of sociological interest - also raises professional, legal and ethical concerns.

2
Q

What are the 4 major sociological approaches to relationships between patients and professionals?

A
  1. Functionalism (emphasises consensus and reciprocity)
  2. Conflict theory (emphasises conflict)
  3. Interpretivism/Interactionism (emphasises the
    meanings that people ascribe to social situations)
  4. Patient-centred/Partnership models (emphasis
    partnership)
3
Q

Describe the functionalist approach to relationships between patients and professionals

A

Interested in how a relationship (doctor and patient) characterised by asymmetry could function so well

Patient is vulnerable; doctor is powerful - many taboos have to be broken for relationship to work

Trust has be based on abstract codes of conduct

Medicine restores people to good health and by so doing restores equilibrium

4
Q

What is the sick role according to the functionalist approach to relationships between patients and professionals?

A

Falling ill is a socio-cultural experience

Although they may possess some knowledge of their condition, on the whole lay people don’t have the technical competence to remedy their situation

The sick person is placed in a state of helplessness

5
Q

What are the rights and duties of the sick role according to the functionalist approach to relationships between patients and professionals?

A

On falling ill the sick person enters a social role which is circumscribed by specific rights and duties:
- Being ill presents itself as a legitimate reason to be
freed of social responsibilities and obligations
- The sick person is placed in a situation of dependence:
their new social status demands the attention of
medical care
- The sick person should want to get well and abuse
their legitimised exemption from normal responsibilities
- The sick person is expected to seek out the requisite
technical help in the role of the physician and
cooperate with them in the healing process

6
Q

What is the doctor’s role according to the functionalist approach to relationships between patients and professionals?

A

Doctor’s role as tending to sickness in society

Characterized by certain norms and expectations (that we normally associate with professions)
- Doctors should use skills for the benefit of patients; act
for the welfare of patients rather than their own self-
interests; be objective and non-discriminatory
- Doctors granted intimate access to patients; autonomy;
status; financial reward

7
Q

What are some of the criticisms of the functionalist approach to relationships between patients and professionals?

A

Sick role not well thought out; some patients cannot get better (chronic illness); legitimate and illegitimate occupants of the sick role?

Assumes patients are incompetent and must have a passive role

Assumes rationality and beneficence of medicine

Doesn’t explain why things go wrong

8
Q

Describe the conflict approaches to relationships between patients and professionals, and Eliot Freidson’s connection.

A

By 1960s and 1970s more critical views of medical profession were emerging
Eliot Freidson rejected notions of legitimate authority and trust and replaced them with medical dominance and supressed conflict

Eliot Freidson:
- The doctor’s control is not the product of professional
values or technical expertise alone
- The doctor holds bureaucratic power - ‘gatekeeper’
- Doctors have a monopoly on defining health and illness
which they can exploit
- The patient has little choice but to submit to the
institutionalises dominance of the doctor

9
Q

Describe conflict theory and “medicalization” in regards to relationships between patients and professionals.

A

Lay ideas are marginalised and discounted

Medicine colonises areas previously in control of lay public, and can pathologies aspects of social life

Cultural iatrogenesis (Ivan Illich) - people become dependent on medicine, lose self-reliance and become sick

Idea that “medicalization” of childbirth has resulted in loss of control for women

10
Q

What are some of the criticisms of the conflict approaches to relationships between patients and professionals

A

Is portrayal of patients and doctors as inevitably ion conflict accurate?

Patients are not always passive - can exert control through e.g. non-adherence, use of complementary therapies

Patients may appear deferential in consultation but assert themselves outside of this

Patients can seek to ‘medicalise’ issues, too

11
Q

Describe the Interpretive/interactionist approaches to relationships between patients and professionals.

A

Focus on the meanings that both parties give to the encounter

Interested in patterns - how does order emerge through interaction

Informal, unwritten rules govern almost every aspect of social life - may be much more important than formal rules

12
Q

Describe the patient-centred models in regards to relationships between patients and professionals.

A

Aspiration that patient-professional relationship could be less hierarchical and more cooperative if patients’ views were taken more seriously

A shift away from traditional ‘professional-centred’ model toward a ‘patient-centred’ model

Emphasis on more egalitarian relationship: professional and patient as equals

Underpins many recent policy initiatives

13
Q

Tell me about a patient-centred consultation.

A

Explores the patient’s main reasons for the visit, their concerns and need for information;

Seeks an intergrated understanding of the patient’s world - that is, their whole person, emotional needs and life issues

Finds common ground on what the problem is and mutually agrees on management

Enhances prevention and health promotion

Enhances the continuing relationship between patient and doctor

14
Q

Tell me about shared decision-making.

A

Both the doctor and patient involved in the treatment decision-making process

Both the doctor and the patient share information with each other

Both the doctor and the patient take steps to participate in the decision making process by expressing treatment preferences

A treatment decision is made and both the doctor and the patient agree on the treatment

15
Q

What can patients contribute to healthcare in terms of their consultation and relationship with doctors.

A

Their concerns and priorities in relation to presenting problems

Their personal perceptions of costs and benefits of alternative interventions to improve the problem

Complex judgements about the severity of their health problems and unwillingness to undergo risk, discomfort, or other potential costs

Trade-off issues of survival at cost of quality of life

16
Q

What are soe of the challenges to shared-decision making?

A

People who don’t want to share decision-making

Unknown consequences of involvement - always good?

Under what circumstances could/should the power of patients be limited?

Who does final responsibility rest with?

Is there time to achieve this?