Patient-centered care has evolved from the basic unilateral interaction-observation-measurement (IOM) –based care to partnership form of care, such as informed relations, relationship-centered care, person-centered care and, more recently, patient-provider relationship (Rubenfield and Scheffer, 2006 p. 96). According to Olshansky (2000), the benefit of patient-provider relationship lies in the idea of reciprocity wherein provider plans the care interventions with the patient, while the patient participates and adheres to the planned modes of health care delivery (p. 88-89).
Capezuti, Capezuti and Siegler (2007) emphasize that patient-provider relationship is a legally acknowledged contract based on open and direct care process of care facilitated with open communication (p. 614). Meanwhile, according to the Institute of Medicine (2000), patient-provider relationship is often complicated by the case of the patient being handled by the practitioner, especially if the case is by nature infectious (p. 112-113). With this circumstance at hand, both provider and patient may eventually arrive in an uncomfortable state of care process failing eventually the principal goals of partnered health care delivery.
According to Nash, Manfredi and Bozarth et al. (2001), the infectious state of the patient can greatly affect the quality and directness of care in a patient-provider partnership (p. 172). Both parties have the potential of becoming reluctant or evasive throughout the entire process of health care delivery. According to the Institute of Medicine (2000), rendering care to patients with HIV and other infectious diseases can predispose issues of mistrusts, patient incompliance, compromise the quality of health care delivery and contract misunderstandings (p. 112).
Infectious cases usually trigger stigmatization and reluctance of care on the part of the health care provider, which commonly initiates feelings of reluctance in giving direct care to the patient or offensive exaggerated health care delivery (e. g. more than double gloving during wound care, wearing over-protective suit during basic nursing care, etc. ). On the other hand, according to Nash, Manfredi and Bozarth et al. (2001), once the patient identifies any impression of reluctance or avoidance in the process of health care delivery, mistrust and noncompliance become the initial reactions of the patient (p. 172).
Eventually, the patient refuses to participate in the health care regimen manifesting high-risk behaviors, incompliance to procedure, angry behavior directed to the provider and possibly emotional/psychological upset (Klausner and Hook, 2007 p. 190). Eventually, the health care partnership established by a legally acknowledged institutional contract will fail leaving both parties unsuccessful in achieving a symbiotic health care regimen. The patient becomes non-compliant the provider, remains reluctant to participate, and manifests feelings of insecurities and depression.
According to AMA, a non-compliant patient is considered as a “difficult patient” and candidate for the reconsideration of patient-provider termination of care (Mason, 2004 p. 307). However, in the case of the patient, non-compliance is basically due to the provider’s response over the infectious status of the care recipient. If termination of relationship is considered, the ethical question on breach of duty applies to the provider’s decision, which may aggravate the patient’s condition.