Doctor-patient relationships in general practice--a different model.

Kushner, Thomasine

doi:10.1136/jme.7.3.128

Cited by 18 publications

(9 citation statements)

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“…A study from the Netherlands showed that in 12% of the consultations neither a specific diagnosis could be made nor were the problems explained by the patient's somatic or psychosocial context [30]. This reinforces the patient's role as an important source of knowledge [27] and is one reason why patient-centred work is considered a core competence in PHC [29,31]. …”

Section: Discussionmentioning

confidence: 99%

Priority setting in primary health care - dilemmas and opportunities: a focus group study

et al. 2010

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BackgroundSwedish health care authorities use three key criteria to produce national guidelines for local priority setting: severity of the health condition, expected patient benefit, and cost-effectiveness of medical intervention. Priority setting in primary health care (PHC) has significant implications for health costs and outcomes in the health care system. Nevertheless, these guidelines have been implemented to a very limited degree in PHC. The objective of the study was to qualitatively assess how general practitioners (GPs) and nurses perceive the application of the three key priority-setting criteria.MethodsFocus groups were held with GPs and nurses at primary health care centres, where the staff had a short period of experience in using the criteria for prioritising in their daily work.ResultsThe staff found the three key priority-setting criteria (severity, patient benefit, and cost-effectiveness) to be valuable for priority setting in PHC. However, when the criteria were applied in PHC, three additional dimensions were identified: 1) viewpoint (medical or patient's), 2) timeframe (now or later), and 3) evidence level (group or individual).ConclusionsThe three key priority-setting criteria were useful. Considering the three additional dimensions might enhance implementation of national guidelines in PHC and is probably a prerequisite for the criteria to be useful in priority setting for individual patients.

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Section: Discussionmentioning

confidence: 99%

Priority setting in primary health care - dilemmas and opportunities: a focus group study

et al. 2010

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“…Empowerment in such cases enables a productive partnership with a physician that leads to positive health outcomes [4]. Conversely, a dysfunctional PERP appears when self-efficacy, control, and competences are exerted in a strategic way in which the physician is no more than a means to the patient’s end [38]. This opens the possibilities for the patient to perform manipulative tasks to obtain the treatment that he or she wants without negotiating with the physician such as (1) to exert anger and rejection [39], (2) to intentionally undermine authority [40], (3) to simulate disease, or (4) to assume an authoritative role [5].…”

Section: Introductionmentioning

confidence: 99%

Impact of Social Processes in Online Health Communities on Patient Empowerment in Relationship With the Physician: Emergence of Functional and Dysfunctional Empowerment

Petrič¹,

Atanasova²,

Kamin³

2017

J Med Internet Res

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BackgroundSubstantial research demonstrates the importance of online health communities (OHCs) for patient empowerment, although the impact on the patient-physician relationship is understudied. Patient empowerment also occurs in relationship with the physician, but studies of OHCs mostly disregard this. The question also remains about the nature and consequences of this empowerment, as it might be based on the limited validity of some information in OHCs.ObjectiveThe main purpose of this study was to examine the impact of social processes in OHCs (information exchange with users and health professional moderators, social support, finding meaning, and self-expressing) on functional and dysfunctional patient empowerment in relationship with the physician (PERP). This impact was investigated by taking into account moderating role of eHealth literacy and physician’s paternalism.MethodAn email list–based Web survey on a simple random sample of 25,000 registered users of the most popular general OHC in Slovenia was conducted. A total of 1572 respondents completed the survey. The analyses were conducted on a subsample of 591 regular users, who had visited a physician at least once in the past 2 years. To estimate the impact of social processes in OHC on functional and dysfunctional PERP, we performed a series of hierarchical regression analyses. To determine the moderating role of eHealth literacy and the perceived physician characteristics, interactions were included in the regression analyses.ResultsThe mean age of the respondents in the sample was 37.6 years (SD 10.3) and 83.3% were females. Factor analyses of the PERP revealed a five-factor structure with acceptable fit (root-mean-square error of approximation =.06). Most important results are that functional self-efficacy is positively predicted by information exchange with health professional moderators (beta=.12, P=.02), information exchange with users (beta=.12, P=.05), and giving social support (beta=.13, P=.02), but negatively predicted with receiving social support (beta=−.21, P<.001). Functional control is also predicted by information exchange with health professional moderators (beta=.16, P=.005). Dysfunctional control and competence are inhibited by information exchanges with health professionals (beta=−.12, P=.03), whereas dysfunctional self-efficacy is inhibited by self-expressing (beta=−.12, P=.05). The process of finding meaning likely leads to the development of dysfunctional competences and control if the physician is perceived to be paternalistic (beta=.14, P=.03). Under the condition of high eHealth literacy, the process of finding meaning will inhibit the development of dysfunctional competences and control (beta=−.17, P=.01).ConclusionsSocial processes in OHCs do not have a uniform impact on PERP. This impact is moderated by eHealth literacy and physician paternalism. Exchanging information with health professional moderators in OHCs is the most important factor for stimulating functional PERP as well as diminishing dysfunctional PERP. Social s...

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“…As Kushner describes this traditional model, "the relationship between physician and patient is one where the controlling expert relates to the patient as an object to be carefully observed, evaluated, and expediently dealt with by effecting a cure." 20 Pellegrino also says:…”

Section: Robert Makusmentioning

confidence: 99%

Ethics and Internet Healthcare: An Ontological Reflection

Makus

2001

Camb Q Healthc Ethics

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Recently, when I was diagnosed with an incurable and terminal bone marrow disease, I was dismayed to hear my doctor tell me that there were only three treatments available, two of which were unavailable to me because of my already frail condition. Furthermore, only 15% of patients responded at all to the third treatment, which would not cure but only impede the development of the disease. My response was to verify this information by going to the World Wide Web, and to my delight I found some 20 other treatments (albeit experimental) that my doctor had not mentioned. My experience typifies one of the significant advantages to patients arising out of the development of Internet medicine, and particularly of web sites devoted to health issues: Information previously parceled out by one's doctor is now easily available to anyone with access to a computer.

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Doctor-patient relationships in general practice--a different model.

Abstract: cent of patients seek medical services for something that the physician is socially or politically copyright.

Cited by 18 publications

References 0 publications

Priority setting in primary health care - dilemmas and opportunities: a focus group study

Priority setting in primary health care - dilemmas and opportunities: a focus group study

Impact of Social Processes in Online Health Communities on Patient Empowerment in Relationship With the Physician: Emergence of Functional and Dysfunctional Empowerment

Ethics and Internet Healthcare: An Ontological Reflection

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