Physicians, Relationships With

Relationship-Centered Care

Relationship-centered care is a new framework for conceptualizing health care, focusing on the importance of the involved individuals' relationships with each other and with their community, with the goal of providing meaningful relationships in health care. Relationship-centered care is founded on four basic principles according to the Relationship Centered Care Network:

• 1.
  Patients and physicians bring their unique experiences and qualities to the relationship. Hence, physicians are advised to remain explicitly aware of their own “personhood” and encouraged to manage their emotions in a way that facilitates connecting with patients. A physician is encouraged not just to act respectfully, but to develop genuine respect for patients.
• 2.
  Physician affect and emotion powerfully impact patient care. Physicians are discouraged from excess detachment and encouraged instead to connect through the provision of empathy, incorporating self-awareness.
• 3.
  Physicians and patients have a mutual effect on each other. Although the patient's needs take clear precedence, the physician also benefits and grows from the relationship.
• 4.
  There is a moral basis to the patient-physician relationship. A caring relationship in which the physician takes his or her role seriously and works to educate and support the patient and relevant family is morally desirable, beyond the fundamental purpose of providing quality medical care.

Patient-Centered Care

Patient-centered care is complementary to relationship-centered care, prioritizing the patient's communication style and biopsychosocial needs in each medical encounter. The physician should express him or herself as if “in the shoes of the other,” known as empathy, in response to patient affective and situational cues. Statements such as “I can imagine that would be difficult” or “That sounds scary” have proved beneficial to both parties. Experienced physicians, physicians in training, and medical students who provide empathy to patients are less burned out and more satisfied than their counterparts who do not. Patients who receive empathy from their physician are less anxious and depressed, more satisfied, and more likely to adhere to their physician's recommendations. There is also evidence that these skills are able to be taught. Regrettably, there is evidence that physicians often do not provide adequate empathy in response to patient cues, a phenomenon that has been linked to increased malpractice claims, lower scores in performance evaluations, and decreased patient satisfaction.

Reasons for Inadequate Physician Responses

Medical training can result in emotional numbing and distancing due to such stresses as sleep deprivation, the pressure to succeed in a high-performance environment, role modeling, and coping with the futility of addressing human tragedy and incurable disease. Seven to 10 years of training with 60- to 90-hour work weeks can leave a physician in financial debt, with poor health habits and lack of supportive personal relationships. Continued time stresses in medical practice without much support can tax physicians' emotional resources despite the best intentions. Systems in place throughout training and afterward to address these troubling events include informal and formal support networks, stress management, and educational programs. Fortunately, physicians enter their careers with a desire to help patients, and most learn sustaining coping skills that allow them to work hard to provide high-quality patient care.

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