Developing, validating and consolidating the doctor-patient relationship: the patients' views of a dynamic process.

Abstract

BACKGROUND: Previous research has examined the doctor-patient relationship in terms of its therapeutic effect, the need to consider the patients' models of their illness, and the patients' expectations of their doctor. However, to date, no research has examined the patients' views of the doctor-patient relationship. AIM: To examine patients' views of the process of creating a relationship with their general practitioner (GP). METHOD: A qualitative design was used involving in-depth interviews with 27 frequently attending patients from four urban general practices. They were chosen to provide a heterogeneous group in terms of age, sex, and ethnicity. RESULTS: The responders described creating the relationship in terms of three stages: development, validation, and consolidation. The development stage involved overcoming initial reservations, actively searching for a doctor that met the patient's needs, or knowing from the start that the doctor was the right one for them. The validation stage involved evaluating the nature of the relationship by searching for evidence of caring, comparing their doctor with others, storing key events for illustration of the value of the relationship, recruiting the views of others to support their own perspectives, and the willingness to make tradeoffs. The consolidation stage involved testing and setting boundaries concerned with knowledge, power, and a personal relationship. CONCLUSION: Creating a relationship with a GP is a dynamic process involving an active patient who searches out a GP who matches their own representation of the 'ideal', selects and retains information to validate their choice, and locates mutually acceptable boundaries.