The Yale Journal for Humanities in Medicine

Relationship Medicine

Tomlin J. Paul
tomlin.paul@uwimona.edu.jm

As a family doctor for over 15 years I believe that I have developed my own style and approach to working with patients. It may not be unique but no doubt is influenced by my personality and philosophy. My waiting room is often full not because I am seeing a lot of patients, but because I am seeing a lot in my patients. I am likely to spend more time with patients than the others in the medical centre where I work. I am nearly always the last to leave at nights and even when I tell myself that this is a “quickie” consultation something seems to come up that takes me along a path of reflection and discussion with the patient. I have tried over the years mentally cajoling myself to change. Indeed there is pressure to change. A waiting room of frowning patients and staff irritation with working overtime are among the list. But I have found it hard to change my approach. There is some intrinsic comfort with it, some kind of inner resonance. 

Now as I am getting more and more grounded as a mature family physician, I am actually feeling more comfortable with my approach. I have a lot of patients now who I have been managing for many years. No different from the average family doctor. I am told that my patients are more loyal to me. They won’t consider seeing anyone else when I am on leave. At the end of the day I am distilling all of this experience and I think I have discovered something. Relationship medicine! The history, diagnosis, pathology, preventive screening, and counseling and so on all fall within a framework within which I work. The relationship between doctor and patient! In fact it’s a special kind of doctor-patient relationship. One in which there is really a lot of trust and caring and support but with neatly tucked in professional boundaries. There is an art in packaging the relationship so that the mileposts of professional boundaries are not always flashing yet understood. What is operating is warmth, understanding and a genuine sense of working together. It’s great for influencing medication adherence and for shifting behaviour in healthy directions. Great also for understanding the psychosocial and psychosomatic ailments of my patients.

But it comes at a price. Relationship medicine speaks to the mode of practice or general approach where the relationship is the fuel of the therapeutic process. Everything hangs around that. But on taking stock there is really this poly-relationship situation with all of its demands and expectations. Patients expect more than if there was a watered down relationship. They expect you to follow through when they are admitted for surgery even if you are not the admitting physician. I suppose it is reasonable to ask that, but difficult when many of them are in hospital or are making other demands of you. Attending funerals even a brief appearance seems to be a part of this also. Bring closure where it is needed.

At the end of day, with a large patient clientele, relationship medicine as I have articulated it, can take its toll on strength and stamina. Compassion burnout is always raising its head. Yet I am convinced that it is an approach that has good value for the patient. Can it work in the long run for the physician?

Published: July 28, 2006