Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-22T23:08:04.413Z Has data issue: false hasContentIssue false
  • English
  • Français

The Problem of Futility: III. The Importance of Physician-Patient Communication and a Suggested Guide through the Minefield

Published online by Cambridge University Press:  29 July 2009

Dorothy Rasinski Gregory  and
Miriam Piven Cotler
Dorothy Rasinski Gregory
Affiliation:
Center for Healthcare Ethics, St. Joseph Health System, Orange, California
Miriam Piven Cotler
Affiliation:
Health Research and Community Service, Department of Health Service, California State University, Northridge
Get access Rights & Permissions [Opens in a new window]

Extract

As noted In Part II of this series (CQ 1994;3:133–142), perhaps the most critical elements to define in deciding when treatment Is futile are the goals of therapy from, both the physician's and the patient's point of view. A patient's personal goals are based upon value system., life goals, and personal definition of “quality of life.” These personal goals must then be interpreted and applied in a reasonable and realistic fashion against what the physician has previously described as the legitimate, objective, and attainable therapeutic goals. As far as possible, both, parties must work together to eliminate the uncertainties in their discussion. The ideal situation includes a competent, alert patient and a prudent, caring physician who have had a long-term ongoing relationship. The key to collaboration is communication: a sincere interest in and professional concern for the patient; a willingness to be honest and open; a commitment to talk and to listen; an attempt to make one another feel comfortable in the collaboration; and an effort to recognize and to overcome barriers to communication, whether barriers are personal to either the patient or the physician or are professional, institutional, or societal.

Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 3 , Issue 2 , Spring 1994 , pp. 257 - 269
Copyright
Copyright © Cambridge University Press 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. Quill, TE. Recognizing and adjusting to barriers in doctor-patient communication. Annals of Internal Medicine 1989;111:51–7.CrossRefGoogle ScholarPubMed

2. Baron, RJ. An introduction to medical phenomenology: I can't hear you while I'm listening. Annals of Internal Medicine 1985;103:606–11.CrossRefGoogle ScholarPubMed

3. Kreps, GL, Thornton, BC. Health Communication: Theory and Practice. Prospect Heights, Illinois: Waveland Press, 1992. Note especially Chapter 3.Google Scholar

4. See note 3. Kreps, , Thornton, . 1992:chapt. 2.Google Scholar

5. See note 3. Kreps, , Thornton, . 1992:chapt. 7.Google Scholar

6. Quill, TE, Townsend, P. Bad news: delivery, dialogue and dilemmas. Archives of Internal Medicine 1991;151:463–8.CrossRefGoogle ScholarPubMed

7. Suchman, AL, Mathews, DA. What makes the patient-doctor relationship therapeutic? Exploring the connexial dimension of medical care. Annals of Internal Medicine 1988;108:125–30.CrossRefGoogle ScholarPubMed

8. Morreim, EH. Economic disclosure and economic advocacy: new duties in the medical standard of care. Journal of Legal Medicine 1991;12:275–329, quote at 286.CrossRefGoogle ScholarPubMed

9. See note 6, Quill, et al. 1991;151:465–6.Google Scholar

10. Delbanco, TL. Enriching the doctor-patient relationship by inviting the patient's perspective. Annals of Internal Medicine 1992;116:414–8, quote at 414.CrossRefGoogle ScholarPubMed

11. See note 10. Delbanco, . 1992;116:414–8.Google ScholarMatthews, DS, Feinstein, AR. A review of systems for the personal aspects of patient care. American Journal of the Medical Sciences 1988;295:159–71.CrossRefGoogle ScholarPubMedWolf, S. Studying the person in the patient: a look back at developments. The Pharos 1990;53(2):38–40.Google Scholar

12. Thomasma, DC, Marshall, PS. The clinical humanities program at Loyola University of Chicago. Academic Medicine 1989;64:735–9. Similar programs have been established or are under development at the University of Rochester Medical School, Southern Illinois University School of Medicine, University of California-Davis Medical School, University of California-Irvine Medical School, and the University of California-San Diego Medical School, among many others.CrossRefGoogle ScholarPubMed

13. American Board of Internal Medicine. Clinical competence in internal medicine. Annals of Internal Medicine 1979;90:402–11.CrossRefGoogle Scholar Subcommittee on Evaluation of Humanistic Qualities in the Internist, American Board of Internal Medicine. Evaluation of humanistic qualities in the internist. Annals of Internal Medicine 1983;99:720–4.CrossRefGoogle ScholarLipkin, M Jr, Quill, TE, Napodano, RJ. The medical interview: a core curriculum for residencies in internal medicine. Annals of Internal Medicine 1984;100:277–84.CrossRefGoogle ScholarPubMed

14. Vaughn, S. Joint authorship in the physician-patient interaction. The Pharos 1990;53(3):38–42.Google Scholar

15. See note 8. Morreim, . 1991;12:275–80.Google Scholar

16. Emanuel, LL, Barry, MJ, Stoeckle, JD et al. , Advance directives for medical care-a case for greater use. New England Journal of Medicine 1991;324:889–95.CrossRefGoogle ScholarPubMed

17. The Patient Self-Determination Act was part of the Omnibus Budget Reconciliation Act (OBRA 1990), P. L. 101–508.

18. La Puma, J, Orentlicher, D, Moss, RJ. Advance directives on admission: clinical implications and analysis of the Patient Self-Determination Act of 1990. Journal of the American Medical Association 1991;266:402–5.CrossRefGoogle ScholarPubMedWhite, ML, Fletcher, JC. The Patient Self-Determination Act: on balance, more help than hindrance. Journal of the American Medical Association 1991;266:410–2.CrossRefGoogle ScholarPubMed

19. Humphry, DH. Pinal Exit. Eugene, Oregon: Hemlock Society, 1991.Google Scholar

20. Cogger, BJ. Dying well? A colloquy on euthanasia and assisted suicide. Hastings Center Report 1992;22(2):6.Google ScholarCarson, R. Washington's 1–119. Hastings Center Report 1992;22(2):7–9.CrossRefGoogle ScholarBrock, DW. Voluntary active euthanasia. Hastings Center Report 1992;22(2):10–33.CrossRefGoogle ScholarPubMed

21. See note 20. Crigger, . 1992;22 (2):6;Google ScholarCarson, . 1992;22 (2):7–9;Google ScholarBrock, . 1992;22 (2):10–33.Google Scholar

22. Emanuel, EJ, Emanuel, LL. Proxy decision-making for incompetent patients: an ethical and empirical analysis. Journal of the American Medical Association 1992;267:2067–71.CrossRefGoogle ScholarPubMedLynn, J. Procedures for making medical decisions for incompetent adults. Journal of the American Medical Association 1992;267:2082–4.CrossRefGoogle ScholarPubMedOrentlicher, D. The illusion of patient choice in end-of-life decisions. Journal of the American Medical Association 1992;267:2101–4.CrossRefGoogle ScholarPubMedCapron, AM. Substituting our judgment. Hastings Center Report 1992;22(2):58–9.CrossRefGoogle ScholarPubMed

23. Arnold, RM, Forrow, L. Rewarding medicine: good doctors and good behavior. Annals of Internal Medicine 1990;113:794–8.CrossRefGoogle ScholarPubMed

24. Emanuel, EJ, Emanuel, LL. Four models of the physician-patient relationship. Journal of the American Medical Association 1992;267:2221–6.CrossRefGoogle ScholarPubMed