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MED ETHICS | Professionalism: Physician-Patient Relationship

Helen T. Ocdol, MD || September 25, 2017
Block 2

TOPIC#OUTLINE# Table! 3.! Group# 3s# identification# of# negative# and# positive# points# from#
the#video#segment.#
I.# Definition#of#Terms#
II.# Movie#Segment:#Wit# Negative# Positive#
A.##Class#Reaction#Activity# o#Less#eye#contact# o#Introduced#himself#
B.##Doctors#Examples# o#Asked#closedEended# o#Same#level#with#the#
PPT# # # Audio& & &&&&&&&&&&&Trans 2020# questions# patient#
! o#Asked#double#barrel# o#Explained#that#the#history#
DEFINITION!OF!TERMS! questions# taking#is#part#of#the#
o#Asked#the#questions#too# protocol#
(From Trans 2020)
fast# o#Explained#the#outline#of#
#Professionalism collection of attitudes, values, behaviors o#Doesnt#allow#the#patient# what#he#will#do#
and relationships that act as the foundation of the health to#expound#more# o#Made#small#talk#
professions contract with society. This is about how you o#Sounded#nervous#and#
deal with the patients unsure#
#Empathy experience of understanding another persons o#Asked#the#questions#in#a#
condition from their perspective; an important dimension of disorganized#manner#and#
professionalism; necessary condition if a doctor wants to too#strict#in#the#sequence#
o#Showed#no#interest#
develop honor, integrity and respect for others. This is you
#
trying to understand what the patient's going through. 4.!Physical!Examination!(by!Group!4)!
#Altruism selflessness; principle or practice of concern for #Scenario:#Right#after#the#interview,#the#physical#exam#
the welfare of others. In short, being a good samaritan was#initiated#by#the#resident#and#very#awkwardly#assisted#
! Vivian#to#be#in#position.#Right#before#starting,#the#resident#
MOVIE!SEGMENT:!WIT! remembered#that#he#needed#a#nurse#inside#the#room#to#
Movie#summary:# proceed#with#the#physical#exam.#He#then#left#Vivian#
Vivian#Bearing,#PhD#is#an#English#professor#diagnosed#with# inside#the#room#in#a#very#awkward#position#while#he#ran#
ovarian#cancer#and#a#patient#of#Dr.#Kelekian#who#underwent# out#to#look#for#the#said#nurse.#
several#procedures#and#patient#interview#in#a#hospital.#The# #
video#clip#presented#several#unprofessional#acts#and#attitudes# Table! 4.! Group# 4s# identification# of# negative# and# positive# points# from#
addressed#toward#Vivian.### the#video#segment.#
Negative# Positive#
#Ethical issues during physician and patient encounter o#Showed#no#empathy# o# Draped#patient#w/#blanket#
o#Did#not#inform#patient#of# o# Went#to#find#female#
(From Trans 2020)
procedures#being#done# witness#for#PE#of#pelvic#
o#Patient preparation for examination o#Failed#to#build#rapport# area#
o#Conduct of ancillary procedures o#Did#not#ask#if#patient#was# o# Tried#to#build#rapport#
o#Patient interview comfortable# #
! o#Did#not#ask#if#patient#was#
Class!Reaction!Activity! comfortable#
1.!X@Ray!(by!Group!1)! #
#Scenario:#Vivian#Bearing#was#brought#in#the#XERay#room# Doctors!Examples!
where#she#was#interviewed#rudely#by#the#staff#before#the# 1.& Being&a&professional&is&being&on&time&and&respecting&the&
procedure.# time&of&your&patient&and&your&colleagues&&
# 2.& Being&a&professional&is&to&be&compassionate,&considerate&
Table!1.!Group#1s#identification#of#acts#of#unprofessionalism#and#points# and&kind&especially&with&the&patients&
on#how#to#act#professional.#
#e.g.&When&you&are&transporting&your&patient&never&just&
Unprofessionalism# Professionalism#
leave&the&patient&but&explain&to&the&patient&what&will&
o#No#eye#contact! o# Show#empathy# happen&and&where&you&are&going&
o#No#instructions#and# o# Respect#the#patient# 3.& Being&a&professional&is&respecting&everybody&in&the&
guidance! o# Be#clear#in#words# workplace&&
o#Rude! o# Establish#rapport# #E.g.&When&answering&a&business&phone&always&answer&
o#No#empathy!
with&proper&phone&courtesy&
o#No#rapport!
#E.g.&appreciate&and&be&thankful&to&the&information&or&
o#Did#not#put#patient#at#ease!
good&endorsements&given&to&you&by&your&colleagues&&
#
#
2.!CT!Scan!(by!Group!2)!
REFERENCES!
#Scenario:#Vivian#Bearing#was#then#brought#to#the#CT#
Scan#room#where#she#was#again#asked#of#her#identifying# #Movie#Clip:#Wit#
data.#Before#the#procedure#she#was#assisted#by#the#staff# #Group#Presentations#
to#the#CT#Scan#and#was#also#assisted#after.##Upon# #Trans#2020#
noticing#that#the#wheelchair#was#missing#the#staff#acted# #
rudely#and#expressed#that#she#must#go#to#the#trouble#of# QUIZ!
finding#it#for#her.# Identify#if#Professional#(P)#or#Unprofessional#(Un)#
#Reaction:#The#group#presented#that#the#patient#should#be# 1.#Leaving#the#patient#uninformed#and#haphazardly#in#the#
welcomed#with#respect#and#should#be#interviewed#with#a# hallway#
professional#attitude.#The#patient#should#be#assisted#and# 2.#Covering#the#patient#with#a#sheet#during#physical#exam#
ensured#in#comfort#at#all#times.# 3.#Talking#to#the#patient#with#respect#and#empathy#
# 4.#Conduction#of#procedures#fast#and#precisely#without#talking#
Table!2.!Group#2s#identification#of#the#negative#and#positive#points#in# to#the#patient#
the#segment.# 5.#Retrieving#identifying#data#upon#conduction#of#every#
Negative# Positive# procedure#
o#Does#not#explain# o#Guided#by#nurse#to#the# #
procedure#before#doing#it# CT#scan#room# Answers:#
o#Touching#or#moving#the# o#Assisted#patient#in#sitting# Un,#P,#P,#Un,#P#
patient#without#permission# position#after#the# #
o#Got#angry#with#the#patient# procedure# #
o#Used#sarcasm#while#doing# #
his/her#responsibility! #
# #
3.!Patient!Interview!(by!Group!3)!! #
#Scenario:#Vivian#was#sent#to#a#medical#resident#who#was# #
working#under#her#attending#consultant.#The#resident#was# #
her#former#student#in#one#of#her#classes.#Prior#to#the# #
interview#the#resident#tried#to#establish#rapport#and# #
proceeded#to#a#doctor#centered#interview.## #
# #
# #
#

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 MED ETHICS Professionalism: Physician-Patient Relationship

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APPENDIX!A!
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The Techniques of Skilled Interviewing
(From Trans 2020)

1.#Active listening the process of closely attending to what the patient is communicating, being aware of the patients emotional
state, and using verbal and nonverbal skills to encourage the speaker to continue and expand upon important concerns
#Minimize note taking and focus more on how the patient delivers his story
2.#Guided questioning use open-ended questions, not questions that are answerable by yes or no. Tell the patient to describe
his/her feelings.
3.#Nonverbal communication communication that does not involve speech occurs continuously and provides important clues to
feelings and emotions
#Allows you to read patient more effectively and send messages of your own
#Mirroring your position to the patient can signify rapport
#Moving closer or physical contact can convey empathy or help patient gain control of difficult feelings
#Close attention
o#eye-contact
o#facial expression
o#head position
o#movement (nodding, interpersonal distance, placement of arms and legs crossed, neutral, open)
4.#Empathic responses to express empathy, you must first recognize thepatients feelings.
#When you sense important but unexpressed feelings from the patients face, voice, behavior or words, gently ask: How do
you feel about that? or That seems to trouble you, can you say more?
5.#Validation validate or acknowledge the legitimacy of his emotional experience by stating something like:
#Being in that accident must have been very scary. Car accidents are always unsettling because they remind us of our
vulnerability and mortality. That could explain why you still feel upset.
#Helps the patient feel that such emotions are legitimate and understandable
6.!Reassurance
#Naiintindihan ko po kayo or I understand how you feel reaasures the patient and encourages him to talk more about his
condition.
7.! Partnering when building your relationships with patients, be explicit about your commitment to an ongoing partnership
#Some doctors give their personal phone numbers so patients can text them directly and ask them about medications or
procedures on what to do next
8.!Summarization this communicates to the patients that you have been listening carefully and clarifies the history
#Identifies what you know and what you dont know
# After giving summary, you can ask Anything else? to let the patient add other information and correct any
misunderstandings.
9.!Transitions as you move from one part of the history to the next and on to the physical examination, orient the patient with
brief transitional phrases like:
#Now Id like to ask some questions about your past health, to make clear what the patient should expector do next
10.! Empowering the patient help the patient gain confidence to his situation through the following principles of sharing power:
#Evoke the patients perspective
#Convey interest in the person, not just the problem
#Follow the patients leads
#Elicit and validate emotional content
#Share information with the patient, especially at transition points during the visit
# Make your clinical reasoning transparent

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