Regaining the initiative. Forging a new model of the patient-physician relationship

Balint, John A.; Shelton, Wayne

doi:10.1001/jama.275.11.887

Cited by 86 publications

(54 citation statements)

References 21 publications

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“…Only several decades ago, physicians tended to serve a largely paternalistic role in treatment decision making [22,23]. As the medical field advanced and developed additional treatment options (thus necessitating decision-making among available treatment options) and patients became more informed about their own healthcare [23], the emphasis shifted from physician paternalism to shared decision making.…”

Section: The Patient-provider Relationshipmentioning

confidence: 99%

Providers' roles in enhancing patients' adherence to pain self management

Dorflinger

Kerns

Auerbach

2012

Behav. Med. Pract. Policy Res.

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Practice guidelines and empirical research related to pain management encourage clinicians to take active roles in providing education about self management and promoting adoption of a self-management approach. The purpose of the study was to review the relevant literature, summarize aspects of the patientprovider interaction that influence patient engagement in self management for chronic pain, and outline practice recommendations in this area. Review of the literature on aspects of the patient-provider interaction that promote engagement in pain self-management was used. Findings are synthesized into recommendations for providers. Patients benefit from a biopsychosocial and patient-centered approach. Patients are more likely to fully disclose when providers respond empathically, which can improve conceptualization and treatment. Patient education and motivation play important roles in engaging patients in self management. Self management is influenced in part by the patient-provider communication process. Suggestions for communication strategies to facilitate patient engagement in self-management techniques, including empathic discussion of barriers and motivation enhancement, are provided. KEYWORDSChronic pain, Self management, Doctor-patient communication, Patient-centered care, Adherence Pain is one of the most common presenting problems in medical settings [1], and the majority of pain treatment tends to be carried out in the primary care context [2]. Pain that persists beyond 3 months and that does not remit with typical treatments for acute pain, such as rest, non-steroidal anti-inflammatory drugs, and heat or ice, is considered chronic pain. It is estimated that more than 100 million Americans have chronic pain [3], and prevalence in other countries varies from about 10-50 % of the general population [4]. Not only is chronic pain a prevalent health issue but it also significantly impacts quality of life [5][6][7][8] and the costs of care, and lost productivity are estimated to total almost $635 billion each year [3].Pain guidelines have recommended selfmanagement strategies in the treatment of chronic pain [9,10]. Self management differs from other treatments such as surgery and medication in that it emphasizes the patient's own control over his/her pain experience rather than relying on external factors to treat pain symptoms. At its most rudimentary level, self management consists of basic methods such as distraction, physical activity, and ice or heat to manage pain. Many patients use these practices on their own or are able to easily implement them after receiving reassurance and encouragement from their providers. Other patients may benefit from additional self-management techniques, such as those emphasized in cognitivebehavioral treatment for chronic pain, that aim to modify the thoughts and behaviors that contribute to the maintenance and exacerbation of pain. Such self-management skills include time-based pacing, relaxation, stress management, and identifying and modifying catastrophic ...

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Section: The Patient-provider Relationshipmentioning

confidence: 99%

Providers' roles in enhancing patients' adherence to pain self management

Dorflinger

Kerns

Auerbach

2012

Behav. Med. Pract. Policy Res.

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“…1 The quintessential character of the physician-patient relationship, however, has been diffi cult to defi ne, especially in the face of mounting societal pressures for fi scal constraint and population-based health care. 2 In any consultation several attributes of the physician-patient relationship may affect the outcome, including a longitudinal relationship between patient and physician (continuity of care) 3 ; concordance, or agreement, between the patient and physician on the problem or need and its management 4 ; patients' trust in their physician to act in their best interest; and the ability of the physician to enable the patient toward effective self-care (patient enablement). 5 Which of these aspects is most closely associated with outcomes of primary health care has not been established.…”

Section: Introductionmentioning

confidence: 99%

Physician-Patient Relationship and Medication Compliance: A Primary Care Investigation

Kerse

Buetow²,

Mainous³

et al. 2004

The Annals of Family Medicine

307

209

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PURPOSEWe assessed the relationship between 4 attributes of the physicianpatient relationship and medication compliance. METHODSWe conducted a waiting room survey of patients consulting 22 general practitioners in 14 randomly selected practices in Auckland, New Zealand (81% response rate). A total of 370 consecutive patients (75% response rate) completed survey instruments about 4 attributes of the physician-patient relationship. Continuity of care (assessed from use of a usual physician, length of continuity, and perceived importance of continuity) and trust in the physician were ascertained before the consultation. After the consultation the Patient Enablement Index measured the physician's ability to enable patients in self-care, and concordance between the patient and physician was measured by a 6-item inventory of perceived agreement about the presenting problem and management, were ascertained immediately after the consultation. Compliance with prescribed medication therapy was ascertained by telephone follow-up 4 days after the consultation.RESULTS Overall, 220 patients (61%) received a prescription, and 79% of these patients were taking the medication at follow-up. In a univariate analysis adjusted for clustering, only trust and physician-patient concordance were signifi cantly related to compliance. In analysis further adjusted for health and demographic factors, physician-patient concordance was independently related to compliance (odds ratio = 1.34, 95% confi dence interval, 1.04-1.72).CONCLUSIONS Primary care consultations with higher levels of patient-reported physician-patient concordance were associated with one-third greater medication compliance. An emphasis on understanding and facilitating agreement between physician and patient may benefi t outcomes in primary care.

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“…Una razón para esta aparente superioridad en comportamientos negativos observados en los médicos en formación es la libertad que puedan haber sentido los pacientes para contestar, conocedores de los fines del estudio y el anonimato de las encuestas. Goic postula que estos comportamientos presentes en los médicos en general pueden deberse a que "las bases éticas de la relación del médico con su paciente se han debilitado, probablemente por vacíos en la formación de los médicos en las Escuelas de Medicina y falta de reflexión de los profesionales respecto a sus conductas cotidianas" (25).…”

Section: Discussionunclassified

Nivel de satisfacción general y análisis de la relación médico paciente de los médicos en entrenamiento en las salas de hospitalización de medicina interna.

Fernández¹,

Sánchez²,

Linares³

2013

Rev Med Hered

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Revisar la relación médico paciente y conocer el nivel de satisfacción general de los pacientes hospitalizados con respecto a los médicos. Pacientes y métodos: Estudio descriptivo transversal. Se encuestó a 64 pacientes hospitalizados en las salas de medicina interna del Hospital Nacional Arzobispo Loayza en marzo de 2003. Se valoraron los niveles de satisfacción general de los pacientes con respecto a los médicos y su comportamiento. Se consignaron las variables clínicas y demográficas: edad, sexo, nivel educativo, nivel socioeconómico, empleo, estancia hospitalaria, tiempo de enfermedad mayor a un año, número de hospitalizaciones previas en los últimos 5 años, médico en entrenamiento identificado como su médico encargado y número de pacientes a su cargo. Resultados: La edad de los pacientes en promedio fue de 42 años, 56% fueron mujeres, 34% con educación primaria, 67% en el nivel socioeconómico E, 88% veía al interno como el médico en formación más próximo a él. El nivel de satisfacción general fue 82.8%, con niveles de satisfacción menores para las habilidades de comunicación con el paciente 73%, el ejercicio de la autonomía 31%, la consideración de la perspectiva del paciente y sus valores 21% y los aspectos psicosociales 18%. Conclusión: El nivel de satisfacción general es similar al evaluado en otros países, siendo necesario reforzar en los médicos en entrenamiento: las habilidades de la comunicación, el ejercicio de la autonomía de los pacientes, la valoración de la perspectiva del paciente y los aspectos psicosociales. (Rev Med Hered 2003;14: 175-180).

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Regaining the initiative. Forging a new model of the patient-physician relationship

Cited by 86 publications

References 21 publications

Providers' roles in enhancing patients' adherence to pain self management

Providers' roles in enhancing patients' adherence to pain self management

Physician-Patient Relationship and Medication Compliance: A Primary Care Investigation

Nivel de satisfacción general y análisis de la relación médico paciente de los médicos en entrenamiento en las salas de hospitalización de medicina interna.

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