The relationship between the doctor and a possible patient is established when the physician asks the person for the first time as how he could be of possible help. This direct and simple enquiry is the beginning of the trust of the patient that has to be put in the physician for any treatment to proceed. The patient is in need of help at that time, and has to trust the professional for getting the help and the patients want to do it. They need a person to take care of them during their period of suffering from illness. This relationship between the patient and the physician in the financial sphere also involves the same amount of reliance, confidence and trust, as otherwise, not treatment can be undertaken. This makes it essential that the physicians clearly mention to the patients when there is any conflict of interest in their relationship to the patients. (The Core Program: Trust and the Patient -- Professional Relationship)
How this relationship is explained in financial terms is however a very different matter and raises many questions for the professional as also for the patient. In the very beginning the patient has been asked the famous question and with his active reply, the patient has shown his trust in the physician. The continuation of the trust depends on the behavior of the physician, and he has to carry the relationship on. When the mutual trust is set up, only then can the relationship be expected to continue for a future relationship. This has been clearly mentioned in the writings of different authors and they have discussed in terms of virtue ethics. For the physician to continue the relationship he has to demonstrate his four main virtues of compassion, discernment, trustworthiness and integrity.
Whenever the question of trust comes up one has to keep two aspects of the physician in mind and the first of these is the capacity of the physician to solve the problem. The second part is the sense of morality that is built in the physician. The changes in the healthcare systems that have taken place have led to a situation where there is now no direct and personal relationship between the physician and the patient. The institutions stand in between and this makes the personal aspects of the physician less significant. He is just doing his job, and this has much less of a direct, moral question. The six essential elements that exist in the relationship between the physician and the patient still have to be considered. These are competence, compassion, communication, choice, continuity and avoidance of conflict of interest. The area most affected is in comprehensible communication and that lads to participative decision making by the groups of physician and patient that is most affected. This is also highly affected by the barriers between the patient and the physician in terms of socioeconomic differences. (The Core Program: Trust and the Patient -- Professional Relationship)
The importance of good communications between the physician and the patient has been highlighted by many experts in this field. The improvement in this is expected to increase the overall effectiveness of the treatment as also the acceptance by the patients of the rules for treatment that he is expected to follow. This matter has been further studied by physician and medical sociologist, Howard Waitzkin. According to him the most important factor in the relationship between the professional and patients happened due to their differences in terms of social class. This led him to study the subject in depth and he finally concluded that the professional generally controlled patients by not giving them the full information, and the amount of information that was communicated to the patient also depended a lot on the social class of the patient. This led to those from the upper middle class getting more information from their physician than patients belonging to the lower middle of working class patients.
The same differences have been explained by others in terms of social distance rather than in terms of economic distances. This means that where the social class of the patient and the physician and the patient were the same, they were more likely to share more information. When the professionals are asked about the same problem, they generally mention that the patients will not be able to understand, or that the patient will feel that the illness threatens their lives. This is not necessarily correct and recent studies have shown that many of the professionals are probably misguided in their assumptions of the competence of the patients, or make overestimates of their psychological impact from the information given by the physician. These harm participative decision making. (The Core Program: Trust and the Patient -- Professional Relationship)
According to medical research there have been studies showing that relationship centered healthcare increases the satisfaction of patients. This also improves the results that are achieved from the process of their treatment. There are many components in this process of treatment process and they can be listed as listening, shared decision making and maintaining a respect for each other. This also commits both the physician and the patient to continue on a plan of action that has been agreed on by them. At present there is no data regarding the medical administrative settings which will result in a relationship centered behavior of both. The attempt should be to make an effort to find out this component. For this purpose there was a group of 45 meetings that were conducted in different healthcare institutions. The aim of these meetings was to try to find out the frequency and types of relationship that were indulged in by the group leaders. (Health Administration Press)
The results showed that when female leaders were present, they praised largely the frequency and relationship centered behavior, and this was also accepted by others on a lower basis. Among other relationship centered behavior that were used for a lesser number of occurrences were giving a verbal summary of discussions. This responded to feelings expressed by members and set up specific, time bound objectives. There were also some associations that may raise the hackles of some. When the leaders were female, they generally received more grades in terms of satisfactions, whereas the male leadership provided more verbal reactions. Probably this is similar in physician and patient interactions, and there may be less of outside points that may come up if the agenda of the meeting is decided in advance. This sort of a study has not been conducted earlier in the history of medicine. The main result of the findings is to encourage the chairmen of meetings in these settings to use a collaborative approach and also decide on areas where they should focus. This however shows that more research is required on the subject to come to any final conclusion. (Health Administration Press)
Another great problem in the country is financial as one of six Americans does not have medical insurance, or insured for less value than what they require, or a Medicaid beneficiary or has special needs for healthcare. These persons are thus compelled to go through very complicated means to get the healthcare they require. These are composed of institutions, financing sources and programs that are combined in what is now called "healthcare safety net." The fact still remains that this is not a complete system and is nether comprehensive or integrated. This can be viewed from a total national angle and then one will find that there are many differences in this net based on locally important socioeconomic and political conditions. Factors in this are the strength and configuration of the economy of the state and its tax base, the total numbers of poor and uninsured as well as the…