What Makes the Patient-Doctor Relationship Therapeutic? Exploring the Connexional Dimension of Medical Care

Abstract

Physicians do not receive from the medical model the same explicit guidance in relating to their patients as in making diagnoses and prescribing pharmacologic and other treatments. To meet this need, we offer a framework for expanding the model. Therapeutic contact takes place within a connexional, or transpersonal, dimension of human experience, within which basic human needs for connection and meaning are met. Although seldom explicitly recognized, connexional experience is basic to medical care. Awareness of this dimension of experience leads clinicians to appreciate that establishing a therapeutic relationship is one of the principal goals of medical practice. It also reframes the doctor's task to make clinical uncertainty more tolerable and situations in which there is no appropriate biomedical response (such as care of the terminally ill) less frustrating and more fulfilling.

Effects of a Focused Patient-Centered Care Curriculum on the Experiences of Internal Medicine Residents and their Patients

“…10 Other curricular programs targeting individual aspects of care have produced favorable attitudinal outcomes. [11][12][13][14] This curriculum specifically addresses continuity of care, patient communication and education, and safe transitions of care, but focuses on knowing patients as individuals.…”

Shared presence in physician-patient communication: A graphic representation.

“…Many within medicine and other health professions have worked to describe the state of being we term shared presence, without using these specific words (Carmichael & Carmichael, 1981;Epstein & Street, 2011;Matthews et al, 1993;McPhee, 1981;Suchman & Matthews, 1988). Shared presence has 8 found some renown on canvas and as a short aphorism (Moore, 2008;Peabody, 1927), and there exist a variety of anecdotes from practice that patients and physicians have used to create images of its existence or absence.…”

“…It is fostered by the ability to recognize fully the existence of self, other, and all that lies in between (McPhee, 1981). When presence is shared, patients feel known, understood, and able to cope with both disease and illness; physicians sense the existence of a connection that is therapeutic independent of the biomedical treatments they offer (Matthews, Suchman, & Branch, 1993;Suchman & Matthews, 1988).…”

What do clinicians derive from partnering with their patients?

“…(25) Suchman and Matthews use the term "connexional dimension" to describe what Remen refers to as meaning, and define it as a "drive to reach beyond the boundaries of the self, to feel connected once again to other people and to the world". (26) This renewed call for connecting is a hallmark of the recent attention to relationship-centered care (27)(28) and partnership (29) between clinicians and their patients. This literature emphasizes the reciprocal nature of all health care relationships and the importance of selfawareness in establishing partnerships with patients.…”