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Lecture 9

ANTHROP 3HI3 Lecture Notes - Lecture 9: Patient Participation, White Coat, Enculturation

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ANTHROP 3HI3 Lecture 09
February 4, 2016 February 4, 2016
Priscilla Medeiros, 1
Physician-Patient Interaction
Discussed in class next Thursday (February 11th)
Even if doctors and patients are from the same background, they still view health in very
different ways that are based on their every day interactions
Disease A Practitioner’s Perspective
*The individual experience is incomplete without the practitioners account of health
Practitioners gradually acquire a perspective on ill health through experience
o An individual learns the characteristics and norms of a culture by a group or
another individual
Practitioners have a high social status, and a socially legitimized role as a healer
creating certain standards
Medicine’s approach has been humanitarian
o Main concern has been to treat illness and prove human welfare and alleviate
human pain and suffering
o Scientific rationality hypotheses must be able to be tested under objective,
empirical and controlled situations
o Practitioner serves the purpose of legitimizing a patient’s experience in society
Need a more holistic approach social, cultural, and psychological
o Factors such as an individuals personality, culture, socio-economic status and
beliefs are largely considered irrelevant in biomedical diagnoses
Physician-Patient Relationship:
Based on trust step towards creating more patient-centred care
o Need to listen to the patient and extract their narratives this is the main goal of
the patient-physician relationship
Central in the diagnosis and treatment of illness and disease
Care is respectful of and responsive to individual patient needs and preferences
Focuses on addressing the patient as a whole person
o Incorporating family and friends
o Understanding verbal and non-verbal cues
o Engaging in discussions around the social implications of illness and disease
o Understanding the implication of lifestyles
Is a continuous relationship at all stages of life
o It is constantly changing and adjusting
o Biotechnical skills and intrapersonal skills are required by a physician to help the
o “Negotiation” is continued by the two individuals in order to communicate the
requirements of both
o This negotiation is on going it never ceases
Fundamental Elements of the Relationship:
o 1. The patient has the right to discuss their care
o 2. The patient plays a pivotal role in health care decisions
o 3. The patient has the right to courtesy, respect, dignity, and responsiveness
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ANTHROP 3HI3 Lecture 09
February 4, 2016 February 4, 2016
Priscilla Medeiros, 2
o 4. The patient has the right to confidentiality
§ Physicians should not reveal information without the consent of the
patient unless required by the law or to protect the patient
o 5. The patient has the right to continuity of health care
§ Physicians may not discontinue treatment without providing the patient
with sufficient information for alternative treatments
o 6. The patient has a basic right to adequate health care
§ Dependent on society providing resources so that no patient is deprived
of necessary care because of their inability to pay for treatment
Physician-Patient Negotiation:
Important for obtaining information needed for diagnosis
Important for maintaining practitioner-patient relationships
Helps patients feel comfortable in communicating their health concerns
Leads to culturally competent care and the resolving of differences
o Establishing goals in treatment and resolving differences between the individuals
Result of poor negotiations is the practitioner ignoring the requests of the patient and
imposing their understandings of health and disease on a patient which can result in
non compliance
o Shared decision making must occur between both parties
o Patients play a pivotal role in their care every step of their care
§ Physicians should show respect for patient and understand their
Elements of Negotiation:
o 1. Prepare the environment
o 2. Prepare oneself
o 3. Observe the patient
o 4. Greet the patient
o 5. Begin the interview
o 6. Detect and overcome barriers to communication
o 7. Survey problems
o 8. Negotiate priorities
o 9. Develop a narrative thread
o 10. Establish the life context of the patient
o 11. Establish a safety net
o 12. Present findings and options
o 13. Negotiate plans
o 14. Close interview
Strengths and limitations of these steps:
o Does it ever remove the individual from the center of patient-focused care?
o Not every interaction will be able to flow through these steps
§ Emotional aspects
§ Interruptions from outside sources, etc.
o Social influences and contexts that prevent the physician from being able to
adapt to the steps
o Doctors become robotic when there are so many patients that they have to see
everyday it becomes hard to individualize patients, and easier to simply
diagnose the patient biomedically
Main reason for engaging in negotiations:
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