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Physician and Patient Relationships

Updated on February 9, 2014

A Physician's Perspective

The extraordinarily varied population physicians come into contact with on a daily basis certainly presents a challenge. As human beings, we are all prone to negative judgments, whether they are simplistic and inadvertent or otherwise. In such a role, avoiding said discernments holds a great deal of importance. The desire to assist an individual and see to their best interest is, of course, the very definition of the Hippocratic Oath. Gender, race, and age among other factors are all aspects that can influence negativity in one’s approach in such circumstances. Not allowing these features to cloud procedural duty is integral to performing in the best and most ethical way.

A study was conducted in the vein of this concern. The experiment piloted was designed to find whether or not an individual’s socioeconomic status, age, or gender influenced overall clinical decision making. It also evaluated whether or not these same attributes of the physician influenced these factors in one noticeable way or another. Sixteen videotapes of doctor and patient encounters were created, all of which encompassed only two different disorders; depression and polymyalgia rheumatica. The individuals were randomly assigned and sported only four certain attributes among them. Ages were 65 or 80 years old, both genders were included, and some hailed from blue collar professions while others worked in white. From the northeastern United States, 128 eligible physicians were chosen and tested in this way. The specific results evaluated included the most likely diagnosis, probability of utmost certainty remaining in regards to said diagnosis, and the number of tests that would be ordered in regards to each individual.

The outcome of this study was an interesting one. The attributes of the patients had no bearing on the conclusions regarding testing or diagnostic criteria. Instead, the features of the physicians themselves seem to have had a considerable influence. This is in direct contrast with what Bayesian decision theorists would see as influential. The clinically extraneous characteristics of the practicing doctors seemed to persuade the eventual outcomes much more than the individual differences in those who came to them for help. The reasoning behind this unanticipated consequence could be widespread. First of all, every physician in and of themselves is an individual as well. While they worked through medical school and likely learned the same lessons, they still function as unique entities all their own. With that said, it is inevitable that their own personal perspectives and opinions will influence their work despite similar years of study. Physicians will always debate when presented with the same scenario, just as others would do the same in other careers. The distinctiveness of every individual person extends into what they do for a living and how they go about it. Fundamentally, this may work to explain the findings of this particular study.

Several epidemiological studies over the years have served to stand in contrast with these findings. They worked to estimate the contribution of certain patient attributes, such as age, ethnicity, and gender, to the distribution or prevalence of a broad range of disease groups. This is now referred to as social patterning. Being that some of these attributes are considered risk factors when it comes to such concerns as cancer or heart disease, they are integral to take into consideration when evaluating cause or origin in diagnosis. Because of this, it is clear how patient characteristics could in fact influence or sway a physician’s clinical choices. One of the best examples of this theoretical viewpoint is The Framingham Heart Study conducted in the United States. Several factors that could contribute to coronary heart disease were identified, such as its perceived increase in middle aged to older men. Medical sociologists seem to overlook these elements when attempting to evaluate the doctor-patient relationship as a whole. However, the previously mentioned and continually emerging decision theorists contend that these aspects cannot be ignored in such an analysis. These individuals challenge that the relationship itself should not be evaluated, but rather only the decision making in regards to the physicians themselves. Ideally, attributes that are epidemiologically associated with a medical condition should influence their decisions; according to this perspective. Clearly, it is not a factor that is sensibly ignored and it is perceptive to say in light of this information that it is a large part of the clinical diagnostic process. With this in mind, it may be reasonable to keep this at the forefront when attempting to evaluate a physician’s perspective on each individual patient; particularly considering that some personal attributes are statistically directly linked with certain conditions.

Overall, the two studies outlined seem to show two different sides to clinical decision making and the general physician approach to their relationship with patients. One focuses much more heavily on said rapport, closely evaluating the attributes and their effect on initial impressions and eventual diagnostic process. The other seems to go farther, including the statistical information regarding these characteristics and their connection to certain conditions. While the first study is rather in depth and brings up poignant reasoning, considering that certain attributes which have been linked rather directly to various life-threatening illnesses is not an integral portion of such an analysis is closed-minded. If they have enough bearing to be given attention in regards to overall diagnosis, it stands to reason that this information cannot be overlooked when assessing the doctor-patient relationship.

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