The Essential Anatomy of the Doctor-Patient Relationship, with Narrative Illustrations

To derive benefit from medical care, a patient must be able to trust the physician. This trust exists only to the extent that the patient feels confident that he or she occupies the doctors central focus at every medical encounter, and that this focus is being used to derive a full measure of healthful benefit. This is the beginning and end of the doctors work and is best accomplished by every doctor understanding and maximizing each element of the doctor patient relationship. These elements of the doctor patient relationship are carefully dissected in this book, and then illustrated with consequential and true case histories of patients. The science to these elements for example, the methods of clinical reasoning are succinctly described, but always the elements are artfully illustrated by descriptions of their real-life application to human beings. That these cases celebrate the grace and courage and resiliency of individual patients is no accident, as a doctors patients represent worthy brothers and sisters, fellow travelers walking the lonesome valley of an individual human life, affected by both illnesses and triumphs of all sorts. Their stories offer practical insights for all readers, not just for physicians or prospective physicians, and I hope some of them make you smile. Because of the burgeoning complexities of medicine and the social contexts in which medicine is practiced, multiple physicians are often involved in the care of a patient, something which has become quite evident in the recent Covid 19 pandemic. However, each physician involved in the care of a patient at a particular moment in time has the responsibility to understand and respect the ideals of the doctor patient relationship, to maintain and fortify it, even if the next visit is with yet another, different physician, thus enabling the doctor patient relationship to be the vehicle that transports the patient some distance down a path towards feeling better, a path towards a medical outcome that is helpful, sometimes healing, and always hopeful. We live in a time when there are powerful and complex forces undermining the doctor patient relationship, the most important of which is the lack of available medical care for poor people, preventing them from having the benefit of the doctor patient relationship in the first place. We have seen this vividly in the aftermath of Covid 19; none of the patients who ended up dying alone in the Old Soldiers Home in Massachusetts or piled up and hidden in nursing homes in New Jersey or New York City had a good doctor. There are other forces undermining the doctor patient relationship that are not so brutally apparent but threaten both patients and their doctors; we would do well to identify and combat these, together.