Attaching a New Understanding to the Patient-Physician Relationship in Family Practice

Abstract

Background: As a result of continuity of care with patients and their families, family physicians are uniquely poised to form enduring clinical relationships with their patients. The degree of collaboration in and satisfaction with the patient-provider alliance has been shown to have important implications for treatment outcomes across a range of medical problems. Providing optimal care can require family physicians to appreciate the sequelae of having clinically relevant aspects of past relationships emerge in the health care relationship, both in their patients and in themselves. A conceptual model is essential to assist in recognizing these key aspects.Methods: A literature search was conducted using MEDLINE. Key words entered were "illness" and "attachment theory." Thirty-five English-only articles appeared from which further relevant references were gathered.Results: Attachment theory serves as a useful model for highlighting important features of physicianpatient relationships, which can affect treatment outcome in the family practice setting. It posits that everyone has an innate need to form strong attachment bonds to their earliest caregivers. To ensure survival, the child adapts its bonding to the caregiver's attachment style. With time, the maturing person develops a style of relating in subsequent caregiving relationships based on these early, and to some extent later, close relationships. Insecure attachment styles that can develop-dismissing, preoccupied, and fearful-have been shown to affect the clinical relationship and medical treatment outcomes often in important and predictable ways.

Patient-provider relationship as mediator between adult attachment and self-management in primary care patients with multiple chronic conditions

“…increased awareness of symptoms of illness reported to the physician) and to a hyperactive search for proximity, e.g. by the catastrophizing of symptoms [13]. Patients´ attachment styles can influence their health seeking behavior and the ability to accept help from primary care physicians and other health care professionals [18].…”

“…Patients scoring high on the avoidance scale have learned to suppress their attachment needs and use deactivating attachment strategies. The main characteristics of deactivating strategies are denying attachment needs, trivializing risks, as well as the repression of negative emotions and cognitions [13]. Avoidant patients are also characterized by high levels of self-reliance, greater interpersonal distance [14] and minimal help seeking behavior and expression of distress [15,16].…”

Adult attachment as mediator between recollections of childhood and satisfaction with life

“…For example, Hunter & Maunder, (2001), offers examples of how attachment theory may guide the psychological management of patients with medical and surgical illnesses. Others have suggested an attachment perspective to guide the patient-physician relationship (Tan, Zimmermann, & Rodin, 2005;Thompson & Ciechanowski, 2003), as well as the therapeutic relationship in psychotherapy (Holmes, 2001;Slade, 1999). In future studies, these suggestions should be extended and empirically tested.…”

Attachment and pain: Recent findings and future directions

“…Recently, a number of researchers have pointed to the importance of provider sensitivity to attachment-related needs and motives, and tailoring caregiver interactions to patient attachment styles (e.g. Tan et al, 2005;Thompson & Ciechanowski, 2003).…”