Physicians relationships with

Some companies dominate specific fields and the ability to build and defend their franchise within a market segment seems to be one of the important features that single out successful companies. It takes years, if not decades, to build a franchise and, once built, companies will do all they can to maintain their position within a given field. Because they have been in a field for a while, companies would have established relationships with their customers, especially local or international opinion leaders. This group of physicians will work on the early development trials for a new product, will act as experts at the time of regulatory approval, publish papers on the product and discuss its use and its place in management of the disease in question at global conferences. 

When obtaining informed consent for the research project the physician should be particularly cautious if the subject is in a dependent relationship with the physician or... 

The physician should fully inform the patient which aspects of the care are related to the research. The refusal of a patient to participate in a study must never interfere with the patient physician relationship. 

In sum, studies covering a number of different therapeutic classes suggest that DTCA encourages patients to seek medical help, but these DTCA efforts do not meaningfully interfere with the patient-physician relationship. In spite of considerable DTCA spending, prescription choice is still determined primarily by physicians, once patients come to visit their offices. 

When obtaining informed consent for the research project the physician should be particularly cautious if the subject is in a dependent relationship with the physician or may consent under duress. In that case the informed consent should be obtained by a well-informed physician who is not engaged m the investigation and who is completely independent of this relationship. 

The correlates of attitudes toward lithium compliance in bipolar patients were studied by Cochran and Gitlin (189). This questionnaire study was part of a larger design looking at factors in lithium prophylaxis. The questionnaire packets were sent to 146 patients, 48 of whom were ultimately included in the analysis. This study evaluated the usefulness of Ajzen and Fishbein s Theory of Reasoned Action to explain the relationships among lithium-related beliefs and attitudes, normative beliefs, behavioral intentions, and self-reported compliance with treatment. According to the model, lithium patients normative beliefs (i.e., beliefs that other relevant people such as family, friends, personal psychiatrist, and lithium experts want the patient to take lithium) predict their subjective norms, which is the expectation that others want them to take lithium. Subsequently, both the subjective norm and the evaluative behavioral attitudes (i.e., positive nature of treatment) were predictive of the patients reported intent to take lithium. This, in turn, was predictive of concurrent self-reported compliance with the medication regimen. These results underscore the importance of the patient-physician relationship in lithium compliance. 

One study suggested that if a physician has a relationship with a pharmaceutical company, he or she tends to prescribe more of its products (Komesaroff and Kerridge 2002). In itself, this is not evidence of wrongdoing by either party. There are many potential explanations as to why this occurs. A pharmaceutical company may inform a physician about a new product because this is the best product available for the treatment of certain of the physician s patients. In this case, the relationship may result in a "win-win" situation. The pharmaceutical company incurs costs educating the physician about the new product, but may recoup these costs and make a profit on sales prescribed by the physician. The physician may obtain information he needs to give better care to some of his patients and they may benefit accordingly. 

While emphasizing patient care, the general approach used by the CMA policy on Physicians and the Pharmaceutical Industry (CMA 2001) is not inconsistent with that used by the AMA and the ACP. One of the general principles of the CMA policy requires the primary objective of interactions between physicians and industry to be the advancement of health of Canadians rather than the private good of physicians or industry. Another is that relationships with industry are appropriate only insofar as they do not negatively affect the fiduciary nature of the patient-physician relationship. The principles also instruct physicians to resolve any conflict of interest between themselves and their patients resulting from interactions with industry in favor of their patients. They specifically warn physicians to avoid any self-interest in their prescribing and referral practices (CMA 2001). 

Pharmacists desiring to implement new professional services must develop relationships with other health care professionals such as physicians, nurses,... 

How can you develop a relationship with a payer or physician group for the purpose of conducting economic analyses on your patients ... 

Rather, we assume that you want to improve your collaborative relationships with physicians. We suggest you can do this by knowing more about psychotropic medications and how they work in the brain. 

Dr. P calls her colleague Dr. S to talk about the referral. She chooses Dr. S because she is a woman (Laura seems more comfortable with female physicians) because she knows that Dr. S has a warm, caring style and tends to have strong relationships with her patients and because she knows Dr. S is knowledgeable about eating disorders and doesn t prescribe medication casually. Dr. P knows that she has one chance at helping Laura connect with a psychiatrist and consider medication, so she chooses the psychiatrist carefully. 

At times, patients want therapists to choose the physician they will see. If their insurance allows that freedom, we are happy to comply. We maintain relationships with different types of physicians, each with different strengths. At times, two psychiatrists may be equally qualified but have different areas of expertise. We hope that our patients benefit from onr detailed knowledge of possible referral sources. We try to match the patient with the physician by thinking about the personality of the patient and the physician s interview style. In addition, we often offer to call our colleague, to say that we are sending a specific patient. We hope that this process communicates to the patients that they can expect the same kind of caring, professional behavior from our respected colleague that they have come to expect from us. We find that these personal relationships provide a safe, calm context in which patients can consider their treatment options. 

A good relationship with the physician paves the way to effective collaboration (Seaburn et ah, 1996). As in work with a new patient, joining is the most critical task in building a good relationship. Minuchin and Fishman (1981) define joining as the glue that holds the therapeutic system together (p. 32). This is equally true for the professionals in the therapeutic system. Collaboration is much easier if professionals like one another and have confidence in one another s abilities. 

Triangulation comes in many different forms. Avoiding this trap is easier with strong, unified, collaborative relationships. With that aim, it may prove beneficial to have an initial joint session with the physician and/or patient to prevent triangulation and cultivate communication. Fostering the collaborative relationship allows a therapist or physician to respond to triangulation attempts with a restatement of the treatment mission, a recommendation to the patient to direct concerns to the appropriate person, or in the above example, education about the differences between psychiatric evaluation and therapy. 

Whether a drug is legal or illegal, approved or disapproved, obtained from a physician or bought on the black market, if the user is aware of its nature, can maintain a useful effect from it over time, can easily separate himself or herself from it, and can remain free from adverse effects, that is a good relationship with the drug. 

Ultimately, your physician will make the decision as to which drug or drugs might be best for you, at least to start with. If you have a good relationship with him or her—as you should have, for heaven s sake—you can experiment until you find the winning combination. 

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