Physician Focus: The Physician-Patient Relationship

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Program Highlights:

  • The physician-patient relationship has been regarded as the foundation of good health care since the days of the Greek physician Hippocrates more than 2,000 years ago.
  • Choosing a physician is one of the most important medical decisions a patient will make, and multiple factors should be considered when making the selection.
  • The relationship is changing from a paternalistic one – where doctors give orders and patients follow them – to one of shared decision making between physician and patient.
  • With the advent of new models of care, the relationship will continue to evolve, with greater emphasis on quality of care and with patients experiencing more of a team approach to their care.

Since the days of the Greek physician Hippocrates, the physician-patient relationship has been regarded as the key to good health care. Physicians believe that notion remains as valid today as it was when the author of the Hippocratic Oath practiced medicine some 400 years before the birth of Christ.

“Choosing a primary care physician is one of the most important medical decisions that anyone might make,” says Dennis M. Dimitri, M.D., a board-certified family physician who practices in Worcester, Mass.

Dr. Dimitri, a Clinical Associate Professor and Vice Chair of the Department of Family Medicine and Community Health at UMass Memorial Medical Center and UMass Medical School in Worcester and current Vice President of the Massachusetts Medical Society, joined fellow family physician and program host Mavis Jaworski, M.D. for the September edition of Physician Focus to discuss the many aspects of the all-important physician-patient relationship.

The relationship begins, of course, with the selection of a physician, and Dr. Dimitri cautions patients to consider many factors when choosing. “There’s no one doctor who is perfect for everybody, so you have to find a person who is right for you,” he says.

Besides the obvious ones of location, insurance, and office hours, other factors that should influence the selection are the comfort level with the physician, the ability to communicate and develop trust, and the style of the physician – whether or not he or she will engage in shared decision-making about a patient’s care.

“Not that many years ago,” says Dr. Dimitri, “the primary model for the physician-patient relationship was a much more paternalistic one – I’m the doctor, I will tell you what you should do. But today it’s different.”

“We’ve gone from a model where the content expert - the physician - imparted his or her expertise to the patient and the patient was expected to follow doctor’s orders, to a model where there’s much more shared decision-making, where doctors try to motivate patients to be more active in their care."

One might argue that picking a physician is even more important today with the growing prevalence of such models of care as the patient-centered medical home and accountable care organization.

“The patient-centered medical home represents a rejuvenation of a traditional way of providing care to patients that goes back decades,” he says. Describing it as more of a structure about the way care is delivered than a geographical location, Dr. Dimitri says that a patient can expect continuity of care through a medical home by a team-approach led by a primary care physician. Such a model of care, he says, fits within the larger concept of the accountable care organization (ACO), where patients will find the full range of care that they may need.

Dr. Dimitri believes that the movement to medical homes and ACOs, which will put much greater emphasis on the quality of care for a patient, will have a positive aspect on the physician-patient relationship.
“Patients will be able to know,” he says, “that the doctor is working on their behalf, to improve the quality of care they are receiving. This will enhance the overall health of the patient and continue to change the physician-patient relationship in a way that’s really about what’s best for the patient."

From the physician’s perspective, the importance of the physician-patient relationship has stood the test of time. “Going back to the time of Hippocrates,” Dr. Dimitri notes, “the physician-patient relationship has been regarded as sacrosanct. That relationship is the critical element in getting the care a patient needs. Today, it’s not a lot different than it was 2,000 years ago."

Watch the above video for more conversation, including discussion about, the role of medical support staff and office personnel in the physician-patient relationship, the barriers to a good relationship, what physicians and patients might do if the relationship gets rocky, and what patients can do to get the most out of their visits with their physicians.

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