DOCTORING: MEDICAL HUMANITIES SEGMENT-- YEAR 3
THE PHYSICIAN-PATIENT RELATIONSHIP

INTRODUCTION

The Doctoring: Medical Humanities curriculum is designed to provide students with core knowledge in the humanities, emphasizing application of the content and methodologies of humanities disciplines to the practice of medicine. Substantive areas of teaching emphasis include ethics, health policy, law, medical history, and psychosocial care. During Year 3, the Doctoring: Medical Humanities Segment is a two-week learning experience entitled, "The Physician-Patient Relationship."

The physician-patient relationship in American society has been characterized by complex and sometimes contradictory forces -- codified in laws and defined by customary practices as well as by cultural and historical expectations. Since ancient times, physicians have recognized that the health and well-being of patients depend upon a collaborative interaction between patients and physicians. This historical regard for the physician-patient relationship underlies current recognition of the physician-patient relationship as a central strength of American medical practice.

Over the years, many forces have shaped the nature and scope of the relationship between physicians and patients -- forces as diverse as technological advancement, economic trends, legislative enactments, and cultural and religious values. These forces will continue to have significant impact on the physician-patient relationship, particularly as the health care system in the United States undergoes major changes. Because the physician-patient relationship serves as the cornerstone for achieving, maintaining, and improving health, it will be essential for physicians to maintain clear commitment to strengthening that relationship. In this regard, physicians are well served to understand and subscribe to the fundamental elements of the relationship.

This Doctoring: Medical Humanities Clerkship is designed to allow students to explore the physician-patient relationship from a variety of perspectives: to look at the ethical underpinnings of the relationship; to examine laws that set forth rights and responsibilities in the relationship; to consider the importance of meaningful communication between physicians and patients; to look at forces that influence professional judgment and clinical decision-making; and to examine certain compelling aspects of the relationship, including end-of-life care.

GENERAL LEARNING OBJECTIVES

Students will be able to:

1. Discuss important ethical, historical, and legal perspectives on the physician-patient relationship.

2. Identify legal rights and responsibilities withing the physician-patient relationship, with emphasis on the standard of care and professional liability in the context of medical malpractice litigation..

3. Describe ethical and legal principles that give rise to and shape the doctrine of informed consent as well as the informed consent interchange between physician and patient.

4. Discuss ethical and legal considerations that bear upon privacy and confidentiality within the physician-patient relationship.

5. Describe the value of meaningful communication between physicians and patients in the clinical setting and its importance in strengthening the physician-patient relationship.

6. Identify and discuss issues of bias that affect the physician-patient relationship.

7. Discuss the clinical, ethical, legal, and psychosocial aspects of decision-making relative to withholding/withdrawing life-sustaining treatment from patients who are terminally ill or permanently comatose.

8. Describe clinical, ethical, and psychosocial considerations that bear upon assessment and treatment of pain in situations where patients are terminally ill, with emphasis on palliative care and hospice care.

9. Discuss ethical and legal issues arising out of the controversy surrounding physician participation in assisted death.

10. Describe ethical, legal, and policy considerations relating to organ donation and transplantation as an aspect of the physician-patient relationship.

11. Discuss the effect of an impaired physician-patient relationship and describe available legal and professional responses.

FORMAT

Three classroom approaches will be used throughout this Doctoring: Medical Humanities Clerkshp: (1) plenary sessions (e.g., seminars, panel discussions, and case studies); (2) tutor groups; and (3) standardized patient interactions. During plenary sessions, core material will be presented. The information provided during these sessions complements required reading assignments. In conjunction with assigned readings, the content of plenary sessions will constitute the major basis for the final written examination.

Tutor group sessions are designed to allow in-depth exploration of material covered during plenary sessions. Approximately seven students are assigned to each tutor group, which will meet with the same tutor during all sessions. Each student will be responsible for presenting certain assigned cases in the tutor group setting. Because tutor group participation constitutes an important part of the overall performance evaluation, students will be evaluated on the basis of their case presentations as well as their interaction as informed participants in the discussion of cases presented by other students.

The standardized patient interaction involves a 15-minute, video-taped, physician-patient encounter during which students must individually demonstrate adherence to the applicable standards of care, conformity with principles of informed consent, recognition of issues of confidentiality and privacy (including public reporting obligations), and effective physician-patient communication, with emphasis on psychosocial care. Students should prepare for the standardized patient interaction by undertaking a review of plenary session notes and assigned readings, as well as through self-directed study. Following the standardized patient interview, students are required to prepare a written report setting forth the strengths and weaknesses of their individual physician-patient interactions and detailing the issues involved in the case. Each student will participate in a scheduled faculty-student feedback session involving formal interactive review of the videotape.

For access to the Doctoring: Medical Humanities Segment--Year 3 document please click on THE PHYSICIAN-PATIENT RELATIONSHIP .