The patient-physician relationship in the face of oncological disease: A review of literature on the emotional and psychological reactions of patients and physician

The physician-patient relationship is daily destabilized by emotional reactions and psychic defenses that cancer arises in the two partners. Continued scientific and technological progresses which were reached by medicine in recent years, and particularly oncologic clinical discoveries, increased the chance of not only survival but also healing. Nevertheless, cancer diagnosis is still a hard existential text that destabilizes everyday life, all the psychic and relational balance, inevitably causing a psychological and social change not only in the patient who is affected but also into the wide social network around him (family, friends, doctors, healthcare team). The aim of this review is to understand how problems, feelings, emotions, distresses or defense mechanisms could garble the relation and the communication dynamics between physician and patients and then prejudicing the efficacy of oncologic therapeutic compliance. Pubmed and Scopus were searched, using strings related to "cancer", "physician-patient relations", burn-out", "compliance", and "communication", identifying literature published from 2000 to January 2015. Extracted papers were assessed for their relevance (10 of 412 papers initially reviewed). Results indicate that a good and empathetic relationship between physician and patient were related to good therapeutic adherence. In particular, a good physician-patient relation maximizes the impact of clinical therapies and reduces psychophysical implications

Can This Marriage Be Saved?

Market forces in health care are paradoxically pulling physicians and hospitals apart and together at the same time. What are these forces and trends? Is the long-standing marriage of interdependence and productivity between them destined to fail, or can it be saved and even strengthened by emerging delivery and governance models in the so-called "market revolution" of consumer-driven health care? What are the implications for health care policy and practice? These are issues we explore in this Arizona Health Futures Policy Primer

Psychometric Properties of the Wake Forest Physician Trust Scale with Young and Older Adults

Trust is an essential component of any interpersonal relationship, but it is particularly integral to the patient-physician relationship. Patient-physician trust increases willingness to seek treatment, disclose sensitive information, adhere to medical recommendations, and share decision-making authority. While there have been developments in current research on the psychosocial variables associated with patient-physician trust, there continues to be the need for a psychometrically sound measure of trust, as well as a further need for psychometric evaluation of already developed measures. The purpose of the study was to reexamine a measure of patient-physician trust, the Wake Forest Physician Trust Scale (WFPTS), using more properly selected measures to obtain convergent and discriminant validity evidence as well as reliability evidence. Although the WFPTS was chosen due to its appropriate and comprehensive scale development process, construct validity evidence with an adult population was questionable and there was no reported validity and/or reliability evidence for an older adult population. Three hundred and forty English-speaking, community-dwelling adults were recruited to participate in this study. Data was collected with the WFPTS and measures of trustworthiness, patient satisfaction, decision-making, health locus of control, confidentiality, health, personality traits, and physician empathy to gather validity evidence for the WFPTS with adult and older adult samples. Measures of internal consistency also were obtained. Scores of the WFPTS exhibited satisfactory internal consistency and good convergent validity with significant, moderate to strong correlations with both the young adult and older adult samples. Discriminant validity evidence was also demonstrated with each age group based on weak relations with a measure of openness to experience. Findings from this study provide support for the psychometric properties of the WFPTS with young and older adult populations. These results also confirm the validity of data obtained with the WFPTS with young adults and provide support for the use of this instrument with older adults. Future directions for research with this instrument are discussed

Interprofessional communication with hospitalist and consultant physicians in general internal medicine : a qualitative study

This study helps to improve our understanding of the collaborative environment in GIM, comparing the communication styles and strategies of hospitalist and consultant physicians, as well as the experiences of providers working with them. The implications of this research are globally important for understanding how to create opportunities for physicians and their colleagues to meaningfully and consistently participate in interprofessional communication which has been shown to improve patient, provider, and organizational outcomes

Getting Obligations Right: Autonomy and Shared Decision Making

Shared Decision Making (‘SDM’) is one of the most significant developments in Western health care practices in recent years. Whereas traditional models of care operate on the basis of the physician as the primary medical decision maker, SDM requires patients to be supported to consider options in order to achieve informed preferences by mutually sharing the best available evidence. According to its proponents, SDM is the right way to interpret the clinician-patient relationship because it fulfils the ethical imperative of respecting patient autonomy. However, there is no consensus about how decisions in SDM contexts relate to the principle of respect for autonomy. In response, I demonstrate that in order to make decisions about what treatment they will or will not receive, patients will be required to meet different conditions depending on the approach proponents of SDM take to understanding personal autonomy. Due to the fact that different conceptions of autonomy yield different obligations, I argue that if physicians and patients satisfied all the conditions described in standard accounts of SDM, then SDM would undermine patient autonomy

In the eye of the beholder: mutual obligations and areas of ambiguity in the hospital-physician relationship

Internationally, many countries are increasing provider accountability for cost and quality of the delivered care. In this challenging environment hospital executives struggle to build effective hospital-physician relations. However, despite the importance of the hospital-physician relationship there has been little research which has examined how physicians and hospital executives describe the terms of their working relationship. This paper seeks to fill this gap by reporting findings of a qualitative study in which we explored the psychological contract between physicians and the hospital they practice at. In-depth interviews with physicians and executives (n=30) of three Belgian hospitals were performed. Our analysis of the transcribed interviews yielded a rich understanding of how physicians and hospital executives interpret and experience mutual obligations and areas of ambiguity within their psychological contract. We found that a distinction should be made between on the one hand administrative obligations (adequate operational support, responsive decision making processes and attractive facilities) and on the other hand professional obligations (clinical excellence and physician autonomous medical decision making). In addition, two areas of ambiguity could be identified reflecting both dimensions of the psychological contract. Firstly, physicians act as independent caregivers generating professional fees. A trade-off exists in their day-to-day interaction with the hospital. Therefore the interpretation about the way the care should be organized differs between executives and physicians. Secondly, hospital prospective financing systems lay the accent on cost-effective care from a societal perspective. In contrast, physicians are remunerated mainly by fee-for-service. The extent to which physicians should take into account the impact that their medical decisions have on the hospital bottom line varies. Our aspiration is that the findings of this study will assist in supporting hospital executives and physicians to build cooperative relationships needed to improve the quality and cost-effectiveness of current health care delivery

Situating care in mainstream health economics: an ethical dilemma?

Standard health economics concentrates on the provision of care by medical professionals. Yet ‘care’ receives scant analysis; it is portrayed as a spillover effect or externality in the form of interdependent utility functions. In this context care can only be conceived as either acts of altruism or as social capital. Both conceptions are subject to considerable problems stemming from mainstream health economics’ reliance on a reductionist social model built around instrumental rationality and consequentialism. Subsequently, this implies a disregard for moral rules and duties and the compassionate aspects of behaviour. Care as an externality is a second-order concern relative to self-interested utility maximization, and is therefore crowded out by the parameters of the standard model. We outline an alternative relational approach to conceptualising care based on the social embeddedness of the individual that emphasises the ethical properties of care. The deontological dimension of care suggests that standard health economics is likely to undervalue the importance of care and caring in medicine