THE DOCTOR-PATIENT RELATIONSHIP.

The Doctor-Patient Relationship

The Doctor-Patient Relationship

Introduction

The special nature of the relationship between doctor and patient has been appreciated since antiquity (Laín Entralgo). As much a part of sickness and medicine as the diseases that make people ill, this relationship makes a sick person a patient and a medical person a doctor and a clinician. It is the vehicle through which physicians exercise their authority (not to be confused with authoritarianism), without which the practice of the art is impossible (Needleman). An examination of the way the relationship is formed and its potential for effectiveness suggests that this special bond is a basic part of the human condition with cultural and social dimensions.

In emergencies, when doctor and patient have never previously met, the power of the relationship can become effective immediately. Within moments a doctor who is a stranger can ease pain, make panic subside, and improve breathing. (Physicians can also worsen symptoms and exacerbate panic by wrong actions.) The bond between doctor and patient is effective across cultural boundaries, even in the presence of antagonisms, and despite sometimes formidable social and environmental impediments. This paper critically examines the concept of partnership when applied to the doctor-patient relationship.

Discussion

Physicianhood is a role—a set of performances, duties, obligations, entitlements, and limitations connected to a function or status. The socialization of medical students includes learning about the doctor's role so that they emerge both as physicians and in the role of physicians. Given its sociocultural nature, it has its counterpart in the patient, who provides for the doctor's words and action access to the patient and the patient's body not available to ordinary relationships. Because the connection between doctor and patient is bilateral, the power of sickness to make patients susceptible to change at all levels of the human condition is matched ideally by the power of this benevolent relationship to induce physicians to extend themselves at all levels. (West 2004, 76)

The ability to employ the spoken language to obtain information from and about the sick person, gain the patient's cooperation, and provide information to the patient is a central element in the art of medicine. Doctor-patient communication is unlike many other verbal transactions, despite its use of ordinary language. The patient is in the conversation with the doctor for a specific purpose that is vital for the patient and diagnostically or therapeutically significant for the physician. The patient and the doctor have important joint purposes in the service of which the conversation is both necessary and crucial.

The patient wants the doctor to pay attention to his or her symptoms and concerns about the illness, and is worried lest these not be properly expressed or their importance not be appreciated. Doctors want to hear the clues to the diagnosis that only the patient's story can convey. Yet, some things that are important to the patient may not be of interest to the doctor and vice-versa. If the doctor attends solely to the evidence for disease, discarding everything else the patient says as ...