[Psychological aspects of the professional-patient relationship].
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This paper addresses a neglected area of medical student education--terminating the doctor-patient relationship. Rich clinical teaching opportunities are lost when educators fail to illustrate the significant emotional aspects of ending this highly personal affect-laden experience. The author explores these teaching opportunities through examination of elements of doctor-patient relationships, professional development, unresolved doctor-patient conflicts, role underevaluation, patient gifts, and referral procedures.
The Orange County Department of Mental Health developed a code of ethics to give its variety of employees a single set of standards for patient care and professional behavior in a community mental health program. The need for the code grew from problems of role definition and interdisciplinary collaboration that repeatedly arose during the program's development. General principles for the code were extracted from various professional codes, from issues arising in the day-to-day workings of the program, and from existing laws. The code, presented here, defines principles related to confidentiality, professional conduct, quality of service, moral and legal standards, clients' rights, and therapist-client relationships.
In summary, the physician's duty to inform has been described and discussed. The minority and majority rule have also been defined and analyzed along with the major causes of physician failure and resistance to disclose risks. In a proper physician-patient relationship, informed consent controversy should be rare. A calm, clear, direct and properly documented disclosure of risks of a procedure is the best defense in any jurisdiction.
PURPOSE: To analyse subjective experiences of power of adults with noncommunicable diseases in relationships with healthcare practitioners as well as underlying facilitators and barriers of these experiences. METHODS: Systematic review (4 databases) of experiences using reflexive thematic analysis underpinned by critical realist approach. The analysis was conducted with an abductive reasoning using previous theories on social power as well as retroduction. RESULTS: Based on 24 studies, we formed three themes, which depict experiences of power as 1) the position, equal ability and freedom to make one's own choices and (re)negotiate within shared dialogue, 2) the ability to use knowledge to claim one's rights, 3) resistance. Facilitators were connected to acknowledgement as an equally valuable individual, positive healthcare practitioner attitudes and actions towards patient activity and views, safety in the relationship as well as to sufficient, clear and varied information. Main barriers were experiences of dehumanisation, negative healthcare practitioner attitudes and actions, perceived or assumed practitioner domination in interactions, lack of or incomprehensible knowledge and testimonial smothering. CONCLUSION: Results suggest that adults with noncommunicable diseases may experience power primarily as a positive power: being acknowledged as having legitimate position to make decisions and being in possession of varied knowledge through which they can gain agency to protect and claim their rights, by resisting, if necessary. Healthcare practitioners are in key position to support these experiences through positive transforming actions, while knowledge asymmetries, persistent inequality and paternalistic structures continue to hinder it.
With growing emphasis for ethical behavior of professionals in contemporary American society, those mental health specialists involved in the community must focus on their own behavior. This becomes a difficult task, since it is apparent that current ethical guidelines for community psychologists are not comprehensive enough to be adequately helpful. Nine areas of conflicting values and ethical concerns are considered in an effort to begin formulation of a blueprint for community mental health workers. These areas include community participation, continuity of services, politics, planning, autonomy versus manipulation, overism, minority groups, training, and consultation. Ethical principles generic to each area are put forth as proposed guidelines for professional activities and as propagators of discussion and debate.
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1. Research is an important area within the purview of medical ethics. The Nuremberg Code and the Helsinki Declaration provide well established guidelines in this field. 2. Specific ethical issues still requiring clarification in psychopharmacological research are the informed consent, the benefit/risk ratio and the choice of placebo or standard. 3. Peer review committees, if well chosen for their objectivity, general competence and special expertise, are likely to be the best arbiters regarding such questions. 4. Legislation and other political interventions--unfortunately not always objective, competent or expert in the exercise of their powers--have recently developed into rampant paraethical problems that are plaguing medical treatment and research in many parts of the world and need to be dealt with urgently through internationally coordinated efforts. The WHO would appear to be the most appropriate agency for such action.
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Thirty adults willing their body at death to medical science were compared on a number of personality variables with 30 nondonors, both groups equated for age, education, and socioeconomic status. Donors are internally directed, masters of their fate; nondonors rely on chance or luck to explain outcome. A more definite body image characterizes donors while nondonors are more concerned about body integrity. Donors accept their mortality while nondonors worry more about death. At the fantasy level donors display more hostility, depression, and guilt, and the prospective act of donation may represent an attempt at atonement. Donation represents a convenient and socially acceptable outlet for expression of humanitarian needs by donors.
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Thirty-two relatives of cadaver kidney donors were interviewed six months or longer after the donor's death. Most had positive attitudes to kidney transplantation that had been strengthened by experience, especially when they knew that they were fulfilling the donor's wishes. Twenty-three of the relatives had gained some solace from knowing that others might benefit from their misfortune, but three claimed adverse effects. In identifying the factors that influenced them to grant permission or hesitate, relatives revealed defects in the way their permission had been sought. Twelve did not clearly understand the donor's hopeless prognosis until then, and seven reacted adversely to the interviewers, finding them blunt and callous. Nevertheless, most were pleased that they had been asked. Doctors who care for unconscious, dying patients should try to give relatives explicit information on the patient's condition, whether or not the patient is a potential kidney donor, and permission for organ recovery should not be sought until they understand that death is inevitable.