Intended for healthcare professionals

General Practice

Primary care: core values Patient centred primary care

BMJ 1998; 316 doi: (Published 20 June 1998) Cite this as: BMJ 1998;316:1882
  1. Les Toop, Pegasus professor of general practicea
  1. aDepartment of Public Health and General Practice, Christchurch School of Medicine, Christchurch, New Zealand,
  2. bSeries editor: Mike Pringle

    This is the second in a series of six articles reflecting on the core values that will underpin the development of primary care

    The importance and primacy of the clinician-Fpatient relationship cannot be overstated. The perceived intrinsic quality of this relationship initially allows two individuals, previously unknown to each other, to feel comfortable with an often high level of intimacy. With time the relationship may develop to allow safe and constructive discussion of intensely personal and private matters. The bond that forms may be healing in and of itself.1 However, the changing expectations of both clinicians and patients, together with changes to the context in which the interactions take place, challenge the future of this relationship.

    In this article, the generic term clinician has been chosen deliberately to reflect the increasing variety of health professionals not just doctors now involved in providing primary health care to individuals in the community.2 The term patient has been retained for want of a better one.3

    Summary points

    Although it is central to the discipline of medicine, the clinician-patient relationship is under attack from within through evolving expectations of both parties—and from outside, through changing norms in society

    Models of the consultation in which the doctor maintains a more mature, and controlling, role than the patient have persisted through to the present day

    The doctor of the future will find that such models are increasingly unacceptable, particularly in primary care

    The sustained partnership model ensures a patient centred relationship that does not devalue special skills of the clinician

    Pressures from within the consultation

    The way the clinician and the patient relate to each other is a major determinant of the outcomes of a consultation. Satisfaction for both and degree of patients compliance with management plans are directly related to the quality of various elements of the clinician-patient relationship. …

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