for academy puporses

1. From ancient times, physicians have recognized that the health and well-being of patients
depends upon a collaborative effort between physician and patient. Patients share with
physicians the responsibility for their own health care. The patient-physician relationship
is of greatest benefit to patients when they bring medical problems to the attention of
their physicians in a timely fashion, provide information about their medical condition to
the best of their ability, and work with their physicians in a mutually respectful alliance
The doctor–patient relationship is central to the practice of healthcare and is
essential for the delivery of high-quality health care in the diagnosis and treatment of
disease. The doctor–patient relationship forms one of the foundations of
contemporary medical ethics. Most universities teach students from the beginning,
even before they set foot in hospitals, to maintain a professional rapport with
patients, uphold patients’ dignity, and respect their privacy.
A patient must have confidence in the competence of their physician and must feel
that they can confide in him or her. For most physicians, the establishment of
good rapport with a patient is important. Some medical specialties, such
as psychiatry and family medicine, emphasize the physician–patient relationship
more than others, such as pathology or radiology.
The quality of the patient–physician relationship is important to both parties. The
better the relationship in terms of mutual respect, knowledge, trust, shared values
and perspectives about disease and life, and time available, the better will be the
amount and quality of information about the patient's disease transferred in both
directions, enhancing accuracy of diagnosis and increasing the patient's knowledge
about the disease. Where such a relationship is poor the physician's ability to make
a full assessment is compromised and the patient is more likely to distrust the
diagnosis and proposed treatment, causing decreased compliance to actually follow
the medical advice. In these circumstances and also in cases where there is
genuine divergence of medical opinions, a second opinion from another physician
may be sought or the patient may choose to go to another physician. Additionally,

2. the benefits of any placebo effect are also based upon the patient's subjective
assessment (conscious or unconscious) of the physician's credibility.
The physician may be viewed as superior to the patient simply because the
physician has the knowledge and credentials and is most often the one that is on
home ground.
The physician–patient relationship is also complicated by the patient's suffering
(patient derives from the Latin patior, "suffer") and limited ability to relieve it on his or
her own, potentially resulting in a state of desperation and dependency on the
physician.
A physician should at least be aware of these disparities in order to establish
a good rapport and optimize communication with the patient. It may be further
beneficial for the doctor–patient relationship to have a form ofshared
care with patient empowerment to take a major degree of responsibility for her
or his care.
Fundamental Elements of the Patient-Physician
Relationship
Physicians can best contribute to this alliance by serving as their patients’ advocate and by fostering
these rights:
(1) The patient has the right to receive information from physicians and to discuss the benefits, risks,
and costs of appropriate treatment alternatives. Patients should receive guidance from their physicians
as to the optimal course of action. Patients are also entitled to obtain copies or summaries of their
medical records, to have their questions answered, to be advised of potential conflicts of interest that
their physicians might have, and to receive independent professional opinions.
(2) The patient has the right to make decisions regarding the health care that is recommended by his or
her physician. Accordingly, patients may accept or refuse any recommended medical treatment.
(3) The patient has the right to courtesy, respect, dignity, responsiveness, and timely attention to his
or her needs.

3. (4) The patient has the right to confidentiality. The physician should not reveal confidential
communications or information without the consent of the patient, unless provided for by law or by the
need to protect the welfare of the individual or the public interest.
(5) The patient has the right to continuity of health care. The physician has an obligation to cooperate
in the coordination of medically indicated care with other health care providers treating the patient.
The physician may not discontinue treatment of a patient as long as further treatment is medically
indicated, without giving the patient reasonable assistance and sufficient opportunity to make
alternative arrangements for care.
(6) The patient has a basic right to have available adequate health care. Physicians, along with the rest
of society, should continue to work toward this goal. Fulfillment of this right is dependent on society
providing resources so that no patient is deprived of necessary care because of an inability to pay for
the care.
Tipson BuildingDoctor/PatientRelationsMostof the informationusedfordiagnosisandmanagementis
gleanedfromthe H&P.It isimportantthat youare able to effectivelycommunicate withpatientstobest
helpthem.Essential tocommunicationisbeingable toquicklyestablishrapportwith yourpatients.•
Demonstrate toyourpatientsthatyou understandtheirsituationsandfeelingsbyshowingempathy
duringpatientinterviews.Empatheticcommunicationisone of yourmostvaluedmodalitiesandhelps
to ensure a trustingrelationshipbetweenyouandyourpatients.The followingstepswill strengthen
your patientcommunicationskills:1.Seektominimize distractionsandinterruptionswhenvisitingwith
your patients.Putyourbeeperonsilentmode duringyourvisit.Close adoorif outside noise isa
distraction.(However,askyourpatient’spermissionfirst.) Remember,too,thatpatientscanoffergreat
insightintotheirconditionsfromwhattheytell you.Solimitthe numberof timesyouaskquestionsor
otherwise interruptwhenyourpatientsare presentingtheirchief complaints.2.Engage inactive
listening.Concentrateonwhatthe patientiscommunicatingverballyandnonverbally.Take intoaccount
bothfacts and emotions.3.Be deliberate aboutthe nonverbal cuesyousend.Leanforward,maintain
eye contact,nod appropriately,anddon’tcrossyour arms.4. Offerconcrete feedback.Whenyou
summarize whatyou’ve heard,frame yourresponsesbysaying“Letme see if Ihave thisright…” Seekto
identifyorclarifythe patient’sfeelingsby saying“Tell me how you’re feelingaboutthis”or“I have the
sense that…”5. Allowthe patienttocorrector add to yourresponsesuntil he orshe confirmsyour
understanding— “DidImissanything?”Accordingtoseveral sources,the effective use of empathy
promotesdiagnosticaccuracy,therapeuticadherence andpatientsatisfaction.•Enhance your
counselingandlisteningskillsbyusingasimple five-stepprocess.Gatherinformationaboutthe context
of the patient’svisitbyasking:1) Whatis goingon in yourlife?2) How do youfeel aboutthat(or how
doesitaffectyou)?3) What aboutthe situationtroublesyoumost?And4) How are youhandlingthat?
Thenshowunderstandingbyobserving:5) “That mustbe verydifficultforyou.”Thistechnique is
identifiedbythe acronymBATHE(whichstandsforbackground,affect,trouble,handlingandempathy).
• Be preparedto provide culturallyresponsive care.Be aware of how your owncultural values,beliefs

4. and assumptionsmayinfluenceyourdeliveryof care.Understandthe impactof culture onyour
patient’srecognitionof symptomsandbehaviorsrelatedtoillness.Be readytoaddresslanguage
barriersthroughthe use of familymembers,translators/interpretersandothercommunityresources,if
necessary.•Gain a newperspective onyourpatientsbyassessingyourownbiases.Youwill encounter
patientswho,forone reasonor another,cause youfrustration,grief orevenanxiety.If thisisthe case,
take time to examine whyyoufeelthisway.The reasonaparticularpatientgivesyoutrouble mightbe
foundinyour ownpast.For example,if youruncle wasnoncompliantwithhisdiabetesmanagement,
perhapsyounowhave lesstolerance of patientswhoexhibitsimilarbehavior.O

5. ResearchQuestions
Which factorsare associatedwithpatientsatisfactioninprimaryhealthcare? Isthere a difference in
patientsatisfactionbetweenpublicandprivate sectorsof primaryhealthcare? Isthe level of patient
satisfactionachievedfromaconsultationperceiveddifferentlybypatientsanddoctors?
Aims
To identifythe characteristicsof afamilydoctormostlikelytoleadtopatientsatisfaction Tocompare
and contrastcharacteristicsof familydoctorsinpublicandprivate sectors of primaryhealthcare To
compare patientsatisfactionbetweenpublicandprivate sectorsof primaryhealthcare Objectives
To identify: the perceptionsof patientsinthe governmenthealthcentresof theirdoctors’personality
traits,professionalvalues,dutiesandresponsibilities,communicationskills,andclinical care the
perceptionsof patientsinthe private primaryhealthcare sectorof theirfamilydoctors’personality
traits,professionalvalues,dutiesandresponsibilities,communicationskills,andclinical care the
perceptionsof patientsinbothpublicandprivate sectorsof primaryhealthcare on the mostimportant
characteristicsof a familydoctorthat leadtopatientsatisfactionObjectives Tocompare patient
satisfactionbetweenpublicandprivate sectorsof primaryhealthcare To identifythe perceptionsof
familydoctorsasregards critical factorsin theirpractice associatedwithpatientsatisfaction Toprovide
feedbackonthe resultsof the studyto doctorsin varioussectors of primaryhealthcare Research
Setting Malta isa small islandwithanestimatedpopulationof 410,290 (National StatisticsOffice,2008)
Two -thirdsof primarycare providedbyprivate sector Publicsectorconsistsof 9regional healthcentres
and 47 districtclinics 24 -hourcomprehensivehealthcare servicesfree atpointof deliveryPrimary
HealthCare Patients’firstcontact withhealthcare

6. PrimaryHealthCare
Patients’firstcontactwithhealthcare system Hubfrom whichpatientsare guidedthroughthe health
system(The WorldHealthReport,2008) Place where relationshipsbetweendoctorsandpatients
develop Healthpromotionanddisease prevention Basisconsistsof gooddoctor-patientrelationships
and continuityof care (Azzopardi &D
Factors AffectingPatientSatisfaction
Gooddoctor-patientrelationship Beingempathic;givingthe patienttimeandattention Honesty,
trustworthiness,able tokeepconfidentiality Meetingthe patients’desiresandexpectations;
congruence betweendoctor’sandpatient’sperceptionsof the consultation
Factors AffectingPatientSatisfaction
Easy accessibility Goodcommunication Goodclinical care;givinganexplanationof the symptoms
Continuityof care Qualityof medical facilitiesPrimaryHealthCar
Factors mostlikelytoleadtopatientsatisfaction
1. Beingreadyto explainwhatiswrongbefore givingtreatment
2. Beingup to date withrecentdevelopmentsinthe profession
3. The abilitytomake the rightdiagnosis
4. Beingenthusiastic

7. 5. Having a nice attitude withpatients
6. Beinghonestyandtrustworthy
Doctors’perceptionsof patientsatisfaction
1, Semi-structuredinterviewscarriedoutondoctorsworkinginthe clinics 2. In the publicsector,
doctorsspendmuch lesstime withthe patientthaninthe private sector3. Limitedtime explains
difference incommunicationskillsbetweensectors 4. Poorperceptionof patientsatisfactioninthe
publicsector
Doctor Satisfaction
1. Dependsongooddoctor-patientrelationshipsandcontinuityof care Verylow inpublicsector,high
inprivate sector Affectslevel of patientsatisfactionachievedR