THE NATURE OF THE CLINICAL ENCOUNTER

1
THE NATURE OF THE CLINICAL ENCOUNTER

• AN OVERVIEW

2
CLINICAL DECISION MAKING

• EVERY CLINICAL DECISION INVOLVES A MORAL DECISION
• CHOICES OF ENDS AND MEANS
• MULTIPLE VIEWS OF THE GOOD LIFE IN A
  PLURALISTIC SOCIETY
• VALUES INDIVIDUAL, COMMUNITY, INSTITUTION
• MEDICAL GOODS AS ONE FACET OF DECISIONS
• STRATEGIES FOR IMPLEMENTING DECISIONS

3
THE CLINICAL ENCOUNTERVALUE ENCOUNTER MEDICAL
COMPLAINTCOLLABORATION IN COMMON ENTERPRISE

• PATIENT WEAKNESS VULNERABILITY
• DISEASED STATE
• IGNORANCE
• FEAR
• PATIENT STRENGTH
• KNOWLEDGE OF, AND COMMITMENT TO, MORAL GOODS FOR
  SELF

• CAREGIVER STRENGTH MEDICAL EXPERTISE
• COMMITMENT TO HEALTH AND HEALING POWER
• DIAGNOSTIC, PROGNOSTIC, AND THERAPEUTIC
  KNOWLEDGE, SKILL, AND AUTHORITY
• FAMILIARITY AND COMFORT
• CAREGIVER WEAKNESS
• KNOWLEDGE OF FULL RANGE OF MORAL GOODS FOR
  PATIENT
• KNOWLEDGE OF, AND COMMITMENT TO, MORAL GOODS FOR
  SELF EITHER AS PROFESSIONAL GOODS OR PERSONAL
  GOODS

4
THE GOALS OF MEDICINETHE HASTINGS CENTER (1996)

• THE PREVENTION OF DISEASE AND INJURY AND
  PROMOTION AND MAINTENANCE OF HEALTH
• THE RELIEF OF PAIN AND SUFFERING CAUSED BY
  MALADIES
• THE CARE AND CURE OF THOSE WITH A MALADY, AND THE
  CARE OF THOSE WHO CANNOT BE CURED
• THE AVOIDANCE OF PREMATURE DEATH AND THE PURSUIT
  OF A PEACEFUL DEATH

5
ASPIRATIONS OF MEDICINETHE HASTINGS CENTER (1996)

• TO BE HONORABLE AND TO DIRECT ITS OWN
  PROFESSIONAL LIFE
• TO BE TEMPERATE AND PRUDENT
• TO BE AFFORDABLE AND ECONOMICALLY SUSTAINABLE
• TO BE JUST AND EQUITABLE
• TO BE RESPECTFUL OF HUMAN CHOICE AND DIGNITY

6
THE GOALS OF MEDICINEAMERICAN COLLEGE OF
PHYSICIANS (1984)

• PROMOTE HEALTH
• RELIEVE SUFFERING
• PREVENT UNTIMELY DEATH
• MAINTAIN THE DIGNITY OF THE PATIENT
• NOTE THE EMPHASIS ON THE PATIENT AS THE FOCUS OF
  HEALTHCARE

7
HIPPOCRATESTHE ART OF MEDICINE

• FIRST OF ALL I WOULD DEFINE MEDICINE AS THE
  COMPLETE REMOVAL OF THE DISTRESS OF THE SICK, THE
  ALLEVIATION OF THE MORE VIOLENT DISEASES, AND THE
  REFUSAL TO UNDERTAKE TO CURE CASES IN WHICH THE
  DISEASE HAS ALREADY WON THE MASTERY, KNOWING THAT
  EVERYTHING IS NOT POSSIBLE TO MEDICINE.

8
HIPPOCRATESTHE ART OF MEDICINE

• A MAN WHO THINKS THAT A SCIENCE CAN PERFORM WHAT
  IS OUTSIDE ITS PROVINCE, OR THAT NATURE CAN
  ACCOMPLISH UNNATURAL THINGS, IS GUILTY OF
  IGNORANCE MORE AKIN TO MADNESS THAN TO LACK OF
  LEARNING.
• WHEN A MAN IS ATTACKED BY A DISEASE MORE POWERFUL
  THAN THE INSTRUMENTS OF MEDICINE, IT MUST NOT BE
  EXPECTED THAT MEDICINE SHOULD PROVE VICTORIOUS.

9
HIPPOCRATESTHE ART OF MEDICINE

• I ASSERT THAT, WHEN THE PHYSICIANS FAIL, IT IS
  THE POWER OF THE DISEASE WHICH IS RESPONSIBLE AND
  NOT DEFICIENCIES IN THE SCIENCE OF MEDICINE.