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The Doctor-Patient Relationship: Does it Really Matter?

A large body of literature uses the “doctor-patient relationship” (DPR) is if it were a discrete phenomenon with positive effects on patient satisfaction and clinical outcomes. This paper examines the three assumptions made by this literature: 1) that the DPR is a discrete dichotomous variable, rather than a poorly inter-correlated cluster of attributes; 2) that this cluster of attributes are the most significant predictors of the variables they are purported to effect; and 3) that the beneficial influence of a primary care relationship requires a physician rather than a paraprofessional.

First the components of the DPR addressed in the literature are specified: total physician-patient contact, the comprehensiveness of relationship, patient participation diagnosis and treatment, affectivity of communication, and the intensity of interaction. Since these components are not necessarily co-linear, it is suggested that DPRs are not a discrete, unidimensional variable.

Next, the paper discusses the particular task involved in medical care, and whether these are best carried out by one worker with a medical degree; history-taking; information synthesis; education and counseling; diagnostic and treatment procedures; case-management; and diagnostic and treatment decision-making. The complexity of medical practice, cost-containing managerial efforts at rationalization, and mobilization of non-physician health workers threaten to disaggregate these tasks and assign them to non-physicians.

Next, the paper examines some of the outcomes attributed to the DPR, such as physician and patient satisfaction, compliance with treatment regime, clinical outcomes, and lowered costs. It is argued that the DPR itself appears to make only a minor contribution to determining any of these outcomes.

Finally, the paper asserts that the organized power of the medical profession has supported a black-box approach to the DPR in order to defend physician autonomy against organizational and technological control. A reinterpretation of the DPR literature may suggest that organizational and technological innovations could reduce the role of the physician, and achieve or surpass all the desired outcomes of medicine.

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James Hughes Ph.D., the Executive Director of the Institute for Ethics and Emerging Technologies, is a bioethicist and sociologist who serves as the Associate Provost for Institutional Research, Assessment and Planning for the University of Massachusetts Boston. He is author of Citizen Cyborg and is working on a second book tentatively titled Cyborg Buddha. From 1999-2011 he produced the syndicated weekly radio program, Changesurfer Radio. (Subscribe to the J. Hughes RSS feed)



COMMENTS

Refreshing to have a different viewpoint than the mainstream.  Agree: DPR not one thing; though confidence vs distance is significant.  The role of paraprofessionals is underestimated.

I was surprised at a recent meeting that GPs did not raise objection on this issue at a presentation of remote patient monitoring equipment.  But the personal touch is valuable!

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