‘Both sides need to keep the relationship going’

BMJ 2003; 326 doi: (Published 12 June 2003) Cite this as: BMJ 2003;326:1337
  1. Raj Persaud, consultant psychiatrist
  1. Maudsley Hospital, London

    The doctor-patient relationship has never fully recovered from Freud. Before the advent of psychoanalysis, patients went to doctors, who administered a treatment—perhaps a tablet or a procedure. The relationship between physicians and client was not the primary issue; it was merely a mechanism that facilitated delivery of the treatment. After the Freudian revolution, the relationship between doctor and patient could itself become the prescription.

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    Is it now a doctor's remit to provide the kind of positive supportive relationship that is difficult to find elsewhere? Even if doctors were willing to shoulder this project, the public should beware. Harold Shipman was, after all, by many accounts, popular with his patients.

    In Freudian analysis much of the work of the “doctor” is to think hard and analyse the nature of the relationship that develops with the client. The doctor even has to relentlessly question his or her personal emotional reaction to the patient, and analyse that, partly to ensure the doctor-patient relationship can survive the physician's own neuroses. This relationship thing is getting …

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