An evolving view of the patient-clinician relationship

The relationship you develop with your patient as an independent physician can often be an influencing factor in that patient’s engagement in their own care, which in turn can influence their health outcomes. While the field of medicine once was viewed as an esteemed career choice, with patients seeing their clinician as the ultimate authority in regard to their care, over the past few years the patient-clinician relationship has evolved significantly.

Medicine began as a paternalistic, highly esteemed field, dating back to 91BC. Asclepiades established Greek medicine in Rome during that period, bringing a prestige to Greek medicine and laying the groundwork for Greece’s Methodic school of medicine. That school continues to influence how medicine is practiced in the 21st century, according to researchers.

Since those early days of healthcare, of course, the practice of medicine has shifted to embrace feminism, the civil rights movement, and the challenge to authority that was prevalent in the 1960s and 70s. As a part of those movements, the idea that physicians were the sole experts and decision makers regarding a patient’s care shifted the physician-patient dynamic.

In 2022, research has found that even some physicians’ interest and perception of the medical field may be declining. For example, 68% of physicians under the age of 40 said in a recent survey that they would choose the field of medicine again for their career, a number that is down from 76% the previous year. There are many factors involved in those findings, however, including increased costs and administrative tasks faced by independent physicians.

However, the increasing movement toward patient autonomy and self-determination contributes to the evolving patient-clinician relationship in a positive way as well. Joseph Carrese, MD, a bioethicist, physician, and professor in the department of medicine at Baltimore-based Johns Hopkins, says that "The model of the doctor-patient relationship changed to one where now, I think appropriately, [it's] sort of a partnership."

That shared decision making process, which AHRQ defines as “a model of patient-centered care that enables and encourages people to play a role in the medical decisions that affect their health,” presents a more balanced model with patients being more active participants in their own care.

Gary Kaplan, MD, who served as CEO of Seattle-based Virginia Mason Franciscan Health from 2000 to 2020, says that although patients have access to much more information in today’s electronic information age, "I would submit that it's really an opportunity because the more aware, the more dialed in a patient is to their own health and well-being, the better they will be able to embrace healthy behaviors and the advice of their clinicians."

The clinician’s role in educating patients, particularly overcoming the disinformation that has become so prevalent in the past few years, continues to be important to the overall health and well-being of those patients. Likewise, the positive patient-clinician relationship, that incorporates mutual respect and trust, continues to make a difference in patient outcomes.

Trust in healthcare clinicians fell somewhat during the height of the pandemic. Even then, though, patients tended to trust their own physicians more than the healthcare system generally. A 2021 survey conducted at the University of Chicago found that:

• 84% of patients trusted their personal physicians

• 64% trusted the healthcare system as a whole

• 98% of physicians said that spending time with patients is an important component in building trust

• 77% of patients felt that their physicians do not spend enough time with them.

Evolving attitudes toward the medical profession includes steps toward leveling the hierarchy between patients, physicians, and their care teams, opening the door for enhanced shared-decision making and strengthening the patient-clinician relationship.