The Doctor-Patient Relationship: Does it Really Matter?
J. Hughes(e-mail) jhugheschangesurfer.com
August 1991
Abstract
A large body of literature purports to find that the "doctor-patient relationship" (DPR) is 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, comprehensiveness of relationship, patient participation diagnosis and treatment, affectivity of communication, and invasiveness of relationship. Formulas for measuring these variables are proposed. Since these components not necessarily co-linear, it is suggested that DPRs are not a discrete, unidimensional variable.
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. 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.