Download - The Concept of Care
AND EIGHT MODELS OF PHYSICIAN-PATIENT RELATIONSHIPS
The Concept of Care
The Lady With the Lamp
A nurseConsidered “curing”, the
use of therapeutics, less important to patient outcome
Assigned the task of “caring” to the nurse
“Doctors cure and nurses care”
Does this paradigm still exist?
Ingrained into society Patients influence professional
self-perceptionWhat are the implications?
Lack of clarity on the concept of care
Dissociates physicians from caring, and encourages a one-dimensional idea of nursing care
Producing the Dichotomy
Expectation of nurses to: Follow procedures Report incidents to supervisors Organize wards/departments
Whereas physicians: Order procedures Make decisions Lead wards/departments
Why Men in Medicine Tend to be MDs
Project danger into intimacyMore comfortable with
personal achievement
Why Most Nurses are Women
Project danger into situations related to personal achievement
More comfortable in activities that involve closeness
Medicine an objective science that denies subjectivity
Another suggestion
Early 19th-century thinking shifted the female image from seductive to pure
This prudery confined the social roles they were qualified to fill
Seen as unfit for medicine based on the need to restrain natural sympathies
On the Contrary
Male nursing graduates 1,694 in 1972 3,492 in 1981
More likely to advance to higher positions
Although...
Historical Case
Pre-1870 “Nurses” were
housewives/daughters “Domestic Medicine”
advised to rarely consult with physicians
In physician’s presence, nurses act as assistants
Professionalizing the Physician
Involved a separation from laypersons
Requires emphasis on special skills
At odds with empathy and caring
Concept of Care
Distinction between “care” and “cure”?
“Cure” from “curare” – to care for
Therefore cure a part of caring Possible to cure without caring?
Caring For versus Caring About
Two definitions for care: “A burdened state of mind arising from... Concern
about anything... Mental perturberation Caring about
“Oversight with the view to protection, preservation, or guidance: hence to have the care of” Caring for
Care-based Interaction
Caring For and About a Patient
Caring For, but Not About a Patient
Caring About, but Not For a Patient
Caring Neither For nor About a Patient
Caring For and About A Patient
Caring For, but Not About a Patient
Caring About, but Not For a Patient
Neither Caring For nor About a Patient
Four Models of the Physician-Patient Relationship
GoalsPhysician
obligationsRole of patient
valuesConception of
patient autonomy
Paternalistic Model
Aka Parental or PriestlyGoal to promote patient’s
well-being despite preference
Assumes shared objective values
Little/no autonomy“You’ll thank me later”Guardian
Informative Model
Aka Scientific or Engineer
Goal to provide extensive information and let patient decide intervention
Assumes patient values are known and fixed
Full autonomyTechnical expert
Interpretive Model
Goal to elucidate patient values and help find a suitable intervention
Patient values are unclear
Autonomy in self-understanding
Counselor or Advisor
Deliberative Model
Goal to support admirable values and providing relevant information
Open to development through moral discussion
Self-developmentFriend or Teacher
Connecting the Models
For/About For/About For/About For/About
Paternalistic Informative Interpretive Deliberative
Sources
E. Emanuel & L. Emanuel, Four Models of the Physician-Patient Relationship. In E. Boetzkes & W. Waluchow (Eds.), Readings in Health Care Ethics (pp.39-49). Toronto: Broadview Press.
N. Jecker & D. Self, Separating Care and Cure: An Anaylysis of Historical and Contemporary Images of Nursing and Medicine. In E. Boetzkes & W. Waluchow (Eds.), Readings in Health Care Ethics (pp.57-68). Toronto: Broadview Press.