01 Relatie Medic-pacient 2016

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     "  Poate apare atunci cand interese proprii ori ale unor terti apropriati

    ori membrii ai familiei (pana la gradul III) se intersecteaza cu datoria

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    !   ingrijirea medicala

    !   luarea unei decizii

    !   Cercetare

    !   Evolutia carierei profesionale

    !   publicarea stiintifica, etc.

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     Model paternalist:

    bazat pe atitudinea

    paternalista a medicului(de inspira"ie european!)

     Model informativ: bazatpe autonomia pacientului

    in relatie cu medicul(deinspira"ie american!)

     Model interpretativ

    bazat pe autonomia

    pacientului in relatie cumedicul

     Modelul deliberativ:

    bazat pe dezvoltarea

    unei rela"ii

    Principiul eticcare prevaleaz!

    Beneficien!a asupraautonomiei.

    Autonomia asupra beneficen!ei

    Autonomia asupra beneficen!ei.

    Beneficen!a se împlete#tecu autonomia.

    Cine decide înmodelul de

    rela"ie.Rolul medicului

     Medicul 

    Medicul este în control. Medicul ca reprezentant al pacientului.

     Pacientul 

    Pacientul este în control. Medicul ca un consultantmedical

     Pacientul 

    Pacientul este în control Medicul ca interpret.

     Pacientul .

    Pacientul este în control Medicul ca prieten.

    Alian!a terapeutic"

    Construc"iamodelului de

    rela"ie

    i. Medicul estedepozitarulcunoa#terii

    ii. Medicul staruie sa isi pastrezeindependenta

    iii. Valorile mediculuisunt transferateasupra pacientului

    i. Prin exercitiuldrepturilor sale,informare, libertate,

     pacientul seautodetermina.

    ii. Pacientul î#iadministreaz" singur

     propriile valori

    i. Prin intuitivismmedicul anticipeaz" dorin!ele pacientului.

    ii. Medicul este unconsilier si uninterpret

    iii. Medicul coboaralanga pacient pentrua-l ajuta sa isiregaseasca propriilesale valori în!elegandinforma!ia

    i. Prin auto-dezvoltaremedicul oferacunoastere

    ii. pacientul dobandesteel singur informatia,in cunostiinta decauza.

    iii. Medicul ridica pacientul la nivelulintelegerii sale

    iv. Alianta terapeuticav. Medicul este

     prietenul pe care îl ai pentru scurt timp

    vi. Decizia decurge

    dintr-o negociere

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    Avantajelemodelului de

    rela"ie

    i. Model umanist.ii. Medicul are libertate

     profesional" de a-#ialege calea

    iii. Medicul este lipsit decondi!ionalit"!i

    iv. Medicul poate damasura valorii saledupa competenta

    v. Implicare personal" amedicului redus"

    vi. Timp minimconsumat

    vii. Încrederea în medic

    la cote ridicate

    i. Model legalist.ii. Natura rela!iei nu se

     bazeaz" pe umanism,ci pe competen!"

    iii. Pacientul esteautonom

    iv. Drepturile pacientului sunt prioritare, legalismuleste prioritar 

    v. Pacientul se implic" maximal în îngrijirea#i ia decizii

    vi. Medicul nu este

    implicat personal sir "mâne un consultantmedical

    vii. Încrederea pacientului (rel.fiduciara) este la cotereduse

    i. Model mixt.umanist-legalist

    ii. Pacientul esteautonom, în controlulsau #i îl are al"turi pemedic care îl ajuta s" 

    se reg"seasc"iii. Încrederea (rela!ie

    fiduciar ") în mediceste la cote ridicate

    iv. Deliberarea se faceatat asupra valorilorce !in de starea des"n"tate cat #i asupra

    valorilor pacientuluiv. Natura rela!iei ia in

    considerareumanismul dar se

     bazeaza pecompetenta

    vi. Imp"rt vina unui e#ec

    i. Model mixt.umanist-legalist

    ii. Medicul #i pacientulau o rela!ie empatic"

    iii. Cei doi conlucreaz" iv. Pacientul #tie c" 

    lucreaz" pentru sine#i este mândru deatitudinea sa delupt"tor 

    v. Încredere în medic(rel. fiduciara este lacote înalte (cele maiînalte) dublat" de

    încredere în reu#it"vi. R  "spunderea

    medicului, chiardac" exist", estediluata în deciziacomun"

    Li it l i R l !i i R l !i i R l !i i R l ti t

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    Limitelemodelului de

    rela"ie

    i. Rela!iedezechilibrat":medicul este încontrolul actuluimedical:

    ii. Deciziile provenind

    din valorilemedicului pot s" nufie pe placul

     pacientului.iii. Persoana medicului

    devine importan!"  prinalegerile/deciziile

    sale #i competen!a sa.medicul providen!ialsau ca sursa anefericirii pacientului(totul sau nimic)

    iv. Medicul poate ajunges" cunoasc" boala dars" nu î#i aminteasc" 

    numele pacientuluiv. Asumare integral" a

    responsabilit"!ilor decatre medic

    vi. Responsabilitateinalta

    vii. Malpraxis

    i. Rela!iedezechilibrata:

     pacientul este încontrolul actuluimedical.! Este el apt s" 

    aleag"?! I#i dore#te s" aleag"?

    ! Poate el sa aleagaîntre optiuni,

     beneficii si riscuri?i. Medicul nu e

    independent

    ii. Medicul nufinalizeaza planulterapeutic

    iii. Cine r  "spunde pentrudestinul pacientului?

    iv. Cine r  "spunde pentruactul medical?

    v. Unde este umanismul

    actului medical?vi. Malpraxis

    i. Rela!ie u#ordezechilibrat": : unmedic lipsit de

    intui ! ie spre a

    în ! elege bine

    dorin ! ele pacientului

    ori un medic careinfluen ! eaz "  potschimba deciziile

     pacientului careastfel se dovede#te inmod real lipsit su

     privat de o real" autonomie

    ii. Pacientul poate primimai mult" sau mai pu!in" îngrijiremedical" decât #i-ardori.

    iii. Persoana mediculuidevine important" 

     prin interpret"rile

    saleiv. Comunicarea dificil " 

     sau incomplet "  poate pava esecul.

    i. Relatie aparentcongruenta siechilibrata

    ii. Implicare afectiv" din partea medicului

    iii. Timp mult consumat

    iv. E#ecul actuluimedical si al rela!ieidevine e#ec personalce afecteazaimaginea medicului

    v. Mare nevoie deobiectivitate

     profesional":

    subiectivismul poatedistruge rezultatulvi. Rela!ie continu" ce

    nu poate fi întrerupt" f "r " daune

    vii. Pacientul unui singurmedic

    Ri il i Ri d i Ri d i i Ri d i i Ri d d lt

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    Riscurilemodelului

    i. Risc de eroaremedical"

    ii. Risc de malpraxisiii. Încredere în#elat" iv. Rela!ie

    depersonalizant" (în

    extrem)

    i. Risc de anomie arela!iei (indiferenta

     profesional")ii. Risc de lipsa de

    umanism medicaliii. Pierderea valorilor

     profesionale #i adirec!iei actuluimedical

    iv. Medic f  "r " decizie,anomic, indecis,neimplinit

     profesionalv. Absen!a încrederii

    medicului in el si a pacientului in medicvi. Risc de malpraxis:

    ! Cineva raspunde! medicul preia

    r "spunderealaboratorului

    i. Risc de eroare prinlipsa intui!ieivalorilor personaleale pacientului

    ii. Eroare profesional":adesea nu se

    intervineiii. Risc de influen!areiv. Risc de malpraxis

    i. Risc de dezvoltare arelatiei dincolo de

     profesionalismii. Risc de eroare

    medical" izvorât" din lips" de

    competent",neglijent", u#urin!",temeritate

    iii. Încredere în#elat"iv. Pacientul ramas fara

    medic si farasperanta

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