The Doctor-Patient Relationship

The doctor and patient relationship is the cornerstone of the healthcare system, with impacts that extend beyond the individual. It relies on trust and communication to deliver quality medical care, ensure accurate information exchanges, and support informed decision-making.

Especially in the United States, there is a growing demand for whole-person healthcare that includes emotional and psychological health as well as physical care. The doctor-patient connection is key to this comprehensive approach and can impact the success of treatment.

This article talks about some of the models of care and what people want from their provider, as well as what healthcare professionals expect from their patients.

Qualities of the Doctor-Patient Relationship

While there are a number of models designed to help build doctor-patient relationships in which people flourish, there are specific qualities that describe them. These qualities include:

• Trust
• Knowledge
• Regard
• Loyalty

These factors have been shown to have impact in people treated for lupus, cancer, and more. Trust in their provider has been shown to be a key factor in people getting vaccines.

These qualities remain key to patient care, despite challenges like provider time constraints or the development of new technologies including telehealth, artificial intelligence (AI) in healthcare, or sophisticated personalized medicine.

For example, despite the highly technical treatment options that now exist for cancer, people still want information they understand, especially about hard-to-understand concepts like genetics, and to make decisions for themselves in a trusting relationship.

What Patients Want in Healthcare Providers

A 2019 study from Australia sought to identify what people most want from their healthcare providers. Some insights from the results and responses include:

• Emotional and spiritual needs: Patients want to be seen as people, with providers that are attentive and empathetic. It's important to feel that they share power and make decisions for themselves or their loved ones, and that they don't feel defined as their disease.
• Continuity and competency: People want healthcare providers to communicate with them, but also with each other, to ensure they all have the right information. They want to be confident in their knowledge about their health condition, and what to expect from treatments and procedures.
• Trust in provider skills: Patients want to feel safe and know their provider is meeting a standard of care. Pain management, for example, was an important issue to patients uncertain about experiencing pain.

People also want to be sure they have high-quality information about how their condition will impact their lives moving forward, including its effects on family and friends. This can have real impact for people facing a poor prognosis and contemplating end-of-life care.

What Healthcare Providers Want From Patients

The American Medical Association includes patient responsibilities in its definition of ethical medicine and the doctor-patient relationship. Healthcare providers have a reasonable expectation that their patients will:

• Provide as detailed a health history as possible
• Cooperate with treatment plans
• Make healthy lifestyle choices for themselves and those around them
• Accept care from providers in training, though they have a right to refuse
• Behave appropriately in the healthcare setting
• Honor their financial obligations for their care

Because the doctor-patient relationship involves privacy protections, it's important to providers that people know they can be honest about their health and express concerns clearly.

Common Patient-Doctor Relationship Models

There are a number of models for developing the doctor-patient relationship. Three common models are described here. You can ask a healthcare provider about their approach or express your preference about the one you'd like to see.

Active-Passive Model

Some people find that the healthcare provider's power is necessary to the steady course of medical care. The patient seeks information and technical assistance, and the doctor formulates decisions which the patient must accept.

Though this seems appropriate in medical emergencies, this model, known as the activity-passivity model, has lost popularity in the treatment of chronic conditions such as rheumatoid arthritis and lupus.

In this model, the doctor actively treats the patient, but the patient is passive and has no control.

Guidance-Cooperation Model

The guidance-cooperation model is the most prevalent in current medical practice. In this model, the doctor recommends a treatment and the patient cooperates.

This coincides with the "doctor knows best" theory whereby the doctor is supportive and non-authoritarian yet is responsible for choosing the appropriate treatment. The patient, having lesser power, is expected to follow the recommendations of the physician.

Mutual Participation Model

In the third model, the mutual participation model, the doctor and patient share responsibility for making decisions and planning the course of treatment. The patient and doctor are respectful of each other's expectations, point of view, and values.

Some have argued that this is the most appropriate model for chronic illnesses, such as rheumatoid arthritis and lupus, where patients are responsible for implementing their treatment and determining its efficacy. The changes in the course of chronic rheumatic conditions require a doctor and patient to have open communication.

The Effectiveness of Treatment

The effectiveness of treatment is largely dependent on the patient carrying out the directions of the healthcare provider. Taking arthritis as an example, your compliance with care may involve:

• Taking prescribed medications
• Range of motion and strengthening exercises
• Joint protection techniques
• Natural remedies
• Pain relief techniques
• Anti-inflammatory diet
• Weight control
• Physical therapy

A treatment plan assumes that a person will commit to their appropriate care. Some studies have demonstrated that the quality of a doctor-patient relationship can impact effective care, and influence the tests, treatments, and outcomes that people experience.

Summary

The doctor-patient relationship has been described as “a consensual relationship in which the patient knowingly seeks the physician’s assistance and in which the physician knowingly accepts the person as a patient." Its importance is based on trust, knowledge, regard, and loyalty.

Patients have certain expectations about their care, and healthcare providers have a right to certain commitments from their patients, like honesty and good-faith compliance with treatment plans. The doctor-patient relationship can affect healthcare outcomes, so don't hesitate to talk openly with your provider about your care and your expectations.