Doctor-Patient Relationship

Abstract

Because everything the physician does to or for his patient has a psychological effect on the patient the doctor-patient relationship is his most powerful tool. Three aspects of this relationship are discussed: 1) the voluntary selection of physician by the patient 2) continuity of treatment by the same physician 3) the third party payment of fees for doctor's services. These three considerations may influence the patient's or the doctor's attitude toward the other. A questionnaire was addressed to the 89 members of the staff of the Institute of the Pennsylvania Hospital which includes four heads of departments of psychiatry, two heads of departments of neurology, members of the departments of psychiatry in all five local medical schools, two past presidents of the APA etc. The psychiatric experiences of the 82 who replied ranged from three to 52 years. Three groups were identifiable on the basis of their formal relationship with psychoanalysis. “A” group (26) had no such formal connection; “B” group (30) included 18 members of the American Psychoanalytic Association and eight graduates of psychoanalytic institutes; and “C” group (30) were students of a psychoanalytic institute. Sixty-six of the respondents were certified in psychiatry by either the American Board of Psychiatry and Neurology or its Canadian equivalent. The Tables show the “guestimated” replies to the question “How important do you feel the patient's voluntary selection of a psychiatrist is to the outcome of his treatment in comparison to the assignment of a psychiatrist of comparable training and experience. It would appear that the respondents felt that voluntary selection was most important for the neurotic, slightly less important for the patient with a character disorder and still less so for the schizophrenic and even less again for the patients suffering from an affective disorder. Other questions asked were: “How important to the outcome of treatment do you feel the uninterrupted continuity of doctor-patient relationship is”? This continuity of treatment by one physician was thought to be most important to all patients with the possible exception of those with affective disorders. Another question was; “In what percentage of their cases was a third party involved in payment”? What percentage of these patients benefitted by this and in what way those not benefitted were hindered? An average of 24% of patients enjoyed some form of third party payment, and 38% of these benefitted from this, mostly because without some financial assistance many patients could not get treatment, and it helps the psychiatrist to give better and more thorough treatment. For the percentage who were hindered by third party payment a number of reasons were given. It would, therefore, appear that the method of payment of physician's fees is at least as important to doctor-patient relationship as the voluntary selection of his physician by the patient.