An analysis of the doctor-patient relationship using Patch Adams.
An analysis of the doctor-patient relationship using Patch Adams. Influences on patients' ratings of physicians: Physicians demographics and personality. An Analysis of the Doctor-Patient Relationship Using Patch Adams . Influences on patients' ratings of physicians: Physicians demographics and personality. J Sch Health. Apr;78(4) doi: /jx. An analysis of the doctor-patient relationship using Patch Adams. Pettit ML(1).
The impressive success of technology has simply pushed the classic skill of communication into a seemingly minor role in patient care. In addition, the reward system which willingly pays much more for a simple manual procedure than for cognitive and interpersonal activities, delivers a similar message. And the patient population confirms this set of priorities. When presented with a large bill for cognitive services one may hear: This societal change has not bypassed the physicians, perhaps making them less empathic and sensitive to the needs of others.
Virtually all studies that have been done to examine which physicians are prone to being sued for malpractice have come to the same conclusion. Perhaps the major factor is a failure in physician—patient communication.
This has been called an evolution from physician-centered medicine to patient-centered medicine. Not all physicians welcomed these changes. Some felt threatened by the concept that patients might question their advice. But in essence they have had no choice. A societal revolution has enveloped them, and, willingly or not, the world had changed. These behaviors were neither defined nor taught. Yet the value of empathic communication with patients was not all that new; it had been discussed impressively many years earlier.
Its classic admonitions retain eternal validity. But serious research on the impact of good physician communication began to flourish only years later. The serious deficiencies in physician communication skills were highlighted by Korsch and her colleagues 10 — 11 and by numerous subsequent researchers. That patients felt better if the physician communicated well was not surprising. But many other tangible benefits have since been described.
But not only will more information be elicited, but patient compliance will be increased, 22 and the objective patient response to therapy will be enhanced. Similarly the Accreditation Council for Graduate Medical Education has placed specific emphasis on the teaching and evaluation of communication skills in all approved residency programs. Detailed curricula are readily available from many different sources, 28 — 30 and I will not present specific data but rather some general observations.
As in other areas of medical education one needs to address the triad of knowledge, attitudes, and skills. The primary emphasis in communication teaching should obviously be on skills to be developed, but attention must also be paid to the provision of an adequate knowledge base and to the insistence on appropriate attitudes on the part of the student.
Many will argue seemingly logically that when the students start to prepare for their clinical clerkships they should get training in communication skills. My own strong prejudice is that the appropriate time to start is at the very beginning of medical school. There have been several studies depicting the socialization changes that medical students undergo during their studies.
The students are most receptive to learning about communication during their early years, when they still identify with the patients before they begin to identify more and more with the members of their profession.
At this early stage they do not yet know very much about diseases, and when they speak to a patient they can discuss with them mostly about what diseases do to them as human beings. In the beginning of their clerkships they are appropriately more concerned about learning physical diagnosis, pathophysiology, pharmacology, etc. Sadly studies have shown serious fall-offs in empathy as students move through medical school. During the training in the first two years of medical school the AAMC document 27 proposes three goals: But it is essential that teaching communication skills not be confined to the preclinical years.
In subsequent years there should be both enforcement of the material learnt earlier as well as instruction in dealing with more difficult and challenging communication problems, such dealing with the dying patient, the angry patient, and delivering bad news.
These are best taught in the related clinical settings. Thus such subjects as dealing with breaking bad news and the handling of difficult situations might well be part of the teaching in oncology, in the intensive care unit, or in the premature nursery. It is also essential to prevent the erosion of the attitudes and skills achieved in the early years by contacts with many role models who have not the appropriate attitudes and skills, yet have an active teaching role and influence.
Physicians must learn how to deal effectively with different cultures. It is important too that physicians learn how to communicate with patients who are handicapped by blindness, deafness, mental retardation, and psychiatric problems. Unquestionably professionals in the behavioral sciences, particularly the applied ones, have the specialized academic training in the field, rarely matched by most clinicians. However, for a whole variety of reasons, some good and some bad, it is critical to have practicing physicians in major roles in the teaching.
They have practical experience, and medical students relate better to them than they do to non-physicians. The more senior the physicians who play an active role in teaching communication skills, the more likely it is for students to take the teaching seriously. When teaching communication skills is left to junior house staff a clearly negative message is conveyed as to the priority assigned to such teaching.
When students see their own real-life performance on videotape followed by a non-threatening and constructive analysis by classmates and instructors this process has a powerful impact. Faculty development in the area of communication skills and teaching is essential, so that the messages of the teaching are not only not eroded but are reinforced all along the years in medical school.
In an era of managed care and increasing economic pressures on physicians, students will often point out that in real life one does not have enough time in the patient encounter to apply what they learn in the courses on communication.
Nevertheless there are data which show that more depends on the skill of the physician than on the time available. An experienced family physician has described the manner of proper and effective physician—patient communication even in a 5—7-minute patient encounter. Unless there is a serious evaluation process at each portion of the course there will be a tendency to slight the course. Students who do not demonstrate acceptable performance skills should receive remedial training until they achieve the appropriate level of performance.
The introduction of the clinical skills part to the United States Medical Licensing Examination USMLE process inwith a major component consisting of communication skill evaluation, has been very important in providing a message to medical students and physicians that these skills are essential sine qua non for practicing medicine.
The use of the computerized medical record has many advantages and is clearly here to stay. Communication between physician and physician is just as important a skill, which needs training, as that between physician and patient.
In addition, as medicine becomes more complicated and as more different professionals are involved in patient care, it behooves physicians to improve their skills in communication with other essential members of the health care team. The era of the solo physician is long gone, and success in patient management depends in no small degree on excellent relationships and effective respectful communication with other health care professionals. These areas too deserve attention.
Footnotes Conflict of interest: No potential conflict of interest relevant to this article was reported.
The Toronto consensus statement. Education Committee of the General Medical Council. Recommendations on Undergraduate Medical Education. General Medical Council; Association of American Medical Colleges. Learning Objectives for Medical Student Education. Guidelines for Medical Schools.
An analysis of the doctor-patient relationship using Patch Adams.
Association of American Medical Colleges; Consensus statement from the workshop on the teaching and assessment of communication skills in Canadian medical schools. Makoul G, Schofield T. Communication teaching and assessment in medical education: Changes in medical therapy during the past half century. Doctors and patients now at odds. New York Times; The relationship with malpractice claims among primary care physicians and surgeons.
Gaps in doctor-patient communication I: Doctor—patient interaction and patient satisfaction. Due to acute myocardial infarction, she is suddenly hospitalized. During the scene in which she talks with her son in the hospital, Bette asks that the true reason of what happened is not revealed to her husband Jake Tremont Jack Lemmon. She reveals prejudice regarding the age of the doctor in charge he looks about 30 years old and his outfits tight trousers and extravagant belt buckle.
The judgment of the elderly patient in relation to her doctor leads her to even distrust the diagnosis. Hippocrates said that to be good, the doctor should present the following characteristics: Among the many characteristics listed by the father of medicine, the dignified appearance was highlighted in the scene above and has been an element of research for doctors and medical students.
It is possible to assume that the old Bette was born in the first decades of the twentieth century, when all the societies influenced by Western standards ruled the use of more formal dress, with gloves and hats, for example.
Although not considering the specific characteristics of the dress pointed out in the scene, a study published in by Yonekura et al. Shorts and facial piercings were prominent items among those that caused most discomfort in patients.
New Movie, Value of Doctor-Patient Relationship
The results showed that Brazilian patients, medical students and doctors developed a better initial impression of physicians who wore traditional dress associated with the profession and more conventional appearance. Brandt 9 brings other interesting points on the subject. On the contrary, although the appearance may be important at the initial and immediate moment of the contact, the behavior demonstrated by the professional during the consultation is the determining factor for the final evaluation of the care received.
Balint shifts the professional from the only passive role to an active one, provided that in the right proportion, evidencing this focus on sentences as the medicine most used in medicine is the physician himself, who, like other medications, needs to be known in his dosage, reactions side effects and toxicity Humanism is innate to the medical profession.
The arts are for the physician a necessary companion that assures his vocational identity The doctor Jack McKee William Hurt is a successful and wealthy surgeon who shows arrogance in his professional attitudes. When diagnosed with throat cancer, he gets to know other patients in the same condition, living on the other side of the doctor-patient relationship. The film shows the awakening of a middle-aged doctor to the importance of affection and compassion in professional care, radically altering his behavior and sensitizing him to a new vision of medicine.
The film also portrays a general practitioner of the family who is elderly. Porto 12 says that the doctor-patient relationship arises and develops during the clinical examination, given its quality depends on the time and attention it devotes to the anamnesis, a task that no machine can perform with the efficiency of the interview. The diagnostic decision goes beyond the sum of the different results of the complementary tests.
The clinical method is characterized by its ability to see the patient as a whole, presenting sensitivity that no other method has. The general practitioner in question is a good example of the fact that the first pillar of research is the physical examination.
However and probably because he valued the opinion of his patient that it was a simple throat infection, he ended up missing the cancer diagnosis by not requesting laboratory and imaging tests. The valorization of scientific knowledge must be accompanied by the humanized reception of the patient, so that the medicine is effective.Patch Adams (3/10) Movie CLIP - Patch Earns His Nickname (1998) HD
Patch Adams After attempting suicide, Hunter Adams Robin Williams admits voluntarily in a sanatorium and, while helping other inmates, discovers that he wishes to be a doctor. He started his undergraduate medical course applying unconventional methods to his patients. It also emphasizes the importance of listening to what the patient says and feels at that moment in which he is so vulnerable.
The doctor- elderly patient relationship is portrayed in an unusual way when Patch helps his roommate, Mitch Philip Seymour Hoffmanto persuade patient Aggie Kennedy Ellen Albertini Dow to eat.
Thus, it demonstrates that the humanization in the care and in the reception of the elderly patient is essential tool to be successful in the treatment. Miranda 13in his article on the doctor- elderly patient relationship, argues that the complexity of the human being, the connection between reason and will, feelings and tendencies, their history, their projects and their families are what make the patients biopsychosocial beings.
The more the doctor knows and respects this reality, the better he interacts with his patient; in this case, the frail elderly. This posture is what makes Patch stand out from his colleagues. Requiem for a dream The actress Ellen Burstyn plays the middle-aged character Sara in a melancholy way that shows what the human being is capable to do to achieve their dreams. The doctor is negligent and does not give attention to Sarah, who develops withdrawal syndrome.
Even in the face of this situation, the professional continues to prescribe abusive and unnecessary amphetamines. Amphetamines are stimulants of the central nervous system that can generate euphoria, maintain vigilance, act as anorexigenics and increasing the autonomous activity of individuals. They were synthesized in the laboratory, sinceto combat obesity, depression and nasal congestion. According to Muakad 14some are can act on the serotonergic system.
This becomes clearly noticeable in scenes in which the character presents mood instability, anxiety, verbiage, chills, sweating and insomnia. The continuous use of amphetamine leads Sara to neuronal degeneration and amphetamine psychosis, and the character ends up having constant visual and auditory hallucinations. The doctor-patient relationship portrayed in the film is unacceptable. There is no care or attention with the patient, establishing only a contract of interests money for illegal prescription between a middle-aged patient who idealizes a dream and a reckless doctor, making her totally dependent of the drug and leading to disastrous consequences.
His doctor and friend Marcello Marcello Ottolenghi quickly examines Gianni when he reports a left shoulder pain radiating to the side of the left upper limb, triggered by physical exertion. He makes the clinical diagnosis of stable angina, but does not request complementary tests, only prescribes medications and changes in lifestyle. He also takes advantage of the meeting with Gianni, even if he is in this condition, to ask you for your favor: Luigi takes advantage of Gianni.
In the relationship between the two, there is the bond of friendship, but the doctor acts irresponsibly, once he submits him to the situation of greater stress, for having to take care of one older woman alone and, in addition, underdiagnoses his health, making therapy difficult.
According to the Medical Code of Ethics, in practicing the profession, the physicians should, in obedience to the ethical principles guiding their activity, ensure and work for the perfect ethical performance of medicine and for the prestige and good reputation of the profession. The article 40 of the aforementioned Code also states: The physician is forbidden to take advantage of situations arising from the doctor-patient relationship to obtain physical, emotional, financial or any other advantage In this movie, the non-valorization of the clinical state presented by Gianni, the patient, and the lack of care and attention can be characterizes as medical negligence, in a situation that, essentially, should be the opposite: The inertia and passivity in front of the picture of angina become even more unpleasant when the doctor overcharges his friend by asking him such a favor.
During the evolution of the disease, among the facts portrayed, he forgets the phone number of the love of his life. The way the physician conducts his care, it is noteworthy the establishment of a relevant trust relationship. To perform the diagnosis he applies cognition tests involving dates, seasons and car models, with questions asked in a persistent, but gentle way. The person is not only a person, but a corporal person 17says Julian Marias, quoted by Miranda.
We are also our body and therefore we find ourselves limited in time and space. The temporal dimension of the human being is its central feature. Man struggles with time, tries to leave it behind, to be above it - the first way to try to overcome it is to keep memories of the past, and the second is to wish to convert the present into something permanent In this sense, the preservation of the autonomy for the health of the elderly, by stimulating the constant reconstruction of the memory, is of extreme importance.
According to a recent scientific Discovery, exercising can contribute to a brain that resists better to the phisycal shrinkage, in addition to stimulating cognitive flexibility. Shi Mija Jeong-hie Yuna year-old lady, lives in the countryside of South Korea, where she raises her teenage grandson.
On a visit to the doctor, she complains of tingling in her right arm and of constant forgetfulness. The doctor prescribes light exercises for the muscles and requests tests. In addition to completing her pension working as a caretaker of a middle class gentleman who had suffered a stroke, she enrolls in a course of poetry and goes on to attend poetry reading and karaokes.
These activities contribute to maintain a productive routine, essential for brain plasticity. Thus, in suggesting the practice of exercises for a year-old woman, the doctor contributed not only to increase her blood flow, but also to the appearance of new vessels and new brain cells 21providing a holistic improvement of the condition.
The doctor-patient relationship, although only briefly in the film, is an example of the attentive look of the physician towards the elderly patient. It was the valorization of one of the less important complaints of Mija that led to the correct diagnosis of the disease.
Grumpy, the former housekeeper appears lying on the stretcher of a hospital corridor, refusing to be attended by a black doctor and asking the nurse to be looked after by an English doctor.
The nurse provides the English doctor who, to her surprise, has Indian ancestry.
He suggests, then, surgery with placement of prosthesis in femoral head executed in pilot project outsourced in hospital in India. The film does not explain why the character needs this surgery. However, one of the main diagnostic hypotheses, in the absence of reference to falls and due to the fact that Muriel is moving in a wheelchair, is osteoarthritis, a disease marked by cartilage degeneration and surrounding structures, pain and progressive loss of joint mobility.