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Relationship-centered Care and the Patient-Physician Relationship

I recently observed a third-year medicine resident interview a 77-year-old established clinic patient with diabetes, hypertension, and mild degenerative joint disease, all well controlled. For the first 19 minutes, of a visit scheduled for 20, the patient focused on reconfirming that her symptoms, unchanged for months, were related to her diagnoses. She also talked animatedly about her granddaughter’s upcoming wedding and the dress she had bequeathed her. As the resident prepared to leave, the patient said, “Oh by the way, Dr. Green, could you give me prescriptions for Valium, Lomotil, and Oscal?” With virtually no time left for discussion, the resident grudgingly wrote scripts for all three medications. After the encounter I asked the resident her opinion of the visit. She said, “I can’t believe she waited until the very last minute to bring up her real concerns. I really like this patient but I’m really unhappy with how this visit went.” Interviewed as part of a practice improvement project, the patient said, “I love Dr. Green. She’s a good listener and really cares about me as a person. She also trusts me to tell her what medications I need and doesn’t waste time telling me how to take them.” This scenario illustrates at least 4 factors that can make physician-patient relationships challenging to engage in and research. They are: 1) communication preferences; 2) visit expectations; 3) communication and relationship; and 4) satisfaction. Several articles in this issue of the Journal of General Internal Medicine explore these issues.