PREPARED BY : AHMAD SAFUAN & SAQAR PRESENTED BY : NIK FARZANA BINTI NIK RAHMAT AIN SYAFIQAH BINTI CHE

E GHANI NUR FARAH ATIKA BINTI MOHD SAID

1-Doctor-Patient (DR-P) Relationship. 2-Types of Doctor-Patient (DR-P) Relationship. 3-Medical Confidentiality. 4-Doctors & Patients Barriers to Effective Communication. 5-Doctors Professional Role. 6-Breach of Confidentiality. 7-Rules for Disclosure. 8-Reasons to Disclose Information. 9-Ethical basis for getting info. 10-Conclusion.

Def : Special relationship created when a prospective patient seeks the advice, care, or treatment of a physician.
Also known as : Client-professional Practitioner-patient Lay-professional encounter The relationship between patient and physician, or should be, is fidelity or trust

Paternalistic: (or guidancecooperation) relationship, involving high physician control and low patient control where the doctor is dominant and acts as a parent figure who decides what he or she believes to be in the patients best interest. Mutuality : relationship is characterized by the active involvement of patients as more equal partners in the consultation and has been described as a meeting between experts. Consumerist: relationship describes a situation in which power relationships are reversed; with the patient taking the active role and the doctor adopting a fairly passive role.

 Two

major obstacles to good physician-patient communication

Difference of language If the physician and the patient do not speak the same language, an interpreter will be required.

Difference of culture Because of different cultural understandings of the nature and causes of illness, patients may not understand the diagnosis and treatment options provided by their physician. In such circumstances physicians should make every reasonable effort to probe their patients understanding of health and healing and communicate their recommendations to the patients as best they can.

So: a non efficient relationship can occur if patients

continue to adopt a passive role even when the doctor reduces some of his or her control, with the consultation therefore lacking sufficient direction.

Confidentiality:
is the right of an individual to have personal medical information kept private. Such information should be available only to the physician .

Medical confidentiality does not cover only what a patient discusses with a doctor

But also :
-Medical records.

-X-Rays. -Lab reports. -Communications between patient and doctor. -Communications between patient and other staff working with the doctor. All these confidentiality will still continue even after the death of the patient.

-Natural human desire for privacy. -Fear of social embarrassment or disapproval. -Fear of discrimination and stigmatization. -Information misused against patient. -Builds confidence and open communication. -Helps to reach the right diagnoses and provide optimal treatment recommendations. -Right to determine with whom, when and how much of personal medical information is shared.

-Lack of specific knowledge. -Lack of counselling skills.

-Lack of time. -Lack of appropriate resources.

-Educational level. -Sex. -Social class. -Different languages.

-Know about and understand the rights of patients. -Be able to communicate with individuals and groups. -Demonstrate the following attitudes and behaviour :

Accept the moral and ethical. Respect patients regardless of their lifestyle, culture, beliefs, race, colour, gender, sexuality, disability, age, social or economic status. Respect right of patients to be fully involved in care decisions, including right to refuse treatment or take part in teaching/ research. Recognise their obligation to understand and deal with patients' healthcare needs by consulting them (and their relatives or carers).

Maintaining confidentiality is difficult in modern medicine and usually it occurs due to carelessness of medical staff and there are many ways for breaching patient's information such as:Conversations in or out of the clinic. Computerized patient information. Release of medical records and disclosure of information. Fax and e-mail also present opportunities for confidentiality to be broken. Elevator chatter. Unguarded conversation with patients friends/relatives.

There are few situations where breach the confidentiality is justified. For examples :
Many individuals require access to a patients health records to provide adequate care to that person, and for students to learn how to practice medicine In different language used between caregivers and patients, there is need to disclose the information to the interpreters to facilitate information Other individuals need to be given information about the patient in case of incompetent patients to make decisions on their behalf and care for them

-Only use when absolutely necessary. -Use the minimum required. -Everyone should be aware of their responsibilities. -Understand and comply with the law.
-Getting explicit consent from the patient

1.Healthcare reasons. Parents (when child is unable to give informed consent). 2. Public interest. Where there is risk of serious harm or death to the patient or other people. 3.Required by law. Complaints committees Child abuse 4.Required by statutory -Drug addiction -Births and deaths

-Ethics, also known as moral philosophy, is a branch

of philosophy that addresses questions about morality that is, concepts such as good and evil, right and wrong, virtue and vice, justice and crime, etc.

Below are the ethical basis for withdrawing information from the patients : We shall respect the rights of patients, colleagues, and other health professionals and safeguard patient confidential and privacy within the constraints of the law Patients records, including even the identification of the patients, must be protected with extreme care.

 We

may release confidential information only with authorization of the patient or under proper legal compulsion. Clinical and other materials used in teaching and writing must be adequately disguised in order to preserve the anonymity of the individuals involved Careful judgment must be made in order to include the parents/guardian in the treatment of a minor. Ethically, we may disclose only that information which is relevant to a given situation. Avoid offering speculation as fact Sensitive information is usually unnecessary

in the clinical judgment of the treating psychiatrist, the risk of danger is deemed to be significant, the psychiatrist may reveal confidential information disclosed by patient. When we are ordered by the court to reveal the confidences entrusted to us by patients, we may comply/ethically hold the right to dissent within the framework of the law. It is ethical to present a patient/former patient to a public gathering /to the news media only if the patient is fully informed of enduring loss of confidentiality is competent.

When

-All medical information that doctors acquire as part of the professional practice is subject to the Duty of Confidentiality. -Confidentiality is not absolute. -Disclosure should only occur with consent, for benefit of patient or with just grounds for disclosure.