doctor–patient relationship doctor–patient relationship the doctor–patient relationship is a central part of health care and the practice of medicine. a doctor–patient relationship is formed when a doctor attends to a patient's medical needs and is usually through consent. this relationship is built on trust, respect, communication, and a common understanding of both the doctor and patients' sides. the trust aspect of this relationship goes is mutual: the doctor trusts the patient to reveal any information that may be relevant to the case, and in turn, the patient trusts the doctor to respect their privacy and not disclose this information to outside parties. part of a series onmedical sociology concepts medicalization doctor-patient relationship shared decision making sick role labelling theory adherence social model of disability sociologists talcott parsons eliot freidson peter conrad ivan illich related topics sociology social medicine public health category an important dynamic of the doctor–patient relationship is that the doctor is bonded by oath to follow certain ethical guidelines. (hippocratic oath) additionally, the healthiness of a doctor–patient relationship is essential to keep the quality of the patient's healthcare high as well as to ensure that the doctor is functioning at their optimum. in more recent times, healthcare has become more patient-centered and this has brought a new dynamic to this ancient relationship. importance a medical practitioner explains an x-ray to the patient. the doctor is providing medical advice to this patient. a physician performs a standard physical examination on his patient. a patient must have confidence in the competence of their physician and must feel that they can confide in them. for most physicians, the establishment of good rapport with a patient is important. some medical specialties, such as psychiatry and family medicine, emphasize the physician–patient relationship more than others, such as pathology or radiology, which have very little contact with patients. the quality of the patient–physician relationship is important to both parties. the doctor and patient's values and perspectives about disease, life, and time available play a role in building up this relationship. a strong relationship between the doctor and patient may lead to frequent, freely-offered quality information about the patient's disease and as a result, better healthcare for the patient and their family. enhancing both the accuracy of the diagnosis and the patient's knowledge about the disease contributes to a good relationship between the doctor and the patient. in a poor doctor–patient relationship, the physician's ability to make a full assessment may be compromised and the patient may be more likely to distrust the diagnosis and proposed treatment. the downstream effects of this mistrust may include decreased patient adherence to the physician's medical advice, which could result in poorer health outcomes for the patient. in these circumstances, and also in cases where there is genuine divergence of medical opinions, a second opinion from another physician may be sought, or the patient may choose to go to another physician that they trust more. additionally, the benefits of any placebo effect are also based upon the patient's subjective assessment (conscious or unconscious) of the physician's credibility and skills. michael and enid balint together pioneered the study of the physician patient relationship in the uk. michael balint's "the doctor, his patient and the illness" (1957) outlined several case histories in detail and became a seminal text. their work is continued by the balint society, the international balint federation and other national balint societies in other countries. it is one of the most influential works on the topic of doctor–patient relationships. in addition, a canadian physician known as sir william osler was known as one of the "big four" professors at the time that the johns hopkins hospital was first founded. at the johns hopkins hospital, osler had invented the world's first medical residency system. in terms of efficacy (i.e. the outcome of treatment), the doctor–patient relationship seems to have a "small, but statistically significant impact on healthcare outcomes". however, due to a relatively small sample size and a minimally effective test, researchers concluded additional research on this topic is necessary. recognizing that patients receive the best care when they work in partnership with doctors, the uk general medical council issued guidance for both of doctors named "ethical guidance for doctors", as well as for patients "what to expect from your doctor" in april 2013. aspects of relationship informed consent main article: informed consent the default medical practice for showing respect to patients and their families is for the doctor to be truthful in informing the patient of their health and to be direct in asking for the patient's consent before giving treatment. historically in many cultures there has been a shift from paternalism, the view that the "doctor always knows best", to the idea that patients must have a choice in the provision of their care and be given the right to provide informed consent to medical procedures. there can be issues with how to handle informed consent in a doctor–patient relationship; for instance, with patients who do not want to know the truth about their condition. furthermore, there are ethical concerns regarding the use of placebo. does giving a sugar pill lead to an undermining of trust between doctor and patient? is deceiving a patient for his or her own good compatible with a respectful and consent-based doctor–patient relationship? these types of questions come up frequently in the healthcare system and the answers to all of these questions are usually far from clear but should be informed by medical ethics. shared decision making health advocacy messages such as this one encourage patients to talk with their doctors about their healthcare. main article: shared decision making shared decision-making involves both the doctor and patient being involved in decisions about treatment. there are varied perspective on what shared decision making involves, but the most commonly used definition involves the sharing of information by both parties, both parties taking steps to build consensus, and reaching an agreement about treatment.: 4 the doctor does not recommend what the patient should do, rather the patient's autonomy is respected and they choose what medical treatment they want to have done. a practice which is an alternative to this is for the doctor to make a person's health decisions without considering that person's treatment goals or having that person's input into the decision-making process is grossly unethical and against the idea of personal autonomy and freedom. the spectrum of a physician's inclusion of a patient into treatment decisions is well represented in ulrich beck's world at risk. at one end of this spectrum is beck's negotiated approach to risk communication, in which the communicator maintains an open dialogue with the patient and settles on a compromise on which both patient and physician agree. a majority of physicians employ a variation of this communication model to some degree, as it is only with this technique that a doctor can maintain the open cooperation of his or her patient. at the opposite end of this spectrum is the technocratic approach to risk communication, in which the physician exerts authoritarian control over the patient's treatment and pushes the patient to accept the treatment plan with which they are presented in a paternalistic manner. this communication model places the physician in a position of omniscience and omnipotence over the patient and leaves little room for patient contribution to a treatment plan. physician communication style physician communication style is crucial to the quality and strength of the doctor–patient relationship. patient-centered communication, which involves asking open-ended questions, having a warm disposition, encouraging emotional expression, and demonstrating interest in the patient's life, has been shown to positively affect the doctor–patient relationship. additionally, this type of communication has been shown to decrease other negative attitudes or assumptions the patient might have about doctors or healthcare as a whole, and has even been shown to improve treatment compliance. another form of communication beneficial to the patient-provider relationship is self-disclosure by the physician in particular. historically, medical teaching institutions have discouraged physicians from disclosing personal or emotional information to patients, as neutrality and professionalism were prioritized. however, self-disclosure by physicians has been shown to increase rapport, the patient's trust, their intention to disclose information, and the patient's desire to continue with the physician. these effects were shown to be associated with empathy, which is another important dimension which is often under-emphasized in physician training. a physician's response to emotional expression by their patient can also determine the quality of the relationship, and influence how comfortable patients are in discussing sensitive issues, feelings, or information that may be critical for their diagnosis or care. more passive, neutral response styles which allow for patients to elaborate on their feelings have been shown to be more beneficial for patients, and make them feel more comfortable. physician avoidance or dismissal of a patient's emotional expression may discourage the patient from opening up, and may be harmful to their relationship with their provider. physician superiority historically, in the paternalistic model, a physician tended to be viewed as dominant or superior to the patient due to the inherent power dynamic of physician's control over the patient's health, treatment course, and access to knowledge about their condition. in this model, physicians tended to convey only the information necessary to convince the patient of their proposed treatment course. the physician–patient relationship is also complicated by the patient's suffering (patient derives from the latin patior, "suffer") and limited ability to relieve it without the physician's intervention, potentially resulting in a state of desperation and dependency on the physician. a physician should be aware of these disparities in order to establish a comfortable, trust-based environment and optimize communication with the patient. additionally, it may be beneficial for the doctor–patient relationship to create a practice of shared care with increased emphasis on patient empowerment in taking a greater degree of responsibility for their care. patients who seek a doctor's help typically do not know or understand the medical science behind their condition, which is why they go to a doctor in the first place. a patient with no medical or scientific background may not be able to understand what is going on with their body without their doctor explaining it to them. as a result, this can be a frightening and frustrating experience, filled with a sense of powerlessness and uncertainty for the patient, though in rare conditions, this pattern tends not to be followed, and due to lack of expertise patients are forced to learn about their conditions.: 155 an in-depth discussion of diagnosis, lab results, and treatment options and outcomes in layman's terms that the patient can understand can be reassuring and give the patient a sense of agency over their condition. concurrently, this type of strong communication between a doctor and their patient can strengthen the physician–patient relationship as well as promote better treatment adherence and health outcomes. coercion under certain conditions healthcare workers are able to treat patients involuntarily, imprison them, or involuntarily administer drugs to alter the patients' ability to think. they may also engage in forms of "informal coercion" where information or access to social services can be used to control a patient. deception lying in the doctor–patient relationship is common.: 164 doctors provide minimal information to patients after medical errors. doctors may lie to patients to displace culpability for poor outcomes and say they avoid giving patients information because it may confuse patients, cause pain, or undermine hope. they may lie to avoid uncomfortable conversation about disability or death, or to encourage patients to accept a particular treatment option.: 165 the experience of being lied to may undermine an individual's trust in others or themselves and reduce faith in one's church, community or society and result in avoidant behaviour to avoid being wounded. patients may seek financial and legal retribution.: 166 patients may lie to doctors for financial reasons such as to receive disability payments, for access to medication, or to avoid incarceration. patients may lie out of embarrassment or shame.: 165 palmeira and sterne suggest that healthcare workers acknowledging the motivations of patients to lie to appear in a positive light to reduce deception by patients.: 167 palmeira and sterne offer different psychological framings and motivations for lying. from the perspective of attachment theory, lying may be used to avoid revealing information about an individual avoid