PDS & PHE Year 1 at Medizinische Universität Wien

Oath of Hippocrates: “The regimen I adopt shall be for the benefit of my patients according to my ability and judgment, and not for their hurt or any wrong.... Whatsoever house I enter, there will I go for the benefit of the sick, refraining from all wrongdoing or corruption, and especially from any act of seduction, male or female.“

Medical doctors and students have strict duties of confidentiality to protect their patients’ important personal and sensitive information. Confidentiality extends beyond death and towards relatives (challenges: phone conversations, chatting on the ward, private life, …). Expectations: 

• Patient waives 
• Legal exceptions (e.g. HIV, tuberculosis, …) 
• Self-protection & higher legal or ethical goods (protecting others) 

Historically, paternalistic model that placed physicians in a position of authority with patients playing a passive role in care. Believed that only a doctor could properly understand symptoms and draw useful conclusions. Patients’ preferences were generally not elicited and were over-ridden if they conflicted with the physicians’ convictions about appropriate care.

1. Respect for persons 
2. Beneficence 
3. Non-Maleficence
4. Justice 

• Paternalistic model
  
  
• Informative & Consumer model: Physician as technical expert and provider of all relevant information – selection of intervention by the patient, execution by the doctor. Physician remains neutral on patient values (clear fast-value-distinction) --> high degree of patient autonomy and control.
  
  
• Interpretative model: Physician as counsellor. Elucidate patients’ values and support selection of intervention. Patient autonomy as self-understanding.
   
• Deliberative / Partnership model: Physician as a teacher / friend – partner in determining best health-related values for the patient. Provides information, ranks values, makes suggestions. Autonomy through dialogue and deliberation. 

• Get a Translator 
• Keep privacy 
• Be empathic 

• Get suitable replacement (ask collogues for help) 
• Find a way to handle your emotions 

• Try to de-escalate 
• Be empathic 
• Recognize “frequent flier” and try to support them 

• The ability to cognitively comprehend and affectively feel the presumed emotions of fellow creatures. 

• Innate ability to perceive, understand and share other people’s emotions. 

• Hence skills can be established, for example raising interest during a conversation, being of help with self-clarification, constructively shaping a dispute (argument)… but also manipulating…

• Cognitive empathy: intellectual, theoretical understanding = Assuming the perspective; The other person’s feelings are being theoretically explored and deduced, without being felt.
   
• Affective Empathy: experiencing the same or similar feelings as the other person = emotional contagion through mirror neurons. Mirror neurons generate the emotions of the other person in ourselves, therefore we are able to know instinctively how the other feels.

Sympathy is a feeling of care and concern for someone, accompanied by a wish to see him better off or happier. Sympathy does not involve a shared perspective or shared emotions. Sympathy and empathy often lead to each other, but not always.

• Enable the patient to feel understood, valued and supported; 

• Encouraging an environment that maximizes accurate and efficient initiation, information gathering and explanation and planning;

• Reducing potential conflict between doctor and patient;

• Developing and maintaining a continuing relationship over time;

• Involving the patient so that she/he understands and is comfortable with the process of the consultation; 

• Increasing both the physicians and the patient’s satisfaction with the consultation

• Discovering as far as possible all the problems that the patient has come to discuss

• Developing an awareness of the patient’s emotional state

• Establishing an agreed agenda and plan of the consultation

• Allowing the patient to feel part of a collaborative process