Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Sep 2012
Review[Placebo and the relationship between doctors and patients. Overview].
In medicine, placebos are used both in scientific studies and for practical therapeutic purposes. In evidence-based medicine, the efficacy of treatment may be determined as the difference between the effects of the verum (the active study drug) and the placebo, the latter being a substance lacking specific action on the disease under consideration. However, the improvements in patients' conditions under placebo treatment may be substantial and comparable to those with verum. ⋯ Interestingly, effects of placebo and of verum can be localized in the brain by physiological and anatomical techniques. With many open questions remaining, research on placebo is currently very active. These aspect and neurobiological findings in particular may facilitate for "scientifically" educated doctors to accept that ineffective materials, i.e., placebos, are in fact effective.
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Sep 2012
[Patients' autonomy and patients' rights].
Patient autonomy is a valuable asset. Under German law, the patient's right to self-determination is ensured by a corresponding duty of the physician to inform. Owing to various case laws of the courts over the last few decades, that duty, in all of its aspects (i.e., informing the patient about risks and benefits, about the diagnosis, about the course of treatment, about necessary patient compliance, and about potential treatment costs) has gained enormous jurisdictional and scientific attention as well as forensic importance. ⋯ Such a goal is difficult, especially in light of regulatory techniques. The discussion about the statute seldom addresses the fact that the suitability of legal norms as a means for public guidance can be limited; in particular, they do not guarantee that a dialogue between patient and physician about risks and benefits will ensue on the basis of a partnership. Over-regulation can damage faith and confidence in the relationship between patients and physicians.
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Sep 2012
[Patient-centered communication in the physician-patient relationship].
As a result of increasing demands for more patient-centeredness in the German health care system, physician-patient communication has been subject to transformation. Physicians are being requested to take into account their patients' communicative needs, including information, shared decision making, and emotional support, more vigorously than they had been in the past. ⋯ However, a large body of evidence exists-particularly regarding communication between cancer patients and their doctors-that shows that patients' needs are not adequately addressed or met. This potential for optimization is all the more important because targeting patients' needs during doctor-patient communication not only improves patients' satisfaction with the communication, quality of life, and well-being, but may also produce better treatment outcomes.
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Sep 2012
[The physician's role in various clinical contexts. The physician's role in palliative care].
The palliative care physician accompanies patients and their families in times of great disstress and potentially difficult medico-ethical decision making. The main objective of palliative care is the alleviation of pain and distressing symptoms in patients with progressive, incurable illness. By addressing physical problems and psychosocial as well as spiritual needs, palliative care aims at improving the quality of life of patients in order to help them to spend their remaining lifetime with as much autonomy as possible and in dignity. ⋯ Important factors in this approach are time, trust, professional, ethical, communicative, social, and emotional competencies and the attitude of physicians and other professionals. The physician is given responsibility by the patient. In accepting the role as a respondent to another individual's request for help, the physician can avoid the pitfalls of the obsolete paternalistic relationship model, or of one that is either merely autonomy based or of a provider-customer nature.