From a relationship to encounter: an examination of longitudinal and lateral dimensions in the doctor-patient relationship

Existing conceptualizations of the doctor-patient relationship provide little insight into this complex and perhaps now nonexistent "relationship" in the 21st century. Today, the word "relationship" as applied to the doctor-patient experience may be a misnomer-or at least an inappropriate description of the experience. One could ask, for example, if a person's most recent physician visit was more akin to their encounter with their last cab driver, or the person who sold them their last pair of shoes. After reviewing the 20th century theoretical conceptions of the doctor-patient relationship and describing the state of illness and health care delivery and policy in the United States, we develop a theoretical rubric for examining the 21st century physician-patient relationship. We argue that while patients should continue to be educated on how to use their time with physicians effectively and efficiently and physicians should continue to improve their communication with patients, we also argue that for policy purposes, it is not the physician or the patient that needs to change but rather the pressures and constraints of the organizational context within which the doctor-patient encounter takes place. (c) 2005 Elsevier Ltd. All rights reserved.