Empathy and the Practice of Medicine

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Publisher : Yale University Press
ISBN 13 : 9780300066708
Total Pages : 230 pages
Book Rating : 4.0/5 (667 download)

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Book Synopsis Empathy and the Practice of Medicine by : Howard Marget Spiro

Download or read book Empathy and the Practice of Medicine written by Howard Marget Spiro and published by Yale University Press. This book was released on 1993-01-01 with total page 230 pages. Available in PDF, EPUB and Kindle. Book excerpt: The book - which includes essays by physicians, philosophers, and a nurse - is divided into three parts: one deals with how empathy is weakened or lost during the course of medical education and suggests how to remedy this; another describes the historical and philosophical origins of empathy and provides arguments for and against it; and a third section offers compelling accounts of how physicians' empathy for their patients has affected their own lives and the lives of those in their care. We hear, for example, from a physician working in a hospice who relates the ways that the staff try to listen and respond to the needs of the dying; a scientist who interviews candidates for medical school and tells how qualities of empathy are undervalued by selection committees; a nurse who considers what nursing can teach physicians about empathy; another physician who ponders whether the desire to be empathic can hinder the detachment necessary for objective care; and several contributors who show how literature and art can help physicians to develop empathy.

From Detached Concern to Empathy

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Publisher : Oxford University Press
ISBN 13 : 0199747717
Total Pages : 188 pages
Book Rating : 4.1/5 (997 download)

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Book Synopsis From Detached Concern to Empathy by : M.D., Ph.D. Jodi Halpern

Download or read book From Detached Concern to Empathy written by M.D., Ph.D. Jodi Halpern and published by Oxford University Press. This book was released on 2001-05-10 with total page 188 pages. Available in PDF, EPUB and Kindle. Book excerpt: Physicians recognize the importance of patients' emotions in healing yet believe their own emotional responses represent lapses in objectivity. Patients complain that physicians are too detached. Halpern argues that by empathizing with patients, rather than detaching, physicians can best help them. Yet there is no consistent view of what, precisely, clinical empathy involves. This book challenges the traditional assumption that empathy is either purely intellectual or an expression of sympathy. Sympathy, according to many physicians, involves over-identifying with patients, threatening objectivity and respect for patient autonomy. How can doctors use empathy in diagnosing and treating patients rithout jeopardizing objectivity or projecting their values onto patients? Jodi Halpern, a psychiatrist, medical ethicist and philosopher, develops a groundbreaking account of emotional reasoning as the core of clinical empathy. She argues that empathy cannot be based on detached reasoning because it involves emotional skills, including associating with another person's images and spontaneously following another's mood shifts. Yet she argues that these emotional links need not lead to over-identifying with patients or other lapses in rationality but rather can inform medical judgement in ways that detached reasoning cannot. For reflective physicians and discerning patients, this book provides a road map for cultivating empathy in medical practice. For a more general audience, it addresses a basic human question: how can one person's emotions lead to an understanding of how another person is feeling?

What Doctors Feel

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Publisher : Beacon Press
ISBN 13 : 0807073334
Total Pages : 232 pages
Book Rating : 4.8/5 (7 download)

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Book Synopsis What Doctors Feel by : Danielle Ofri

Download or read book What Doctors Feel written by Danielle Ofri and published by Beacon Press. This book was released on 2013-06-04 with total page 232 pages. Available in PDF, EPUB and Kindle. Book excerpt: A look at the emotional side of medicine—the shame, fear, anger, anxiety, empathy, and even love that affect patient care Physicians are assumed to be objective, rational beings, easily able to detach as they guide patients and families through some of life’s most challenging moments. But doctors’ emotional responses to the life-and-death dramas of everyday practice have a profound impact on medical care. And while much has been written about the minds and methods of the medical professionals who save our lives, precious little has been said about their emotions. In What Doctors Feel, Dr. Danielle Ofri has taken on the task of dissecting the hidden emotional responses of doctors, and how these directly influence patients. How do the stresses of medical life—from paperwork to grueling hours to lawsuits to facing death—affect the medical care that doctors can offer their patients? Digging deep into the lives of doctors, Ofri examines the daunting range of emotions—shame, anger, empathy, frustration, hope, pride, occasionally despair, and sometimes even love—that permeate the contemporary doctor-patient connection. Drawing on scientific studies, including some surprising research, Dr. Danielle Ofri offers up an unflinching look at the impact of emotions on health care. With her renowned eye for dramatic detail, Dr. Ofri takes us into the swirling heart of patient care, telling stories of caregivers caught up and occasionally torn down by the whirlwind life of doctoring. She admits to the humiliation of an error that nearly killed one of her patients and her forever fear of making another. She mourns when a beloved patient is denied a heart transplant. She tells the riveting stories of an intern traumatized when she is forced to let a newborn die in her arms, and of a doctor whose daily glass of wine to handle the frustrations of the ER escalates into a destructive addiction. But doctors don’t only feel fear, grief, and frustration. Ofri also reveals that doctors tell bad jokes about “toxic sock syndrome,” cope through gallows humor, find hope in impossible situations, and surrender to ecstatic happiness when they triumph over illness. The stories here reveal the undeniable truth that emotions have a distinct effect on how doctors care for their patients. For both clinicians and patients, understanding what doctors feel can make all the difference in giving and getting the best medical care.

Empathy-Based Ethics

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Publisher : Springer Nature
ISBN 13 : 3030648044
Total Pages : 156 pages
Book Rating : 4.0/5 (36 download)

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Book Synopsis Empathy-Based Ethics by : David Ian Jeffrey

Download or read book Empathy-Based Ethics written by David Ian Jeffrey and published by Springer Nature. This book was released on 2021-01-05 with total page 156 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book explores a new way of applying clinical ethics. Empathy-based ethics is based on the patient–doctor relationship and seeks to encourage a more humane form of medical practice. The author argues that the current emphasis on the biomedical model of medicine and a detached concern form of professionalism have damaged the patient–doctor relationship. He investigates examples of the dehumanization of patients and demonstrates a contrasting view of humane care. The book presents empathy as a relational construct - it provides an in-depth analysis of the process of empathizing. It discusses an empathy-based ethics approach underpinned by clinical examples of the practical application of this new approach. It suggests how empathy-based ethics can be embedded in clinical practice, medical education and research. The book concludes by examining the challenges in implementing such an approach and looks to a future which redresses the current imbalance between biomedical and psychosocial approaches to medicine.

Exploring Empathy with Medical Students

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Publisher : Springer
ISBN 13 : 303011211X
Total Pages : 238 pages
Book Rating : 4.0/5 (31 download)

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Book Synopsis Exploring Empathy with Medical Students by : David Ian Jeffrey

Download or read book Exploring Empathy with Medical Students written by David Ian Jeffrey and published by Springer. This book was released on 2019-01-28 with total page 238 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book investigates new insights into the factors influencing empathy in medical students. Addressing the widely perceived empathy gap in teaching and medical practice, the book presents a new study into how this emotion is facilitated in the UK undergraduate medical curriculum, and its influence on doctor-patient relationships. The author utilises Interpretative Phenomenological Analysis (IPA) to investigate how medical students’ perspective on empathy changed throughout their education. It presents the risks students perceive when connecting emotionally with patients; their use of detachment as a taught coping mechanism; and the question of how they regulate their emotions. The book reveals the tension between students’ connection with and detachment from a patient and their aim to achieve an appropriate balance. The author presents a number of factors which seem to enhance empathy, and explores the balance of scientific biomedical versus psychosocial approaches in medical training. In contrast to the commonly-reported opinion that there has been decline in medical students’ empathy, this book contends that student empathy in fact increased during their training. This new study offers invaluable insight into how students and practitioners may be supported in dealing appropriately with their emotions as well as with those of their patients, thereby facilitating more humane medical care.

Empathy in Health Professions Education and Patient Care

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Author :
Publisher : Springer
ISBN 13 : 3319276255
Total Pages : 450 pages
Book Rating : 4.3/5 (192 download)

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Book Synopsis Empathy in Health Professions Education and Patient Care by : Mohammadreza Hojat

Download or read book Empathy in Health Professions Education and Patient Care written by Mohammadreza Hojat and published by Springer. This book was released on 2016-04-21 with total page 450 pages. Available in PDF, EPUB and Kindle. Book excerpt: In this thorough revision, updating, and expansion of his great 2007 book, Empathy in Patient Care, Professor Hojat offers all of us in healthcare education an uplifting magnum opus that is sure to greatly enhance how we conceptualize, measure, and teach the central professional virtue of empathy. Hojat’s new Empathy in Health Professions Education and Patient Care provides students and professionals across healthcare with the most scientifically rigorous, conceptually vivid, and comprehensive statement ever produced proving once and for all what we all know intuitively – empathy is healing both for those who receive it and for those who give it. This book is filled with great science, great philosophizing, and great ‘how to’ approaches to education. Every student and practitioner in healthcare today should read this and keep it by the bedside in a permanent place of honor. Stephen G Post, Ph.D., Professor of Preventive Medicine, and Founding Director of the Center for Medical Humanities, Compassionate Care, and Bioethics, School of Medicine, Stony Brook University Dr. Hojat has provided, in this new edition, a definitive resource for the evolving area of empathy research and education. For those engaged in medical student or resident education and especially for those dedicated to efforts to improve the patient experience, this book is a treasure trove of primary work in the field of empathy. Leonard H. Calabrese, D.O., Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University The latest edition of Empathy in Health Professions Education and Patient Care grounds the clinical art of empathic caring in the newly recognized contributions of brain imagery and social cognitive neuroscience. Furthermore, it updates the accumulating empirical evidence for the clinical effects of empathy that has been facilitated by the widespread use of the Jefferson Scale of Empathy, a generative contribution to clinical research by this book’s author. In addition, the book is so coherently structured that each chapter contributes to an overall understanding of empathy, while also covering its subject so well that it could stand alone. This makes Empathy in Health Professions Education and Patient Care an excellent choice for clinicians, students, educators and researchers. Herbert Adler, M.D., Ph.D. Clinical Professor of Psychiatry and Human Behavior,Sidney Kimmel Medical College at Thomas Jefferson University It is my firm belief that empathy as defined and assessed by Dr. Hojat in his seminal book has far reaching implications for other areas of human interaction including business, management, government, economics, and international relations. Amir H. Mehryar, Ph.D., Emeritus Professor of Behavioral Sciences and Population Studies, Institute for Research and Training in Management and Planning, Tehran, Iran

Compassionomics

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Publisher :
ISBN 13 : 9781622181063
Total Pages : 0 pages
Book Rating : 4.1/5 (81 download)

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Book Synopsis Compassionomics by : Anthony Mazzarelli

Download or read book Compassionomics written by Anthony Mazzarelli and published by . This book was released on 2019 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: "In Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference, physician scientists Stephen Trzeciak and Anthony Mazzarelli uncover the eye-opening data that compassion could be a wonder drug for the 21st century. Now, for the first time ever, a rigorous review of the science - coupled with captivating stories from the front lines of medicine - demonstrates that human connection in health care matters in astonishing ways. Never before has all the evidence been synthesized together in one place."--Amazon.

Only 10 Seconds to Care: Help and Hope for Busy Clinicians

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Author :
Publisher : ACP Press
ISBN 13 : 1934465615
Total Pages : 220 pages
Book Rating : 4.9/5 (344 download)

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Book Synopsis Only 10 Seconds to Care: Help and Hope for Busy Clinicians by :

Download or read book Only 10 Seconds to Care: Help and Hope for Busy Clinicians written by and published by ACP Press. This book was released on with total page 220 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Empathy

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Publisher : MIT Press
ISBN 13 : 026252595X
Total Pages : 335 pages
Book Rating : 4.2/5 (625 download)

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Book Synopsis Empathy by : Jean Decety

Download or read book Empathy written by Jean Decety and published by MIT Press. This book was released on 2014-01-10 with total page 335 pages. Available in PDF, EPUB and Kindle. Book excerpt: Recent work on empathy theory, research, and applications, by scholars from disciplines ranging from neuroscience to psychoanalysis. There are many reasons for scholars to investigate empathy. Empathy plays a crucial role in human social interaction at all stages of life; it is thought to help motivate positive social behavior, inhibit aggression, and provide the affective and motivational bases for moral development; it is a necessary component of psychotherapy and patient-physician interactions. This volume covers a wide range of topics in empathy theory, research, and applications, helping to integrate perspectives as varied as anthropology and neuroscience. The contributors discuss the evolution of empathy within the mammalian brain and the development of empathy in infants and children; the relationships among empathy, social behavior, compassion, and altruism; the neural underpinnings of empathy; cognitive versus emotional empathy in clinical practice; and the cost of empathy. Taken together, the contributions significantly broaden the interdisciplinary scope of empathy studies, reporting on current knowledge of the evolutionary, social, developmental, cognitive, and neurobiological aspects of empathy and linking this capacity to human communication, including in clinical practice and medical education.

Compassion and Healing in Medicine and Society

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Publisher : JHU Press
ISBN 13 : 1421402203
Total Pages : 553 pages
Book Rating : 4.4/5 (214 download)

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Book Synopsis Compassion and Healing in Medicine and Society by : Gregory Fricchione

Download or read book Compassion and Healing in Medicine and Society written by Gregory Fricchione and published by JHU Press. This book was released on 2011-12 with total page 553 pages. Available in PDF, EPUB and Kindle. Book excerpt: Reconciling the scientific principles of medicine with the love essential for meaningful care is not an easy task, but it is one that Gregory L. Fricchione performs masterfully in Compassion and Healing in Medicine and Society. At the core of this book is a thought-provoking analysis of the relationship between evolutionary science and neuroscience. Fricchione theorizes that the cries for attachment made by seriously ill patients reflect an underlying evolutionary tenet called the separation challenge–attachment solution process. The pleadings of patients, he explains, are verbal expressions of the history of evolution itself. By exploring the roots of a patient’s attachment needs, we come face to face with a critical component of natural selection and the evolutionary process. Medicine engages with the separation challenge–attachment solution process on many levels of scientific knowledge and human meaning and healing. Fricchione applies these concepts to medical care and encourages physicians to fully understand them so they can better treat their patients. Compassionate humanistic care promotes physical, emotional, and spiritual healing precisely because it is consonant with how life, the brain, and humanity have evolved. It is therefore not a luxury of modern medical care but an essential part of it. Fricchione advocates an attachment-based medical system, one in which physicians evaluate stress and resiliency and prescribe an integrative treatment plan for the whole person designed to accentuate the propensity to health. There is a wisdom or perennial philosophy based on compassionate love that, Fricchione stresses, the medical community must take advantage of in designing future health care—and society must appreciate as it faces its separation challenges.

The Empathic Healer

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Publisher : Academic Press
ISBN 13 : 9780120886623
Total Pages : 290 pages
Book Rating : 4.8/5 (866 download)

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Book Synopsis The Empathic Healer by : Michael J. Bennett

Download or read book The Empathic Healer written by Michael J. Bennett and published by Academic Press. This book was released on 2001-03-23 with total page 290 pages. Available in PDF, EPUB and Kindle. Book excerpt: The author establishes a new foundation for the use and value of clinical empathy that is based on a distinction between treatment and healing, and a model for using psychotherapy as a component of an organized system of care: focused, attuned to the patient's presenting motive, and consistent with our understanding of the relationship between mind and brain.

Empathy

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Publisher : BoD – Books on Demand
ISBN 13 : 9535134531
Total Pages : 182 pages
Book Rating : 4.5/5 (351 download)

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Book Synopsis Empathy by : Makiko Kondo

Download or read book Empathy written by Makiko Kondo and published by BoD – Books on Demand. This book was released on 2017-08-23 with total page 182 pages. Available in PDF, EPUB and Kindle. Book excerpt: Empathy, a basic ability for understanding persons holistically, building supportive relationships, and listening attentively, includes being with suffering persons, healing, and inducing catharsis in them. Therefore, it is necessary within occupations supporting humans: education, clinical psychology, nursing, early childhood care, welfare, and medicine. Conversely, there are individual differences in empathy, and promoting its development is difficult. In this book, we use interdisciplinary approaches to empathy; for example, we discuss a new intervention, physical and cross-cultural understanding of empathy, development of empathy, and applications in general and professional education. The significance of this book is its evidence-based interdisciplinary perspective in understanding empathy.

Handbook of the Sociology of Medical Education

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Publisher : Routledge
ISBN 13 : 1134045255
Total Pages : 348 pages
Book Rating : 4.1/5 (34 download)

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Book Synopsis Handbook of the Sociology of Medical Education by : Caragh Brosnan

Download or read book Handbook of the Sociology of Medical Education written by Caragh Brosnan and published by Routledge. This book was released on 2009-09-10 with total page 348 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Handbook of the Sociology of Medical Education provides a contemporary introduction to this classic area of sociology by examining the social origin and implications of the epistemological, organizational and demographic challenges facing medical education in the twenty-first century. Beginning with reflections on the historical and theoretical foundations of the sociology of medical education, the collection then focuses on current issues affecting medical students, the profession and the faculty, before exploring medical education in different national contexts. Leading sociologists analyze: the intersection of medical education and social structures such as gender, ethnicity and disability; the effect of changes in medical practice, such as the emergence of evidence-based medicine, on medical education; and the ongoing debates surrounding the form and content of medical curricula. By examining applied problems within a framework which draws from social theorists such as Pierre Bourdieu, this new collection suggests future directions for the sociological study of medical education and for medical education itself.

Empathy in Patient Care

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Publisher : Springer Science & Business Media
ISBN 13 : 0387336087
Total Pages : 303 pages
Book Rating : 4.3/5 (873 download)

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Book Synopsis Empathy in Patient Care by : Mohammadreza Hojat

Download or read book Empathy in Patient Care written by Mohammadreza Hojat and published by Springer Science & Business Media. This book was released on 2007-11-12 with total page 303 pages. Available in PDF, EPUB and Kindle. Book excerpt: Human beings, regardless of age, sex, or state of health, are designed by evolution to form meaningful interpersonal relationships through verbal and nonverbal communication. The theme that empathic human connections are beneficial to the body and mind underlies all 12 chapters of this book, in which empathy is viewed from a multidisciplinary perspective that includes evolutionary biology; neuropsychology; clinical, social, developmental, and educational psychology; and health care delivery and education.

An Epidemic of Empathy in Healthcare: How to Deliver Compassionate, Connected Patient Care That Creates a Competitive Advantage

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Author :
Publisher : McGraw Hill Professional
ISBN 13 : 1259586316
Total Pages : 208 pages
Book Rating : 4.2/5 (595 download)

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Book Synopsis An Epidemic of Empathy in Healthcare: How to Deliver Compassionate, Connected Patient Care That Creates a Competitive Advantage by : Thomas H. Lee

Download or read book An Epidemic of Empathy in Healthcare: How to Deliver Compassionate, Connected Patient Care That Creates a Competitive Advantage written by Thomas H. Lee and published by McGraw Hill Professional. This book was released on 2015-11-20 with total page 208 pages. Available in PDF, EPUB and Kindle. Book excerpt: The best strategies in healthcare begin with empathy Revolutionary advances in medical knowledge have caused doctors to become so focused on their narrow fields of expertise that they often overlook the simplest fact of all: their patients are suffering. This suffering goes beyond physical pain. It includes the fear, uncertainty, anxiety, confusion, mistrust, and waiting that so often characterize modern healthcare. One of healthcare’s most acclaimed thought leaders, Dr. Thomas H. Lee shows that world-class medical treatment and compassionate care are not mutually exclusive. In An Epidemic of Empathy in Healthcare, he argues that we must have it both ways—that combining advanced science with empathic care is the only way to build the health systems our society needs and deserves. Organizing providers so that care is compassionate and coordinated is not only the right thing to do for patients, it also forms the core of strategy in healthcare’s competitive new marketplace. It provides business advantages to organizations that strive to reduce human suffering effectively, reliably, and efficiently. Lee explains how to develop a culture that treats the patient, not the malady, and he provides step-by-step guidance for unleashing an “epidemic of empathy” by: Developing a shared understanding of the overarching goal—meeting patients’ needs and reducing their suffering Making empathic care a social norm rather than the focus of economic incentives Pinpointing and addressing the most significant causes of patient suffering Collecting and using data to drive improvement Healthcare is entering a new era driven by competition on value—meeting patients’ needs as efficiently as possible. Leaders must make the choice either to move forward and build a new culture designed for twenty-first-century medicine or to maintain old models and practices and be left behind. Lee argues that empathic care resonates with the noblest values of all clinicians. If healthcare organizations can help caregivers live up to these values and focus on alleviating their patients’ suffering, they hold the key to improving value-based care and driving business success. Join the compassionate care movement and unleash an epidemic of empathy! Thomas H. Lee, MD, is Chief Medical Officer of Press Ganey, with more than three decades of experience in healthcare performance improvement as a practicing physician, leader in provider organizations, researcher, and health policy expert. He is a Professor (Part-time) of Medicine at Harvard Medical School and Professor of Health Policy and Management at the Harvard School of Public Health.

Empathy: Real Stories to Inspire and Enlighten Busy Clinicians

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Author :
Publisher : McGraw Hill Professional
ISBN 13 : 1260473422
Total Pages : 296 pages
Book Rating : 4.2/5 (64 download)

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Book Synopsis Empathy: Real Stories to Inspire and Enlighten Busy Clinicians by : Daniel E. Epner

Download or read book Empathy: Real Stories to Inspire and Enlighten Busy Clinicians written by Daniel E. Epner and published by McGraw Hill Professional. This book was released on 2022-04-22 with total page 296 pages. Available in PDF, EPUB and Kindle. Book excerpt: For anyone who communicates directly with patients—the complete guide to handling emotionally charged conversations with the empathy vulnerable people deserve Empathy: Real Stories to Inspire and Enlighten Busy Clinicians helps you approach tough conversations with patients in a new, more effective way―by imagining what patients and their families may be thinking and feeling, and then communicating that recognition clearly and confidently. The authors use stories to illustrate what empathy looks and sounds like on an operational level―rather than a theoretical, scientific, or conceptual level―and provide the actionable advice you need to make empathy the central focus when faced with challenging scenarios, such as “denial,” questions about prognosis, existential concerns, difficult family dynamics, anger, and nonmedical opiate use. The viewpoints presented are drawn from a diverse group of clinicians from a variety of medical disciplines, including oncology, palliative medicine, pediatrics, psychology, chaplaincy, and ophthalmology. Each chapter is anchored by a true but anonymized story that clearly illustrates how empathy can unfold in the clinical setting. Vignettes throughout provide sample dialogue and examples of actual words and phrases that help clinicians connect with patients under the most trying circumstances. Much more than a guide to breaking bad news or an overview of all communication skills, Empathy: Real Stories to Inspire and Enlighten Busy Clinicians is a must-read for anyone connected to the healthcare industry.

Compassion

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Publisher : Royal College of General Practitioners
ISBN 13 : 0850844150
Total Pages : 224 pages
Book Rating : 4.8/5 (58 download)

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Book Synopsis Compassion by : Rodger Charlton

Download or read book Compassion written by Rodger Charlton and published by Royal College of General Practitioners. This book was released on 2015-10-07 with total page 224 pages. Available in PDF, EPUB and Kindle. Book excerpt: Compassion takes as its starting point 'Cum scientia caritas', the motto of the Royal College of General Practitioners. Translated as 'Science with compassion', it captures the technical and caring aspects of being a doctor. Science is continually developing but compassion is unchanging. But how relevant is compassion to the NHS today? Compassion is central to the practice of health care. Patients require compassion as much as they require knowledge and technical skill from their healthcare professionals. Compassion should be a motivation for anyone choosing a career in primary care. However, in recent years there have been startling instances where compassion has not been shown. Compassion: Compassion, Continuity and Caring in the NHS is a reminder that compassion is at the heart of good medical practice. The book is split into sections on patients, education and training, clinicians and future developments. There are overview chapters on access to health care, the changing model of NHS care, a history of GP selection procedures and ways of preparing the next generation of GPs. This wide-ranging book also contains chapters on specific topics: the role of the multidisciplinary team, homeless patients, prescribing, nursing in primary care, post-conflict symptoms, suicide prevention and more. Personal perspectives are also given: A layman provides a personal account of the end-of-life care his wife received. A junior doctor reflects on the different factors that guide compassion. And a doctor from the United States offers a worrying picture of primary health care's possible fate. This book looks to the future too with chapters on scholarship, building resilience, mindfulness, continuity of care and the development of a new professionalism. This book will help the reader reconsider and re-evaluate compassion - the characteristic so important in creating a long-term relationship between health professional and patient.