Doctor-patient relationships in chronic illness: insights from forensic psychiatry

doi:10.1136/bmj.330.7492.667

BMJ 2005;330:667-670 (19 March), doi:10.1136/bmj.330.7492.667

Education and debate

Doctor-patient relationships in chronic illness: insights from forensic psychiatry

Colin Campbell, lecturer in forensic psychiatry¹, Gill McGauley, senior lecturer in forensic psychotherapy¹

¹ St. George's Hospital Medical School, London, SW17 0RE

Correspondence to: G McGauley gmcgaule@sghms.ac.uk

Collaborative management of chronic illness is undermined byneglect of emotional and psychological factors in both the patientand doctor

The first 150 words of the full text of this article appear below.

Introduction

Chronic diseases are the world's leading cause of death andare projected to increase substantially to become the main causeof disability by 2020.¹ In response, a common core of strategiesfor managing chronic illnesses has been identified that emphasisesthe importance of collaborative care.² However, less attentionhas been given to the effect of managing chronic illness onthe doctor and how this manifests in the therapeutic relationship.We draw on our work with patients in a high secure psychiatrichospital to highlight this gap and suggest how it may be addressedin medical education.

Do doctors want to manage chronic illnesses?

Most medical students want to become doctors to heal patients.³In reality, most will spend much of their time caring for patientsfor whom no cure is possible. Medicine's success in the pursuitof cure has fundamentally changed the expectations of doctors;medical success has often become equated with cure and medicalfailure with . . . [Full text of this article]

Relevance of forensic psychiatry to management

A gap in collaborative care

Bridging the collaborative gap

Redefining expectations

Taking the patient

Attending to the system

Toxic processes

The role of medical education and the future

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