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The Doctor – Patient relationship

Both doctor and patient should feel comfortable exchanging information (e.g. about symptoms and treatment side effects) and working together to make treatment decisions. This applies to your GP and the hospital doctor.

Every doctor-patient relationship evolves and requires time and effort for both parties. There are countless reasons why tensions could arise in a doctor-patient relationship. You might feel that your doctor isn’t listening to your concerns, won’t answer your questions or doesn’t take your fears seriously. If it is the case, don’t be afraid to tell your doctor that you feel unable to address certain issues with him or her; that you don’t understand their medical language; or that you are not getting enough time to discuss your problems. For those who are uncomfortable approaching the doctor directly with a problem, ask a nurse or relative to talk to the doctor on your behalf.

Whilst some relationships may not be easy, ask yourself whether the doctor’s expertise outweighs a disappointing manner? Most doctors want to do the right thing, and should respond well but if you continually feel that you are not getting what you need, consider asking for a new doctor. Particularly with a complex conditon such as CUP, it is perfectly acceptable to ask for a ‘second opinion’. ‘Choice’ is an integral part of the NHS Constitution.

To get the best service, you need to take a proactive role in your own healthcare and your relationship with your doctors.

Some work by the Consumer Liaison Group of the National Cancer Research Institute in 2014 identifies what all cancer patients want:

  • I want my disease to be picked up early and treatment started without delay.
  • I want to fully understand my diagnosis and treatment options.
  • I want to be cared for as a person not an NHS patient number.
  • I want to live with the same quality of life.
  • I want support after my treatment is finished.


Consent and informed consent

Informed consent  is a very important principal in the medical profession’s dealings with the patient. This is particularly relevant in relation to treatment and trials where the clinician should ensure he or she has informed consent from the patient. In non emergency situations, written informed consent is generally required before many medical procedures, such as surgery, biopsies, endoscopy, and radiographic procedures.

The doctor must explain to the patient the diagnosis, the nature of the procedure, including the risks involved and the chances of success, and the alternative methods of treatment that are available. Nurses or other members of the health care team may be involved in filling out the consent form and witnessing the signature of the patient. In medical research, the patient must be informed that the procedure is experimental and that the patient may withdraw consent at any time. In addition, the person signing the consent form must be informed of the risks and benefits of the experimental procedure and of alternative treatments.

Consent is voluntary agreement with an action proposed by another. Consent is an act of reason; the person giving consent must be of sufficient mental capacity and be in possession of all essential information in order to give valid consent. A person who is an infant, is mentally incompetent, or is under the influence of drugs is incapable of giving consent. Consent must also be free of coercion or fraud.

Informed consent is consent of a patient or other recipient of services based on the principles of autonomy and privacy; this has become the requirement at the center of morally valid decision making in health care and research. Seven criteria define informed consent: (1) competence to understand and to decide, (2) voluntary decision making, (3) disclosure of material information, (4) recommendation of a plan, (5) comprehension of terms 3 and 4, (6) decision in favor of a plan, and (7) authorization of the plan. A person gives informed consent only if all of these criteria are met. If all of the criteria are met except that the person rejects the plan, that person makes an informed refusal.

Definitions from the Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. (2003).

Understanding is the key to making informed decisions and this does not develop from the hospital just ‘dumping’ information on patients. The doctor needs to communicate information in a way the patient understands; and, to act ethically, he or she needs to believe that a patient is making an informed choice based on understanding.