Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

The Concept of Respect

The importance of respect and appreciation are taught very early in childhood. The roots of both are come from religious ideology and the history of mankind. We are to be appreciative of all that we have and all that is done for us.

The intertwined concept of respect and appreciation transcends all cultures. In some countries, the emphasis is so great that social ostracism or even severe punishment result from showing failing to show respect.

Here in America, we are taught to respect those who are in positions of authority. We also respect those who do things for us that we cannot do for ourselves.

Many years ago, when patients paid cash (or equivalent) for health services, there was a consistent bond between those treating and those being treated. They had, in essence, a voluntary contractual arrangement. The physician derived his/her income from the patient’s payment for services rendered. The patient trusted the physician because of an ongoing relationship which spanned the years. The relationship was based upon mutual need and trust.

The worker_s compensation system, and later the HMO/PPO/Managed care arrangements, changed that relationship. The patient paid for only a part of his/her own healthcare, and the choice of physician was confined to an employer panel or an insurer network. The concept of freedom of choice was eroded, and inevitably, so was the feeling of trust.

In the worker_s compensation system, the patient is acutely aware that they have minimal discretion in the choice of physician. The patient feels that the physician_s relationship is more with the insurer than with the the patient. They distrust this arrangement, and with that loss of trust comes loss of respect for the person delivering the service.

The less a patient directly pays for a service, the less the patient needs to express appreciation. The patient believes, and behaves as though, “you do not care about me…consequently, I do not care about you…I am not paying for this so I do not owe you anything emotionally any more than I owe you financially.”

Quite simply, some patients cannot appreciate something which they never directly chosen nor for which they have never directly paid. It is perfectly acceptable to remind a patient that regardless of the circumstance of their injury _ a circumstance that has nothing to do with you _ that mutual respect is still the cornerstone of any relationship.”

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