Doctor-Patient Relationships
By Lahari, Lydia, Nandini, Nicole, Vrutika
Playlist
The historical relationship between doctor and patient has been essential through the ages. Although the doctor-patient relationship has changed over time, the main concepts of empathy, communication, consent, and boundaries are still standards to which doctors adhere (Smith). Beyond professionalism, the doctor-patient relationship has direct ties to the patient’s overall health outcomes, as longitudinal studies have shown that worsened physician-patient relationships were associated with worsened functional health in patients (Olaisen, et. al.). This collection of essays seeks to understand how different socio-economic and socio-cultural factors affect the doctor-patient relationship and identify some of the struggles those of minoritized, alternative, or marginalized identities face when seeking care within a traditional clinical doctor-patient relationship. The main factors of interest were substance use, insurance statuses, home remedies, religious affiliations, and autonomy of various patients whose stories were detailed in the Southern Oral History Program (SOHP). Through five essays, we explore such factors and stories.
The role of drug abuse in low-income communities is prevalent in those who are less likely to receive adequate treatment from their primary care providers. When assessing the role of opioids and drug usage in the doctor-patient relationship, it is evident that a delicate balance must be struck between addressing the patient’s pain management needs and mitigating the risks associated with opioid use, including addiction, dependency, and adverse health effects. By understanding the stories of patients such as Arch Woodard and Debbie Smith, individuals from the SOHP, who have had insightful experiences surrounding drug abuse or the Opioid crisis. The families of substance abuse patients in low-income areas have informed their care, we seek to summarize and catalog the stress and stigma substance abuse adds to the doctor-patient relationship.
Many struggles also exist in maintaining a consistent doctor-patient relationship for those with Medicare, Medicaid, or uninsured status. While these social welfare programs were initially created to help solve access to care issues, qualifying for such programs and finding consistent care as an uninsured individual who cannot afford private or government-issued insurance can be difficult for many patients of different backgrounds. The essay examines how the personal narratives of Laura, a woman who faced a traumatic delivery due to lack of adequate healthcare, Carla Norwood, who was on “Pink Medicare” and faced stigma during her pregnancy, and Ebony Talley-Brame, who created an innovative transportation service for those on Medicare and in her community to maintain their doctor-patient relationships. Through these narratives, we seek to understand how doctors may enforce stigma around public insurance and how these insurances either help or harm the doctor-patient relationship.
Alternative healing systems and natural remedies also have their role in the doctor-patient relationship. In modern medicine, pharmaceuticals and biomedical approaches to treatment take a front-line approach. However, many individuals of lower economic status or even immigrants who have grown up in different cultures may look to these alternative age-old remedies as a means for resolving their issues. However, from a physician’s perspective, they might not be able to completely understand their patient nor how to navigate validating their patient while still offering applicable care. These perspectives are highlighted in the SOHP interviews of Janet Ross, Rodriguez Ysaura, and Talley Ebony who embraced naturopathic remedies to treat their ailments despite professional backlash. In this essay, we seek to understand how to bridge the divide in understanding between a physician and patient and hypothesize a world wherein modern medicine may coexist and even support the use of more naturopathic routes.
Religion can also play a part in the doctor-patient relationship, and it is crucial to understand how its influence can be present in various ways, such as through overarching values and as a source of hope. Additionally, third parties also exist that can serve as religious intermediaries within the relationship. For example, Norma Armwood is a behavioral health specialist and bridge counselor who helps HIV positive patients receive primary care, in which she uses spirituality as a basis to connect with her patients, as she serves as the in-between for patients and doctors. We aim to understand religion’s impact on successful doctor-patient relationships.
The last essay will explore the nuances of autonomy that minors possess in medical contexts. With child patients, the traditional doctor-patient dynamic becomes more complex since their parents/guardians are also key participants in the relationship and decision-making process. This raises important questions about the extent to which minors’ autonomy and right to be informed should be respected and encouraged, and how to navigate situations where the wishes of the child patient and parents may be in conflict. Additionally, cultural differences play a key role in this dynamic; both Tammy Blackman and Albrea Crowder discuss in their oral histories how many children of the Latina community are extremely autonomous with their medical decisions while others experience more parental oversight.
There are many factors that contribute to the experience that go beyond the ones that we will be discussing in these essays. Our limited scope is due to the fact that we are focusing on the topics identified by those interviewed through the SOHP. For example, according to a study by Elayyan et al., cultural differences between the patient and doctor, occupational differences, pressure on physicians at work, or mood in the day may influence the doctor-patient relationship. The doctor-patient relationship is both individual but can be examined as a whole concept within larger population-based concerns, and through our collective work we hope to acknowledge both perspectives and leave readers with a better understanding of the complex doctor-patient relationship.
Works Cited
Elayyan, Muntaha, Janet Rankin, and M. W. Chaarani. “Factors Affecting Empathetic Patient Care Behaviour among Medical Doctors and Nurses: An Integrative Literature Review.” Eastern Mediterranean Health Journal, vol. 24, no. 3, 2018, pp. 311-318.
Olaisen, R. Henry, et al. “Assessing the Longitudinal Impact of Physician-Patient Relationship on Functional Health.” PubMed Central.
Smith, Yolanda. “Doctor-Patient Relationship.” News Medical-Life Sciences.
Student Essays
Religion in the Doctor-Patient Relationship
Introduction Religious beliefs are a crucial sociocultural factor that plays a role in the doctor-patient relationship. With religion being historically heavily intertwined with the medical field since 3000 BC, the interconnections of the two in the modern day are crucial … Read more
Drug Abuse Effect on the Doctor-Patient Relationship
Introduction Starting in the 1990s (following the 1980s crack addiction), the use of opioid medications began to rise for reasons surrounding patient care.[1] The introduction of opioids as prescription drugs was well-intentioned and focused on relieving patients’ pain. Another intention … Read more
Integrating Alternative Healing into Modern Healthcare & Navigating the Doctor-Patient Relationship
Introduction to Alternative Medicine and Allopathic Medicine The term alternative medicine was coined in the 1800s to distinguish between care systems of the Eastern world and care systems of the West – which are referred to as allopathic medicine. Allopathic … Read more
The Autonomy of Minors in the Doctor-Patient Relationship
Child autonomy in the doctor-patient relationship is a complex issue that involves balancing the child’s right to self-determination with the need for protection and guidance from parents and healthcare providers. There are many nuances to child autonomy in medical settings, … Read more
Insurance Stigma in the Doctor-Patient Relationship
The doctor-patient relationship is not impervious to the financial stressors of the American healthcare system. With only 54.5 percent of Americans being covered by employer-based insurance, the country’s patchwork system serves almost two-fifths of its population on Medicare and Medicaid, … Read more