2) Models & Varieties of the Physician

• Basic concepts in medical ethics include models and varieties of the physician-patient relationship, theories of motivation, components of behavior, doctor and patient perspective, and models of Physician-patient relationship.
• The physician-patient relationship is fundamental for providing and receiving excellent care.
• The physician-patient relationship is under stress in the current healthcare environment due to health plans' cost-containment policies and patients' reliance on the Physician to have a contract with the NHIF.
• Principle for autonomy, described in the Lisbon Declaration, includes the following patient rights: Every patient has the right to choose his own doctor, Every patient has the right to accept or refuse treatment after having received information, Every patient has the right to accept or refuse participation in the study, and Every patient has the right to die with dignity.
• Respect for autonomy in medical ethics means that every patient has the right to receive further information from the doctor about the disease.
• Physicians should sit down, attend to patient comfort, establish eye contact, listen without interrupting, show attention with nonverbal cues, such as nodding, allow silences while patients search for words, acknowledge and legitimize feelings, explain and reassure during examinations, and ask explicitly if there are other areas of concern.
• The relationship between patients and doctors is often unstated and dynamic, and the kind of relationship that works best for a patient may change as conditions change.
• The physician - family relationship also holds considerable healing power, and there exists the potential to pursue options that can improve the quality of life and health for the entire family.
• Doctors and patients should choose a “relationship fit” that is most effective for their health outcomes.
• The effectiveness of the patient - physician relationship directly relates to health outcomes.
• The physician must respect the patients' right to choose a doctor and treatment.
• Communication in medicine is a basic human need that takes place in its three interrelated parts: perceptual, communicative, and interactive.
• A good doctor, according to a patient, is one who can recognize and manage anxiety in the patient, establish and maintain support, provide information and explanations about the various procedures, possible complications, etc.
• A bad doctor, according to a patient, is one who lacks social skills rather than professional skills, is unresponsive to patients' needs, and is less likely to keep the appointment or to arrive on time.
• Fiduciary relationship, derived from the Latin word for "confidence" or "trust", is the bond of trust between the patient and the physician that is vital to the diagnostic and therapeutic process and forms the basis for the physician-patient relationship.
• Occasionally, a physician may face requests for services, such as contraception or abortion, which raise a conflict for the physician.
• Physicians do not know what certain degree should they reach in communication
• While the physician may decline to provide the requested service, the patient must be treated as a respected, autonomous individual.
• The patient can challenge to unilateral decision making by physicians in reaching diagnosis and working out treatment plans
• Physicians do not have to provide medical services in opposition to their personal beliefs.
• Communication, office experience, hospital experience, education, integration, decision-making, and outcomes are the principal elements that are essential to the relationship.
• During the second half of the twentieth century, the physician - patient relationship has evolved towards shared decision making.
• Physicians can entirely know patient’s value
• Weak paternalism is when the patient can not give his informed consent due to age, incompetence.
• Consumerism can simplify the complicated relationship with “buyer and seller” relationship, is it good or bad?
• Reversing the very basic nature of the power relationship.
• Patients nowadays have higher education and better economic status
• Patients have been increasingly entitled to weigh the benefits and risks of alternative treatments, including the alternative of no treatment, and to select the alternative that best promotes their own values.
• The ability to question doctors
• Physicians need to work with the patient to articulate the problem and refine the request.
• The concept of patient’s autonomy
• In strong paternalism, the patient is competent to give his consent, but the doctor does not provide him with sufficient information.
• It is acceptable to have a nonjudgmental discussion with a patient regarding her need for the service, and to ensure that the patient understands alternative forms of therapy.
• The physician’s right to withdraw services formally from a patient if he or she feels it is impossible to satisfy the patient’s demand
• The physician - patient interaction ensures that patients receive the interventions that best promote their health and well - being
• Decisions can easily be made from a mutual and collaborative relationship
• Patients can fully understand what problem they are coping with through physicians’ help
• Despite receiving a variety of resource information, the patient refuses any medical intervention.
• Based on the principle of respect for autonomy, the doctor is not respected in the autonomous model.
• In the Interpretive Model, the aim of the physician - patient interaction is to elucidate the patient’s values and what he actually wants and to help the patient select the available medical interventions that realize these values.