Talk:Physician-patient relationship

Physical examination

I moved, from the main page,

Patient expectations

One of the patient's principal expectations is a thorough physical examination.

Not all physician-patient interactions involve a physical examination. For example, a psychiatric encounter emphasizes the interview, but may not include a physical examination.

Other parts of the relationship are cognitive in nature, and may include discussion of the patient's concerts, consultation over test results and medication, etc.

Howard C. Berkowitz 13:20, 24 June 2008 (CDT)

Clinician-clinician interactions (and relationship to clinician-patient)

One area that has had surprisingly little literature, but that I have found absolutely essential in both in developing clinical information systems that physicians actually use, and also in establishing the interpersonal dynamics I want as a patient or surrogate, is the model of how clinicians communicate with one another. Surprisingly, the best example I have seen is in Michael Crichton's old nonfiction book, Five Patients. He describes, anecdotally, the extremely high shared context that may well make the discussion more incomprehensible to laymen than the specialized vocabulary.

I understand that critical discourse theory, assuming that the people using it are working from a standpoint of cognitive psychology or information theory, rather than woo-woo lit'ry criticism, gives some useful models.

This is an area that gets a lot of hallway discussion at conferences on medical information systems. There is a related area that begins with physicians not knowing what a good clinical information system can do for them, and goes on into both how patients can organize for the visit, and how to pass information efficiently and quickly. Just like it can take a year or longer for a fighter pilot to become proficient with the "switchology" of Hands-On-Throttle-And-Stick controls coupled to "glass cockpit" displays, one of the challenges faced both by patients and clinicians are knowing what questions to ask.

In the classic clinical model, "what to ask" is part of a good text in history taking, but it's much more a matter of experiential learning, listening to really good history takers. Sometimes, I despair of progress in medical information presentation. For example, in 1970, I rewrote some Mass General software to use at Georgetown, for presenting clinical lab information. Typically, a chart has reams of paper reports of tests, but, unless someone puts in a lot of manual effort, there's no easy way to see patterns. In the software I mentioned, one of the first things it did was have a running one-week or so tabular display of quantitative lab values versus time. Now, I'll add graphs. How often, however, do you find a surgeon leafing through the chart to get a sense of hematocrit over time, or an endocrinologist looking for glucose trends, or a nephrologist looking for the BUN-creatinine (and perhaps computed creatine clearance)? It's trivially easy to add these to the software, but there is no demand.

I organize my own records in this manner for my personal medical visits, and the initial responses are stunned -- especially since I tie this to a sort of SOAP summary of "what we want to accomplish in this encounter".

This may be research rather than CZ material, although it does bring up the interesting question of CZ-spawned subject matter forums, more active than the current forum system. Howard C. Berkowitz 13:38, 18 July 2008 (CDT)