A doctor-patient rapport is very important as a patient would feel much more comfortable allowing an intimate examination and confiding in a doctor who they can easily communicate with. This kind of relationship has mutual benefit to both the doctor and the patient. The more the information a doctor can get out of a patient, the easier and more accurate it is to diagnose a disease. The doctor also benefits from the relationship in that a happy client will more often than not refer their family and friends to that doctor.
This means more business for the doctor and more confidence knowing that someone appreciates their work. A patient will benefit in that the doctor will take enough time to explain, as much possible, the nature of the disease, how to prevent it from recurring, what to do and what to eat so that they can heal quickly. The patient also gets a chance to ask as many questions as they can and express their fears to the doctor. A wrong diagnosis and miscommunication may lead to more visits to the hospital, increased use of the wrong drugs and therefore more expenses.
Such a relationship however is based on an agreement between the two parties and none of the parties can impose it on the other. It is formed when a patient makes a request for a medical exam, diagnosis, advice, opinion or treatment and the doctor agrees to provide them. In some branches of medicine such as psychiatry and family medicine, such a relationship is more important than in other specialties like radiology and pathology. In psychiatry and especially in private practice, a physician is not obliged to treat every patient that walks to their door and can therefore choose the patients he is willing to treat.
A doctor is also, not obliged to handle an emergency case, if the doctor doesn’t not have a prior or existing doctor- patient relationship with that patient. A doctor is however in future obliged to that patient should he choose to accept to treat the patient. A patient is free to terminate the services of the doctor any time as they please and seek them from another doctor. To keep such a relationship professional, both parties must have mutual respect, trust and share the same values and perspectives about life.
In this era of information technology a patient has a lot of information concerning a disease, its symptoms and possible drugs. Therefore, most of the time they visit the hospital, they have a vague idea of what to expect in terms of drugs and tests to be done. If a patient gets a diagnosis that they did not expect and the doctor does not take time to explain it to the patient, this can cause a lot of mistrust and dislike especially if the two do not have good rapport. On the other hand, advice, support and reassurance from a doctor can have a significant effect in the healing process
There are circumstances in which the doctor patient relationship is not created. For example, if the doctor is acting in favor of a third party, like the employer, court or insurance company. In such a case a diagnosis to lead to treatment or the actual treatment is not given and the results of the consultation are mainly sent directly to the third party. There can be barriers to effective communication between a doctor and a patient such as lack of specific knowledge, lack of counseling skills and lack of time and appropriate resources.
There are different types of doctor- patient relationships. The paternalistic relationship relies on a question and answer model to reach to a diagnosis rather than the patients experiences of the illness. It is doctor centered and the patient has little or no control in the consultation. Mostly, the questions require a yes or no answer. Consumerist approach on the other hand is patient centered. In this case the patient knows what they want and their ideas, expectations and beliefs are communicated clearly to the physician. For example in the case of a private nurse employed at home.
In a default relationship, the doctor tries to relinquish control but the patient refuses to accept it, an example is in army recruitment. In mutuality type of relationship, the doctor encourages the patient to speak about how they feel and their point of view by asking open questions. In this case both the doctor and patient communicate and share key decisions concerning the treatment. The history of the doctor patient relationship can be traced back to Talcott Parsons (1951, 1958, and 1978) who was the first scientist to put it in theory, in his Role- Based Analysis of the Doctor- Patient Relationship.
He made an assumption that “illness was a form of dysfunctional deviance that required reintegration with the social organism” (Hughes, 1994). He asserted that illness was a distraction to social responsibility and work and that it should be controlled to prevent its disruptions to social order. He explains that to maintain the social order there was need to develop a legitimate “sick role” that would control the deviance and facilitate a smooth transition between the illness state and the normal performance state.