are verbalizing. They frequently are anxious and
frightened when they visit their physi-
cians and may try to convince themselves that
their illness does not exist. They may
even try unconsciously to divert attention from
the real problem that they perceive to be
threatening. At times, illness is used as a
means to gain attention or as a way to extricate
themselves from a difficult emotional situation.
With this in mind, physicians need to
view their clinical findings in a broader
context involving not only the patient but the
patient's family and social
background.
Knowledge of the patient's origin, education,
home, family, job, and goals is very
desirable. It provides useful information that
permits the physician to establish rapport
with the patient and to develop a good insight
into the patient's illness. Under these cir-
cumstances, mutual trust is developed and an
open channel of communication is estab-
lished.
The traditional one-on-one patient-physician
relationship is changing due to the
change in the setting in which medicine is
practiced today. Frequently, when dealing
with a serious illness, patient care involves a
variety of allied health professionals, in
addition to several medical specialists. A
health team effort is therefore commonly man-
dated, which can prove especially beneficial if
the primary care physician asserts a lead-
ership position and maintains a special status
in the patient's eyes. The primary care
physician needs to retain the ultimate
decision-making authority in the areas of diagno-
sis and treatment. This arrangement should also
be in effect when medicine is practiced
in a group setting, for it is the primary care
physician who has an overview of the
patient's problems and reaction to medications,
as well as knowing the patient's
response to his or her illness and to the
challenges that must be faced.
The modern hospital can be an intimidating
environment for most patients. Being
confined to bed, surrounded by buttons, air
jets, and lights, with one's body invaded by
tubes and wires, visited randomly and at all
hours of the day and night by members of
the health care team--physicians, nurses,
technicians, therapists, and aides--often stim-
ulates a loss of a patient's sense of reality.
This negative situation may be further rein-
forced by transporting the patient to X-ray
departments or special testing and/or therapy
facilities.
The primary care physician frequently serves as
the pivotal link between the patient
and reality. The stressful hospital situation
can be somewhat ameliorated by a strong
doctor-patient relationship.
There are a number of factors that lead to
impersonalization of medical care. These
include:
1. strong efforts to reduce the cost of health
care;
2. heavy reliance on computerization and
technological advances for diagnosis and
treatment;
3. growth of health maintenance organizations
(HMOs), which may not allow
patients to select their
physician;
4. need for more than one physician to be
involved in the care of seriously ill
patients;
5. increased mobility of physicians and
patients;
6. increased frequency of litigation by
patients to express their dissatisfaction with
their physicians or treatment or
results.
In the light of this medical climate, it is
especially challenging for physicians to
maintain a humanistic attitude. It is now even
more essential that each patient, regard-
less of personal circumstances, be treated
carefully and courteously. This means that the
physician-patient relationship needs to be
built on a foundation of respect, integrity, and
compassion. The level of communication between
both sides should allow the patient,
to the fullest possible extent, to gain an
understanding of the nature of the illness, the
treatment protocol, and prognosis.
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