Is the Therapeutic Nature of the Patient-Physician Relationship Being Undermined?

Communicating with Alexithymic and Non-Alexithymic Patients: An Experimental Study of the Effect of Psychosocial Communication and Empathy on Patient Satisfaction

“…To our knowledge, there has been no research to date exploring how physicians in primary care and somatic specialities should relate to these patients. Adherence to the principles advocated in the so-called ‘patient-centred’ [22, 23, 24, 25]and ‘biopsychosocial’ [26, 27, 28, 29]models have been recommended by many authors as generally beneficial in physician-patient encounters. However, research thus far has produced only limited knowledge as to which specific elements have a positive effect on particular patient groups or clinical settings.…”

Trust in Physicians and Medical Institutions: What Is It, Can It Be Measured, and Does It Matter?

“…In addition, it may mediate clinical outcomes. Commentators speculate that trust is a key factor in the mind-body interactions that underlie placebo effects, the effectiveness of alternative medicine, and unexplained variations in outcomes from conventional therapies (Branch 2000;Basmajian 1999;Fogarty, Curbow, Wingard, et al 1999;Mason, Clark, Reeves, et al 1969;Novack 1987;Thomas 1987;Plotkin 1985;Evans 1985;Shapiro and Shapiro 1983;Anderson and Guerwitsch 1982;Caterinicchio 1979).…”

Suicide Prevention in Primary Care: Optimistic Humanism Imagined and Engineered

“…It has been argued that mandates, direct to-consumer advertising, and other point-of-care intruders have adverse implications for clinician self-determination, clinician-patient communication, and patient outcomes. 7,9 For example, it is plausible that routine screening for depression or suicide risk could have unexpected harms (e.g., worsening the already prevalent problem of overtreatment of people with minimal symptoms or risk) that offset the potential benefits. Ahmedani et al call for improvements in suicide risk assessments, but appropriately caution that the United States Preventive Services Task Force (USPSTF) recommends depression screening only "when a system is in place to provide effective care…" Yet even under those conditions, there is a dearth of clinical trials to support a net benefit of depression screening, 3 which is one reason why the UK's National Institute for Health and Clinical Excellence and the Canadian Task Force on Preventive Health Care do not recommend routine depression screening.…”

“…Moreover, the USPSTF currently gives an "I" recommendation (insufficient evidence to recommend for or against) for suicide risk screening. Like other third-party intruders, 9 routinized depression and/or suicide risk screening could have the unintended consequences of thwarting clinician self-determination and alienating some patients. 6 Similarly, having care managers, rather than primary care clinicians, engage patients in discussions about depression or suicide could deprive clinicians of an opportunity to leverage the therapeutic relationship 9 and provide care that is responsive to patients' circumstances.…”

“…Like other third-party intruders, 9 routinized depression and/or suicide risk screening could have the unintended consequences of thwarting clinician self-determination and alienating some patients. 6 Similarly, having care managers, rather than primary care clinicians, engage patients in discussions about depression or suicide could deprive clinicians of an opportunity to leverage the therapeutic relationship 9 and provide care that is responsive to patients' circumstances. 6,10 A recent report in the oncology literature suggests that the patient-clinician bond might mitigate suicide risk.…”