The growing number of web-savvy patients alters the power dynamic in the patient-physician relationship. In the older model of care, physicians served as unchallenged experts who alone devised therapeutic plans for patients.
Society values both the appropriate use of new technological and management innovations and the maintenance of a strong personal and therapeutic relationship between patients and physicians. The medical-home model may be able to accomplish both.
Caregivers often think that so-called “frequent-flyer” patients are at fault for their poor medical outcomes. In many such cases, though, unaddressed psychosocial issues are the root of the patients’ repeat visits to the emergency department.
The greatest pressure to resuscitate the extremely low-birth-weight infant often results from successful marketing efforts that lead families to expect that their premature infants will be cute and healthy.
About 80 percent of children in the ER for suturing preferred a woman doctor; 60 percent of their parents preferred a man, 19 percent, a woman, and 21 percent, the doctor with the most experience.
Physicians new to a case might object to an established care plan. Practice variation, clinical momentum, and how value is assigned by different parties to acute care and comfort measures can each contribute to conflict in these cases.
AMA J Ethics. 2018;20(8):E699-707. doi:
10.1001/amajethics.2018.699.
Awareness of transference reactions, practicing active listening and reflection, pausing, and articulating one’s understanding of another’s emotional motivations can help cultivate deeper patient-clinician relationships at the end of life.
AMA J Ethics. 2018;20(8):E717-723. doi:
10.1001/amajethics.2018.717.
Barriers to effective prognosis conversations include knowledge deficits, misconceptions, cultural differences, and lack of motivation. These can be addressed head-on by good communication interventions.
AMA J Ethics. 2018;20(8):E757-765. doi:
10.1001/amajethics.2018.757.
Tracy Shamas, MSN, APRN and Sarah Gillespie-Heyman, MSN, APRN
Veterans at the end of life have special needs due to posttraumatic stress disorder, environmental exposures, and the influence of military culture on their values. Those who die outside the Veterans Affairs health care system, however, can be at increased risk for receiving outpatient palliative care that is not sensitive to these factors.
AMA J Ethics. 2018;20(8):E787-792. doi:
10.1001/amajethics.2018.787.