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Communication in difficult situations: what would a friend say?

BMJ 2013; 347 doi: (Published 23 August 2013) Cite this as: BMJ 2013;347:f5037
  1. David C J Main, professor of animal welfare, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK
  1. d.c.j.main{at}

You don’t have to be friends to be friendly. David C J Main suggests a simple way to try to encourage more humanity in the way doctors talk to patients

“Farmers and pet owners were not clients; they were friends that she wanted to support.”

This is how I described my wife’s attitude to clinical veterinary practice in my eulogy to her. At the age of 44, Clare was diagnosed as having salivary adenocarcinoma, and she died nine months later from pancreatitis. Her medical treatment (surgery, radiation therapy, intensive care, and, finally, hospice care) has allowed me to consider whether, particularly at the times of crisis, doctors treated her in the same way as she treated her clients most in need—that is, by offering friendship.

Friendship is not a new concept in the doctor-patient relationship. The humanist and theologian Desiderius Erasmus (1466-1536) described the ideal “physician-patient relationship as a friendship based on virtue rather than on utilitarian exchange.”1 More recently, Platonova and colleagues investigated the drivers for patient satisfaction and suggested that their findings “strongly indicate” that primary care doctors “would be well advised to develop stronger interpersonal relationships with their patients.”2

The General Medical Council is, however, …

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