Brief Encounters: Speaking with Patients

• Physician-patient relations
• Physician's practice patterns
• Communication
• Patient participation
• Interviews

  … the secret of the care of the patient is caring for the patient.

-Francis Peabody, 1927

The foundation of good medical care, whether it be health maintenance or treatment of an ill person, is a comfortable, evolving relationship between patient and physician. Since the dawn of medicine with Hippocrates and, later, Plato, this was regarded as the foundation of the art of medicine and was felt to be safely left in the hands of the benign paternalistic physician. New physicians learned this art during a prolonged apprenticeship with a mentor and role model and adapted it to their personalities and practices. With the shift from physician paternalism to patient autonomy as the governing principle in the relationship, renewed attention has turned to the study of the patient–physician encounter.

Much recent literature (1-4) has analyzed what goes on in the patient–physician encounter. These reports are largely based on experience within-patient settings in teaching hospitals or their outpatient clinics. The participants in the studies have been the patients who are admitted to such institutions or are attending their clinics (and who, until recently, have been a selected sample) and the medical students and residents assigned to them, who are in their formative years and are still trying to acquire the art. Furthermore, most of these studies have started from the premise that the medicine practiced in the late 1970s and 1980s had become too scientific, with its focus on pathophysiology, and that it lacked concern for the person of the patient. This same concern was eloquently raised by Peabody in 1927. The initial encounter between the patient, with or without family present, and the physician sets the stage for what we all hope will be a lasting and evolving therapeutic relationship. Therefore, an examination of what happens in this encounter, …