AMA Journal of Ethics. April 2017
This month in Journal of Ethics
Moral Psychology and “Difficult” Clinician-Patient Relationships
Most clinicians have encountered patients they might label as “difficult.” But clinicians’ attitudes and intentions are also critical moral psychological contributors to when and how patient-clinician relationships go wrong. Social, cultural, and environmental factors also influence the quality and therapeutic capacity of patient-clinician relationships. This issue considers possible origins of “difficult” as a label and how it disadvantages patients. Some contributors reiterate the importance of nurturing virtues such as compassion and empathy in clinical practice. Others suggest what it means for clinicians to make good on their professional obligations to try to repair damaged patient-clinician relationships. Beliefs and biases can shape patients’ and clinicians’ perceptions of each other’s communication and behaviors and are particularly important to evaluate from an ethics perspective when clinical encounters don’t go well.
Repairing “Difficult” Patient-Clinician Relationships Denise M. Dudzinski, PhD, MTS, and Carrol Alvarez, MS, RN One strategy for repairing damaged relationships with patients involves listening, empathizing, and setting clear limits and goals.
Forty Years since “Taking Care of the Hateful Patient” Richard B. Gunderman, MD, PhD, and Peter R. Gunderman, MTS The psychoanalytic perspective taken in a landmark article is enriched by encouraging clinicians to see the humanity of so-called “difficult” patients.
How Should Clinicians Respond to Medical Requests from Clinician Family Members of Patients? Commentary by Andrew Thurston, MD When patients’ family members are also colleagues, they might disagree about what’s medically indicated. Expressing empathy and respect is one critical feature of responding well.
Nested Tensions in Care Artwork and captions by Merel Visse, PhD As soon as we care or receive care, our relationships with others are “nested” and pose ethical and aesthetic complexities, as explored in these works of art.
May Ethics in Mental Health and Oncology
June Moral Distress and Medicine
July Quality of Life in Dementia
August Iatrogenesis in Pediatrics
September Incarceration and Correctional Health Care
October Clean Water Access and the Roles of Clinicians
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