Doctor Patient Relationship Talcott Parsons Was The First Essay - Words
Talcott Parsons, the Sick Role and Chronic Illness published in fundamentally changing the doctor-patient relationship. But as the .. Chronic illnesses – from the s onwards more significant than acute illnesses - by definition exclude. No description Talcott Parsons viewed the doctor - patient relationship from a functionalist perspective. With Illness a form of deviance, the dr and patient had an obligation to society; to return to good health as quickly as. Doctor-patient relationship is a special kind of social relationship where by Talcott Parsons in s1. Importance of a good doctor-patient relationship. Clearly the major dissatisfactions which plaintiffs describe are that.
The value implications of these changes are of particular concern. Professionalism for nurses tends to emphasize intellectual and technical skills in an occupation whose major function has been as much the ministering of nurturant and humane care as technical prowess.
For the patient, the options seem to narrow as knowledge and technical skill increase. Whereas once it seemed reasonable to expect physicians to combine technical expertise with emotional sensitivity and skill, and nurses to complement them in both, now the patient gains equality and independence but with increasing emotional distance from caregivers.
Under the current conditions of healthcare, social workers would seem to have a strategic role. They are, after all, uniquely trained in the skills of interpersonal relations, and professionally are intended to function as the patient's advocate for well-being, both within the period of illness and in preparation for the recovery period.
Yet, here, too, the pressures for professional status take an ironic toll. A trend toward private practice with fee-for-service financial rewards attracts social workers toward professional status on the medical model and away from the team model in which their function is to balance the technical with the social.
The same value dilemma confronts all the healing professions. A polarization has developed between two orientations, one centered on the what of healthcare and the other on the how. The former has been called a reductionistic approach, emphasizing biomedical knowledge and technology; the latter is the "social ecology" or "humanistic" approach.
The values of these two approaches are significantly different. The more traditional, reductionistic approach is dominated by faith that all problems of health and illness have rational solutions, and by a dedication to competence in practice and to a community of science that transcends personal interest.
Patient, societal, and ethical issues are seen as matters of opinion not susceptible to rational discourse Pellegrino; Fox, The approach of social ecology, on the other hand, rests on a very different set of values.
The social and behavioral sciences and even the humanities are here as pertinent as the biological sciences; students are selected on the basis of social concern and interest in people and their problems; emphasis is on caring as much as on curing.
The community, not the university hospital, is the proper locus for the education of health professionals. Although one can say that neither of these approaches has sought or gained exclusive dominance, their differences are important enough to generate partisan claims from each about the failures of the past, the needs of the future, and the implications for patients and society.
Both the value of modern science and the critical need for enlightened social and ethical orientations can be found in the way national commissions are addressing the problems of today's healing professions Marston and Jones.
Summary and Conclusions The definition of the professions is the foundation of sociological analysis of the professional—patient relationship. Uniquely among modern occupations, a profession has been seen as an activity that requires extensive training based upon a continuously developing knowledge base coupled with the application of such knowledge for the general welfare of society. Therefore, although the rewards of professional life have been substantial, it is assumed that the professional is not free to exploit such skills and knowledge for personal gain alone, as other entrepreneurs may—the socalled principle of caveat emptor let the buyer beware.
On the contrary, the professional is granted unusual privileges involving access especially to the personal and biological privacy of patients, but only on an implicit contractual premise that such professional rights will conform to general rules of the welfare of society.
Medicine has been the primary subject of such analysis because it is seen as the archetype of professions. Virtually every person needs the help of healing occupations; the other classic professions, the law and the clergy, are not so ubiquitous. Therefore, a large sociological literature grew out of the study of medicine as a profession. However, the practice of medicine has changed radically in modern times and continues to change.
Research in the biomedical sciences is usually considered the major driving force of this transformation, but changes in the social organization of the delivery of health services, the application side of the medical profession, have been no less dramatic. In the wake of both the bioetchnological and application developments, new ethical issues have appeared and earlier ones have deepened.
II. SOCIOLOGICAL PERSPECTIVES
Bioethics as a separate discipline has grown significantly, very likely as a direct consequence of these changes. Sociology, meanwhile, has spawned its own forms of interest in medical ethics.
In part, sociologists have followed the tradition of individualism, which interprets behavior as a social psychological process determined by the values individuals learn and carry with them into social encounters. A different perspective emphasizes the material technologies and organizational constraints that dominate the therapeutic relationship.
For example, the bureaucratization of medicine has advanced, creating a situation in which both doctor and patient meet less as individuals than as members of groups. The resulting formalization has altered the emotional quality of the exchange and the nature of responsibility and accountability for those involved therein.
Conventional wisdom has suggested that the ethical problems of current therapeutic relationships are driven mainly by technical imperatives. Sociologists, in the main, however, have argued that bioethics is determined by the value context in which medical technology must be managed, not by the intrinsic qualities of the technology. The dilemmas—the extension of life at the sacrifice of quality of life, the increased efficiency of neonatology at the cost of disability—are seen as only part of the current medicoethical challenge.
Equally important is the unequal access to the benefits of technological advancement for populations that are disadvantaged by poverty, by race, or by other sources of discrimination. Pressures are increasing for comprehensive entitlement to medical care but, as in the past, the chances for such change remain in doubt.
As analysts have noted, the proportion of national income that will be invested in healthcare is both a value judgment and a product of the political process. As a result, David Mechanic writes: When faced with competing claims on national resources, government finds it easier to restrain growth in programs affecting the poor and disabled, who constitute relatively weak constituencies, than to reduce subsidies shared by large, articulate, and sophisticated segments of the larger American public.
Instead, the economists' model starts from the assumption of a mutual "utility-maximizing" agency contract between the doctor and patient Dranove and White, ; Buchanan, The patient is interested in maximizing consumption of health, and the physician is interested in maximizing income. The studies then focus on the effects of insurance, reimbursement and utilization control structures on doctor behavior, the doctor-patient relationship and the success of medical agency Eisenberg, ; Salmon and Feinglass, For instance, a number of studies have documented that patients without health insurance have less access to doctors, and receive less care from them when they have access Hadley, Steinberg and Feder, ; Kerr and Siu, Research has also demonstrated that different payment structures affect physician behavior Moreno, ; Rodwin, For instance, a recent study of Medicaid case-management found that pediatricians who received augmented Medicaid fees provided a higher volume of services to children than either a group receiving fees-for-service, or a group covered by capitation Hohlen, et al.
Another strain of economistic research picks up on the Freidson observation of physicians' power to define illness, and explores the degree to which physicians "induce demand. Communication and Outcomes Two trends led to the rapid growth of research on doctor-patient communication. The first trend was the interest of physicians and medical educators in improving their ability to elicit patient histories and concerns, and inform patients of their conditions and treatment needs, and thereby achieve successful diagnosis and treatment compliance.
Literally thousands of analyses of consultations have been done since the s to develop methods to teach and improve physician communication skills Stewart and Roter, A second trend, the rise of health consumerism, has encouraged more contractual and conflictual relationships between patient and doctor. An increasingly well-educated population has begun to challenge medical authority, and treat the doctor-patient relationship as another provider-consumer relationship rather than as a sacred trust requiring awe and deference Reeder, ; Haug and Lavin, Opinion polls indicate a steadily declining faith in physicians, and in the American medical system in general Blendon, The consumer, women's health Ruzek,the holistic health movements, and the perception of physician indifference and greed, have also encouraged patients to distrust physicians.
These trends were often portrayed by medical sociologists as democratizing Haug, ; Haug and Lavin, but perceived by physicians with alarm, especially in light of the rise of malpractice litigation. Encouraged by these two trends, symbolic interactionists Anderson and Helm, ; Strauss, and discourse analysts began detailed analyses of doctor-patient communication to tease apart the workings of power and authority within them.
In particular, Howard Waitzkin,has drawn attention to the way that American medical communication reinforces individualistic, bio-medical interpretations of problems with social origins and social solutions, and thus reflects and reproduces social inequality and disenfranchisement.
Doctor/Patient Relationship Talcott Parsons Was the First Essay
Another example is the work of Hayes-Bautista who studied the bargaining between the patient and the doctor over treatment. The patients were observed using "convincing tactics" of a demands, b disclosure that the treatment has not worked, c suggestions, and d leading questions. If these did not achieve the desired change in treatment, they turned to "countering tactics" of arguing that the treatment is too weak, too powerful or insufficient.
To augment their authority, the doctors used tactics of a wielding overwhelming knowledge, b medical threats about the consequences of ignoring advice, c disclosures that the treatment may take longer to work for the patient; or d a personal appeal to the patient as an acquaintance.
The outcome measures of this game theoretic situation were a continuation of the relationship, b patient termination of relationship, c physician termination, and d mutual termination.
Health care marketing became a third major impetus for studies of doctor-patient communication, largely with the goal of identifying the kinds of interactions that improved patient satisfaction.
Research found, not surprisingly, that people like to have doctors talk to them in an egalitarian way, listen, ask a lot of questions, answer a lot of questions, explain things in a simple way that the patient can understand, and allow patients to make decisions about their care DiMatteo, ; Hall, Roter and Katz, ; Roter, Hall and Katz,; Roter and Hall, ; Gerteis, Edgman-Levitan, Daley and Delbanco, Researchers also began to demonstrate that different patterns of communication have effects on the clinical outcomes of patient care.
NHS England » The sick role
The kinds of medical care that patients find satisfying tends to alleviate psychosomatic symptoms and make patients more compliant with their treatment regimes, and thereby produce better clinical outcomes Egbert, et al.
The Decline of the Professions and the Doctor-Patient Relationship To change the health system at all, much less to create a medical system which maximally utilizes self-help and mutual help and which encourages an active rather than a passive role for the patient, will require radical deprofessionalization. We will have to expand radically the use of community health aides; to spread medical knowledge to patients and to non-physician health workers; to minimize the social distance between doctors and patients.
I should emphasize that deprofessionalization has nothing to do with eliminating the skills of the doctors. Skills are of course needed, and I am not proposing that incompetent people perform medical services-we have too much of that as it is! It is the privileges, the power, and the monopolization of medical knowledge that I am speaking of removing when I speak of deprofessionalization.
Ehrenreich and Ehrenreich, But a number of social trends have converged to reduce the ability of patients to have these relationships with physicians. The critical theorists, in turn, have raised questions about whether radically different relationships, with radically different providers of care, might be possible and preferable.
Over-Specialization and the Decline of Primary Care One trend has been the rapid proliferation of specialization among American physicians.
Only one in ten American physicians are in "general practice" general or family practitioners, pediatricians and geriatricianswith a claim to a holistic approach to patients' concerns.
Many researchers assume that increasing specialization will continue to "technologize" and "compartmentalize" doctor-patient interaction. As patients see increasing numbers of poorly coordinated specialists for their myriad problems, the need for "case-managing" generalists becomes ever more acute. Declining Autonomy and Rise of the Organization Remaining independent of organizations, including insurance companies, unions and the government as well as hospitals, has been a consistent and explicit theme of physicians since the turn of the century.
Professional autonomy and independence is the most important factor in their satisfaction with their worklife. One early study was Freidson and Mann's analysis of and data collected from physicians in the nation's large group practices. They performed a factor analysis on all the variables in the study, both organizational and attitudinal, and discovered eight factors.
One of the factors they labeled "physician satisfaction," composed of several highly inter-correlated items: As people continue with their social obligations, medical professionals have to offer them choice of how and where to be treated, so that we do not replace the burden of disease with the burdens of treatment and access to medical advice.
Developments in technology and digital health will help minimise the need for face to face contact, but where it is needed, it should be at the convenience of service users rather than the convenience of the service. A cure will not be the goal of the clinician or person they are helping treat, and the optimisation of physiological parameters such as glycosylated haemoglobin will be only a means to an end.
Identifying and achieving the goals important to patients rather than medical professionals requires a care planning approach, by which the patient and professional act in partnership to identify goals and select the combination of treatments and services most likely to achieve them. We wrestled with the name of this panel: For more details go to: He has a particular interest in integrating physical and mental health. Before studying medicine on the graduate entry course at Oxford, he was a Fulbright fellow at Harvard University and a junior research fellow at Pembroke College, Oxford.