Preserving the Patient-Physician Relationship

A recent commentary (J Noseworthy. NEJM 2019; 2265-9) discussed the need to preserve the patient-physician relationship.  The author, who previously led the Mayo Clinic, makes a number of useful points.  Though, at the outset it is important to recognize that the care at the Mayo clinic is not representative of the care elsewhere.  In this institution, there is a selection bias both of patients and physicians.  Based on my knowledge of patients evaluated there (a small sample), patients are much more likely to undergo extensive evaluations.

Key points:

  • “Physicians in the United States are increasingly caught between the conflicting concepts of medicine as a humanitarian profession and health care as a competitive business.”
  • “Medicine’s most fundamental element remains the relationship between patient and physician…I believe it must remain central to medical practice even as medicine evolves.”
  • Principles include the following:
    • spending adequate time -to deal with uncertainty, treatment plans that are failing, and comfort those at the end of life
    • support the work of a coordinating physician -to address comprehensive care for patients with complex health issues

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