Investigating the Physician-Patient Relationship: Examining Emerging Themes (original) (raw)
The patient–physician relationship: an account of the physician’s perspective
Israel Journal of Health Policy Research
Background: The issue of patient-physician relationships in general, and particularly the trust of patients in their primary care physician has gained much interest in academia and with practitioners in recent years. Most research on this important topic, however, focused on how patients view the relationship and not how the physicians see it. This research strives to bridge this gap, with the resolution of leading to an improved appreciation of this multifaceted relationship. Methods: A survey of 328 actively practicing physicians from all four health maintenance organizations (HMOs) in Israel resulted in a hierarchical formation of components, indicating both the relative as well as absolute importance of each component in the formation of the patient-physician relationship. The sample conducted was a convenience one. Methodologically, we used two different complementary methods of analysis, with the primary emphasis on the Analytic Hierarchical Processing (AHP), a unique and advanced statistical method. Results: The results provide a detailed picture of physicians' attitudes toward the patient-physician relationship. Research indicates that physicians tend to consider the relationship with the patient in a rather pragmatic manner. To date, this attitude was mostly referred to intuitively, without the required rigorous investigation provided by this paper. Specifically, the results indicate that physicians tend to consider the relationship with the patient in a rather pragmatic manner. Namely, while fairness, reliability, devotion, and serviceability received high scores from physicians, social interaction, friendship, familial, as well as appreciation received the lowest scores, indicating low priority for warmth and sociability in the trust relationship from the physician's perspective. The results showed good consistency between the AHP results and the ANOVA comparable analyses. Conclusions: In contrast to patients who traditionally stress the importance of interpersonal skills, physicians stress the significance of the technical expertise and knowledge of health providers, emphasizing the role of competence and performance. Physicians evaluate the relationship on the basis of their ability to solve problems through devotion, serviceability, reliability, and trustworthiness and disregard the "softer" interpersonal aspects such as caring, appreciation, and empathy that have been found to be important to their patients. This illustrates a mismatch in the important components of relationship building that can lead to a loss of trust, satisfaction, and repeat purchase.
Attaching a New Understanding to the Patient-Physician Relationship in Family Practice
The Journal of the American Board of Family Medicine, 2003
Background: As a result of continuity of care with patients and their families, family physicians are uniquely poised to form enduring clinical relationships with their patients. The degree of collaboration in and satisfaction with the patient-provider alliance has been shown to have important implications for treatment outcomes across a range of medical problems. Providing optimal care can require family physicians to appreciate the sequelae of having clinically relevant aspects of past relationships emerge in the health care relationship, both in their patients and in themselves. A conceptual model is essential to assist in recognizing these key aspects. Methods: A literature search was conducted using MEDLINE. Key words entered were "illness" and "attachment theory." Thirty-five English-only articles appeared from which further relevant references were gathered. Results: Attachment theory serves as a useful model for highlighting important features of physicianpatient relationships, which can affect treatment outcome in the family practice setting. It posits that everyone has an innate need to form strong attachment bonds to their earliest caregivers. To ensure survival, the child adapts its bonding to the caregiver's attachment style. With time, the maturing person develops a style of relating in subsequent caregiving relationships based on these early, and to some extent later, close relationships. Insecure attachment styles that can develop-dismissing, preoccupied, and fearful-have been shown to affect the clinical relationship and medical treatment outcomes often in important and predictable ways. Conclusion: Family physicians can more easily adopt an understanding, compassionate, and flexible treatment stance by recognizing patients' unique attachment relationship patterns, thereby improving medical treatment outcome.
A conceptual model of physician-patient relationships: a qualitative study
In any clinical encounter, an effective physician-patient relationship is necessary for achieving the desired outcome. This outcome is successful treatment, and therefore, the relationship should be a healing one. In addition, in the Islamic view, the physician is a manifestation of God's healing attribute, which is usually undermined in everyday therapeutic communications. Yet there are few empirical data about this experience and how it occurs in the clinical context. This study was conducted to develop a model of physician-patient relationship, with the healing process at its core. Our goal was to explain the nature and characteristics of this encounter. In Islamic teachings, healing is defined as " cure " when possible and if not, reducing pain and suffering and ultimately finding a meaning in the illness experience. This study was a qualitative inquiry. Data were collected through 17 open-ended, semi-structured interviews with physicians who had an effective relationship with their patients. The participants' experiences and their perception regarding the relationship were subjected to grounded theory content analysis. For establishing the trustworthiness of the data collection and analysis we used triangulation, peer review, and member checking. The findings showed that the components of the patient-physician healing relationship could be categorized in the four key processes of valuing the patient as a person, effective management of power imbalance, commitment, and the physician's competence and character. This leads to forming the three necessary relational elements of trust, peace and hope, and being acknowledged. Their importance has been better demonstrated in a relationship which incorporates the spiritual aspects of patient care and also physician's satisfaction. The physician-patient relationship has a central role in patient outcome. This relationship has an understandable structure and its components may have an effective impact on promoting the patient's experience of the health system.
Elements that Establish a Healthy Doctor Patient Relationship
Texila International Journal of Basic Medical Sciences, 2019
Background: The doctor patient relationship is the keystone of our health care system. But in modern medicine, there is very little credit given to this relationship. The degradation of the doctor patient relationship has led to unsatisfied patients, frustrated doctors and overall diminution in the quality of health care. Objective: The aim of this study is to emphasize the importance of a good doctor patient relationship. Method: The present study, upon review of several articles, discusses the components of a good doctor patient relationship, and summarizes it into five major categories. From the articles researched, below are a comprehension of the collective information gathered and presented in a redefined, organised manner. Conclusions: The five main categories discussed include: First impressions, mannerisms, communication skills, professionalism qualities, and collaborative decision making. The study also talks about how these five components are integrated, and how it effects the doctor patient relationship, leading to better therapeutic outcomes in patients and long-term job satisfaction in doctors.
Difficulties in Building the Physician–Patient Relationship: the Physician’s Perspective
Postmodern Openings, 2015
The necessity of empirical research in the field of medical services provision is highlighted both by the numerous modifications within the legislative framework (through which the medical system is organized and functions) and by the dysfunctionalities within its existence. The study proposes to pinpoint the factors that may influence the quality of the physician-patient relationship. We identified factors at the level of communication between physician and patient, of empowering and involving the patient, of understanding the patient, of the patient's way through the system, and of relating to a "second opinion." We also present solutions identified by physicians for optimising these relations. The study is based on the analysis of 12 interviews conducted with physicians within public and private institutions in Iaşi. The topics of discussion focused on the following aspects: physician-patient relationship, physician's trust in the patient, particularities of trust relationship, patient empowerment and involvement, level of patient's information, "the second opinion," physician's experience as a patient (or as caregiver). The paper brings attention to the difficulties pinpointed by physicians, in their relation with both the institutions and the patients. The main aspects identified are related to the way in which the physician-patient relationship is
Journal of the American Board of Family Medicine : JABFM
A group of senior leaders from the early generation of academic family medicine reflect on the meaning of being a personal physician, based on their own clinical experiences and as teachers of residents and students in academic health centers. Recognizing that changes in clinical care and education at national and local systems levels have added extraordinary demands to the role of the personal physician, the senior group offers examples of how the discipline might go forward in changing times. Differently organized care such as the Family Health Team model in Ontario, Canada; value-based payment for populations in large health systems; and federal changes in reimbursement for populations can have positive effects on physician satisfaction. These changes and examples of changes in medical student and residency education also have the potential to positively affect the primary care workforce. The authors conclude that, without substantive educational and health system reform, the abi...
The Patient-Physician Relationship and Medical Utilization
The Primary Care Companion to The Journal of Clinical Psychiatry, 2007
The goal of this study was to (1) explore the relationship between medical utilization and characteristics of the patient-physician relationship and (2) evaluate the relationship between physician perception of patient difficulty, chronic medical problems, and patient somatizing tendencies. Method: Patients in an academic family practice center were asked to complete a demographic data sheet, the PRIME-MD Patient Questionnaire, and the Barrett-Lennard Relationship Inventory regarding their relationship with their physicians. Their physicians completed the Difficult Doctor-Patient Relationship Questionnaire. Patient charts were examined for number of office visits and phone calls in the previous year, as well as number of chronic problems and medications. The study was conducted from September 2000 to November 2001. Results: Forms were completed by 165 patients and 20 physicians. Forty-three patients who were approached refused to participate. Patient ratings on the Barrett-Lennard Relationship Inventory were not related to utilization measures. Physician ratings of difficulty were significantly related to phone calls and visits (p < .05), as well as PRIME-MD Patient Questionnaire somatization tendencies (p < .05) but not to number of chronic problems. Patient and physician ratings were not significantly correlated. Gender (p < .001), marital status (p < .04), education (p < .03), and employment status (p < .002) were all related to utilization measures. Conclusion: Medical utilization was associated with somatizing tendencies of patients and the physicians' perception of patient difficulty. Physicians rated patients as difficult if they tended to somatize but not if they had a number of chronic problems.