scholarly journals Per una medicina centrata sul paziente: riflessioni sulla fondazione etica del rapporto medico-paziente

2005 ◽  
Vol 54 (3) ◽  
Author(s):  
Ignacio Carrasco De Paula ◽  
Nunziata Comoretto
Keyword(s):  
Medical Profession ◽  
The Other ◽  
Simple Relationship ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Medical Activity ◽  
Real Community ◽  
Community Concept ◽  
Physician Patient ◽  
Practical Level

Sempre più frequentemente è richiesto al medico di giustificare le proprie decisioni in funzione dei fini e dei valori rilevanti nella medicina. In una medicina realmente centrata sull’uomo, il fine dell’attività medica è nella realizzazione del bene del paziente, mediante un agire adeguato non solo alla salute, ma all’intero essere del paziente, che lo consideri per il valore, infinito, che gli è proprio. Tale concezione antropologica implica, a livello pratico, che non è mai consentita di una persona la discriminazione - trattarla secondo criteri differenti da quelli che derivano dalla sua natura -, la strumentalizzazione - usarla per altri fini, diversi dal bene proprio della stessa - e l’oppressione - agire nei confronti di essa mortificando o tenendo in scarso conto la sua irrinunciabile autonomia e libertà. In una medicina centrata sul paziente il rapporto medico-paziente non è uno strumento dell’attività medica, ma il luogo in cui si realizza l’attività medica. La medicina è il rapporto medico paziente, un rapporto interpersonale, asimmetrico, non definito dalla sola identificazione dei ruoli, ma dall’individuazione di un obiettivo comune. Rapporto medico-paziente non significa dunque semplice “relazione”, ma implica una vera e propria “comunità”, concetto che richiama un’interazione tra le parti, o meglio, una condivisione. Alla base di un buon rapporto medico-paziente, identifichiamo almeno tre fattori: il riconoscimento dell’altro come persona, la costruzione di una vera e appropriata alleanza terapeutica, l’accettazione dei rispettivi ruoli. In conclusione, l’esercizio della professione medica non può prescindere dalla riflessione su quali siano i suoi scopi e, soprattutto, da una concezione antropologica di cosa sia l’uomo perché non ci rapportiamo con il paziente se non in relazione a questo. ---------- More and more frequently physician is required to justify his own decisions in accordance whit the goals and the important values of medicine. In a medicine really centred on patient, the goal of medical activity is the realization of the good of the patient, by acting not only according to health, but whit the whole being of patient, considering him for the value, endless, that is to him really. Such an anthropological conception implicates, to a practical level, that it is never allowed discrimination of the person - to treat him or her according to different criterions than those deriving from his or her nature -, the exploitation - to use him or her for other ends than proper good - and the oppression - to act towards him or her mortifying his or her autonomy and liberty. In a medicine centred on patient, the physician-patient relationship is not a tool of medical activity but the place in which medical activity comes true. The medicine is the physician-patient relationship, a relationship between two persons, asymmetrical, defined not only by the identification of the roles, but by singling out a common objective. Physician-patient relationship doesn’t mean simple relationship, but it implicates a real community, concept that recalls an interaction between the parts, or better, a sharing. At the base of a good physician-patient relationship we identify at least three factors: the recognition of the other as a person, the construction of a true and appropriate therapeutic alliance, the acceptance of the respective roles. In conclusion, the exercise of the medical profession cannot leave the reflection on what its purposes are out of consideration and, above all, an anthropological conception of what the man is because we behave to the patient in conformity with it.

scholarly journals Az internet hatása az orvos–beteg viszonyra

2016 ◽  
Vol 157 (17) ◽  
pp. 680-684 ◽  
Author(s):  
Ilona Gaal
Keyword(s):  
Communication Skills ◽  
Medical Profession ◽  
Theoretical Models ◽  
The Internet ◽  
Decision Making Process ◽  
Daily Routine ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Necessary Evil ◽  
Physician Patient

Internet became an inevitable phenomenon in the physician–patient relationship. The author analyzes it in two theoretical models: the effects on the medical profession and the interference with the decision making process. These will help to explain why patients search the internet for information about their illness, cure and their doctors. Some physicians dislike this, and they are not just worried about the patient, but about their own position and time. This fear is groundless, even if the internet patient can be hard to tackle in the daily routine. Internet can be seen not only as a necessary evil, but with proper communication skills physicians can benefit from their patients’ passion to internet. Orv. Hetil., 2016, 157(17), 680–684.

scholarly journals “仁術”與“方技”: 中國傳統醫患關係的倫理現實

2010 ◽  
Vol 8 (1) ◽  
pp. 33-60
Author(s):  
Guobin CHENG
Keyword(s):  
Medical Profession ◽  
Value Systems ◽  
Medical Professionals ◽  
Patient Relationship ◽  
Professional Relationship ◽  
Physician Patient Relationship ◽  
Objective Standard ◽  
The Social ◽  
The Matrix ◽  
Physician Patient

LANGUAGE NOTE | Document text in Chinese; abstract also in English.本文首先對中國傳統醫學生活的結構和運動模式兩個方面進行了探討，借此提出以下觀點：中國傳統的醫患倫理關係並不是一種典型的職業倫理關係，它建立在中國傳統醫學學術和社會生活的基礎之上，其道德效力整合於這種特定的生活境遇之中；醫生與病人都被整合在社會倫理關係的網路之中，醫患關係根據醫病雙方各自具體的社會倫理身份以及具體的醫療活動場景的不同而運動變化。這樣一種倫理關係使中國傳統醫學生活充滿了矛盾：醫家雖然將醫學稱為“奪造化之權，以救人生死”《醫學源流論˙醫非人人可學論》的大“道”，但又必須承認其在現實性上是一種“持方技以事上”的小“術”，苦苦掙扎在崇高的道德責任感和低下的自我倫理認知之間；病家既保有一種有限的選擇和評價醫生、干預診療活動的自主權，又必須遵循社會倫理法則來認識和調整與醫生的關係，在和醫生的相互角力中維護自己的權益。傳統醫學道德過於追求高尚而遠離普通醫生的生活實際，這就大大消弱了它對現實生活的指導力量，無助於建立一種合理的職業倫理規範，更違背了中國傳統倫理學“德得相通”的最高道德原則。Using examples from ancient texts, this paper contends that the traditional physician-patient relationship should be understood and interpreted within the matrix of the social and ethical network of a society. As such, the physician-patient relationship is not what we call “a professional relationship,” in that there is no fixed or objective standard to qualify it. In the Confucian tradition, for instance, the physician-patient relationship changes according to the social identity of the patient. The moral responsibility of the physician also becomes ambiguous when he or she is required to treat the patient as a “relative” or “friend.” The patient, in contrast, has a very limited “autonomy,” if there is such a thing, to choose his or her own doctors and make medical decisions. The same situation can be seen in Daoist medical practice when the physician has to struggle between the “Dao of medicine” and the “skill of medicine,” or between the moral dimension of medicine and the efficaciousness of medicine. The medical profession in the past was never an independent entity with independent ethical standards, and has always been part of a wider value system.Because of this, when medical professionals nowadays try to adopt Western ideas underpinned by different principles and theories, they find moral clashes between two traditions due to their conflicting value systems. As a result, concepts such as “patient rights” are at odds with the traditional understanding of the physician-patient relationship, which emphasizes context and situation. This paper also criticizes virtue-based morality in China, contending that principle-based morality would be better for reconstructing a more objective standard of morality for medical professionals in China.DOWNLOAD HISTORY | This article has been downloaded 207 times in Digital Commons before migrating into this platform.

scholarly journals 醫乃仁術: 儒家視野下的醫患關係

2009 ◽  
Vol 7 (1) ◽  
pp. 13-41
Author(s):  
Jue WANG
Keyword(s):  
Medical Ethics ◽  
Moral Authority ◽  
The Other ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Potential Conflict ◽  
Moral Principles ◽  
Ethical Implications ◽  
Western Model ◽  
Physician Patient

LANGUAGE NOTE | Document text in Chinese; abstract also in English.本文首先廓清了“醫乃仁術”在傳統儒家思想脈絡裏的含義，並指出從來源上說，它迥異於西方生命倫理學主流，而採取了一種獨特的“不離人倫，親親為本”的視角。然而這種視角使得“醫乃仁術”總是被一種歧義所困擾：它既是一種行善原則，也是一種未顧及自主性原則的行善原則，家長主義的陰影無處不在。“醫乃仁術”的歧義成為中國生命倫理學建設的最大瓶頸。面對這種困境，本文試圖在現代西方生命倫理學話語實踐之外，另闢蹊徑，借助關懷倫理學和美德倫理學的最近研究成果，闡發“醫乃仁術”的合理內涵。This essay addresses the ethical implications of the physician-patient relationship from the Confucian perspective, which holds that the physician must regard the patient as a family member to treat the patient properly. It is well known that there are two primary approaches to moral authority in contemporary Western medical ethics. One is internal, and assumes that the good inherent to medicine is the source of moral authority in medical activities. The other is external, and denies that the ends and ethics of medicine can be determined by typical medical activities. It holds that medical ethics should be based on general moral principles, such as autonomy and justice. However, the Confucian model seems to be at odds with both of these approaches. On the one hand, Confucians do not think that medicine constitutes a self-contained domain of activity with its own ethics; rather, medicine is seen as a continuum of familial relationships and ethics. On the other hand, Confucians also hold that the physician-patient relationship should follow the example of the flexible relationships among family members rather than the rigid general principles of autonomy and justice.The Western model is aimed at action, whereas the Confucian view focuses on personal affective relations. The greatest problem with the Confucian model is its notorious paternalism; that is, it appears to fail to pay sufficient attention to the potential conflict between patient and physician about the good, ignoring the issue of patient autonomy. In the modern Western tradition, the model of the physician-patient relationship is based on two self-sufficient agents (patient and physician) who are united in pursuing a certain good, where each is the final source of what is good for him- or herself. However, the real physician-patient encounter demands a deeper commitment between the two than this model suggests. When entering a physician-patient relationship, what the patient seeks is care from the physician, not autonomy. That is to say, the patient first of all trusts the physician. To earn that trust, it is not enough that the physician treat the patient based only on the principle of autonomy or what the patient requires. Rather, a deep attachment – analogous to a familial relationship – must be developed that can serve as the basis of the encounter between the patient and physician. The Confucian physician-patient model, which is rooted in such a relationship, does not contrast but rather complements its Western counterpart.DOWNLOAD HISTORY | This article has been downloaded 564 times in Digital Commons before migrating into this platform.

scholarly journals Obraz autointerpretacji profesji lekarskiej – narracje lekarzy

2019 ◽  
pp. 283-307
Author(s):  
Beata Antoszewska
Keyword(s):  
Empirical Data ◽  
Medical Profession ◽  
Patient Relationship ◽  
Narrative Interviews ◽  
Physician Patient Relationship ◽  
Interpretive Paradigm ◽  
Provinces Of Poland ◽  
The Senses ◽  
Physician Patient

This paper is an attempt to examine the senses and meanings attributed by physicians to the medical profession. The collected material is part of a larger project devoted to the physician-patient relationship reconstructed on the basis of individual narrations provided by physicians. The conducted research is closely linked to the qualitative perspective: Interpretative Paradigm and Interpretive Paradigm. The study was performed in the period 2015-2017. The examined group consisted of 16 subjects (6 female and 10 male physicians) from several provinces of Poland who were highly esteemed (subjective opinions) by their patients. The empirical data were collected by means of narrative interviews and the methodology applied for the analysis of the content was that of phenomenography.

Eutanasia: una questione di relazione

2007 ◽  
Vol 56 (6) ◽  
Author(s):  
Marianna Gensabella Furnari
Keyword(s):  
Point Of View ◽  
The Other ◽  
Patient Relationship ◽  
Physical Pain ◽  
Physician Patient Relationship ◽  
The Right ◽  
First Moment ◽  
Physician Patient ◽  
The Relationship

L’impostazione classica della questione bioetica dell’eutanasia attraverso il paradigma dei principi conduce a risolvere la questione con un sì, se si privilegia il principio di autonomia, o con un no se si dà il primato al principio dell’indisponibilità della vita. Il saggio muove dalla proposta che sia possibile un altro approccio, basato sull’interazione, suggerita come linea metodica da Warren T. Reich, del paradigma dei principi con gli altri paradigmi della bioetica: l’esperienza, la cura, la virtù. Il primo momento è ripensare l’eutanasia come l’oggetto di una domanda che viene dalla sofferenza e che, come tale, va accolta ed interpretata in un contesto di relazione. A differenza del suicidio, non vi è qui un darsi la morte, ma un domandare la morte all’altro. L’attenzione etica va spostata dal far centro esclusivamente sull’autonomia al focalizzarsi anche e soprattutto sulla relazione, in particolare sulla complessità e le contraddizioni che segnano oggi la relazione tra il paziente e il medico. Anche se chiede una “cura” limite, paradossale che non può essere data, pena la contraddizione e il ribaltamento degli stessi fini della medicina, la domanda di eutanasia non può restare inevasa, ma deve essere accolta, ri-aperta con l’attenzione che il paradigma di cura impone, con l’humanitas che il paradigma di virtù ci consegna. L’attenzione etica all’esperienza di chi domanda la morte diviene il primo momento per trovare una conciliazione tra momenti apparentemente antitetici, come la sacralità e la qualità della vita, per cogliere la complementarità tra diritti apparentemente antitetici come il diritto ad essere lasciati soli e il diritto a non essere lasciati soli, per sostenere insieme la liberazione dal dolore fisico e la liberazione del dolore dell’anima. Spostando il punto di vista dalla libertà alla relazione, il saggio vuole indicare l’impossibilità etica di dire di sì all’eutanasia proprio sul versante della relazione, ponendo al tempo stesso l’accento non solo sulla responsabilità che il dire di sì comporta, ma anche sulle altre responsabilità di cui la domanda di eutanasia ci fa carico: le responsabilità che riguardano la situazione da cui trae origine, e le altre che riguardano ciò che rimane da fare per rispondere alla richiesta di aiuto e di cura che la domanda sottende. Con il movimento proprio dell’etica della cura, il saggio vuole proporre di non risolvere il dilemma in cui la questione bioetica dell’eutanasia sembra costringerci, rinunciando alla vita o alla libertà, ma di provare a ridefinire il contesto da cui il dilemma ha origine, in modo tale che sia possibile tenere insieme vita e libertà. ---------- Classical approach to the problem of the euthanasia, through the paradigm of the principles conducts to solve the matter with a yes, if the principle of autonomy is privileged, or with a no if the primacy is given to the principle of the unavailability of the life. This paper moves from the proposal that another approach is possible, based on the interaction, suggested as methodic line by Warren T. Reich, of the paradigm of the principles with the other paradigms of the bioethics: the experience, the care, the virtue. The first moment is to consider the euthanasia as the object of a question that comes from the suffering and that, as such, it must be welcomed and interpreted in a context of relationship. Unlike the suicide there is not here a killing oneself, but an asking other for death. The ethical attention must be moved from the exclusive center of autonomy to the relationship, particularly on the complexity and the contradictions that mark the physician-patient relationship between today. Even if it asks a limit “care”, paradoxical that cannot be given, or the aims of the medicine itself would be contradicted and overturned, the question of euthanasia cannot stay outstanding, but must be welcomed, opened again with the attention that the paradigm of care imposes, with the humanitas that the paradigm of virtue delivers us. The ethical attention to the experience of whom asks the death it becomes the first moment to find a conciliation among apparently antithetical moments, as the sacredness and the quality of the life, to gather the complementarity among apparently antithetical rights as the right to be left alone and the right not to be left alone, to sustain together the liberation from the physical pain and the liberation from the pain of the soul. Moving the point of view from freedom to relationship the paper wants to point out the ethical impossibility to say yes to the euthanasia just on the side of the relationship, at the same time setting the accent not only on the responsibility that saying yes means, but also on the other responsibilities of which the question of euthanasia ask us: the responsibilities derived by the situation and the others concerning what to answer to the help request and care that the question subtends. In the way proper of the ethics of the care, the paper proposes not to solve the dilemma of the euthanasia abdicating to the life or to the liberty, but trying to redefine the context from which the dilemma has origin, in such way that it is possible to hold together life and liberty.

scholarly journals Medical error: concept, characterization and management

2019 ◽  
Vol 28 (4) ◽  
pp. 255-266
Author(s):  
Vitor Mendonça ◽  
Thomas Gallagher ◽  
Nicholas Hendryx
Keyword(s):  
Medical Errors ◽  
Medical Profession ◽  
Medical Science ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Excessive Pressure ◽  
Near Misses ◽  
Lack Of Information ◽  
Physician Patient

Abstract The objective of this study is to better understand the tensions involved in the fear of making an error due to the harm and risk this would pose to those involved. This is a qualitative study based on the narratives of the experiences lived by ten acting physicians in the state of São Paulo, Brazil. The concept and characterization of errors were discussed, as well as the fear of making an error, the near misses or error in itself, how to deal with errors and what to do to avoid them. The analysis indicates an excessive pressure in the medical profession for error-free practices, with a well-established physician-patient relationship to facilitate the management of medical errors. The error occurs but the lack of information and discussion often leads to its concealment due to fear of possible judgment by society or peers. The establishment of programs that encourage appropriate medical conduct in the event of an error requires coherent answers for humanization in Brazilian medical science.

Simulation-Based Training of Communication and Emotional Competence for the Improvement of Physician-Patient Relationship

2006 ◽  
Author(s):  
Luigi Anolli ◽  
Fabrizia Mantovani ◽  
Alessia Agliati ◽  
Olivia Realdon ◽  
Valentino Zurloni ◽  
...  
Keyword(s):  
Emotional Competence ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Simulation Based ◽  
Physician Patient
Sign in / Sign up

Export Citation Format

Share Document