Ross University Blog

DEAN'S VIEWPOINT: Examining the Physician-Patient Relationship and New Styles of Interaction

October 22, 2014

By Joseph A. Flaherty, MD
Dean and Chancellor, Ross University School of Medicine

The style of interaction between a physician and his or her patient has been evolving over time, but like many aspects of our lives, the pace of change has increased tremendously in the digital age. The three classic models of the doctor-patient relationship were described in 1956 by Thomas S. Szasz, MD and Marc H. Hollender, MD.

  • In one style, the doctor is the authority figure, and the patient passively submits.
  • In the second, the doctor is more of a guide, with whom the patient cooperates.
  • The third style involves mutual participation with the doctor listening to the patient’s input. Medicine is moving toward this style, but all patients are different.

Doctors in the past were often the most educated people in their communities. But that’s no longer the case, and thus the authoritarian style doesn’t always work that well. Despite the desire for an egalitarian relationship, some people don’t want it in practice. They want to be told, “This is what you have.” They don’t want to hear, “I don’t know what caused your fainting spells.” 

The patient also wants to be heard. We have to encourage doctors to become good listeners, and to know that there is much they can learn from their patients. I did. 

There is a new style of physician-patient relationship today that is really the Internet version of what the French, in the 19th century, called Le Malade Au Petit Papier  The Malady of the Little Piece of Paper. That’s when patients came to a doctor’s visit with notes about what they think the problem is, based on what they might have heard from others or what they imagined. In the modern age, people may go online and research their symptoms and come up with their own diagnoses that they offer to their physicians. Or, they may see a prescription drug advertised on TV and feel that it would right for them, so they ask the physician for it, thereby dictating their treatment. We should recognize that people are striving for a laudable goal – learning how their bodies work in health and disease. As physicians, we need to take time to hear their thoughts. 

Every physician must find a style that he or she is comfortable with in relating to patients, and perhaps adapting it to the needs of different patients. We also need to be sensitive to what patients want in this relationship. Some may want us to be their friend which could reduce our effectiveness in being their doctor. When I was a young resident I characteristically introduced myself to patients as “Joe Flaherty” rather than “Dr. Flaherty.” I found most patients were uncomfortable with that and preferred Dr. Flaherty. I realized I was introducing my own intellectualized desire for egalitarianism rather than considering each patient’s unique needs.  

Maybe, when it comes to this most important relationship, one style does not fit all. 

Tags: Leadership

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