Rethinking the doctor-patient relationship in general practice


C. F. Dowrick Senior Lecturer and Head of Department Department of Primary Care University of Liverpool Liverpool L69 3BX UK


The doctor-patient relationship in general practice can best be characterized by its use. Perceptions of it will vary depending on the context within which it is situated, and on the perspective of the observer. The context of British general practice has changed over the past three decades, particularly with the development of large primary care teams and expansion in the content of consultations. From the perspective of general practitioners, this may be resulting in a shift of emphasis from “the relationship” to “consultation techniques”; however, they retain an essentially utilitarian view of the relationship as a means of enabling effective diagnosis and management. Patients appear to have fewer expectations of the relationship than doctors, and there may not be congruence in the aspects of the encounter that each finds satisfying. Sociologists tend to see the doctor-patient relationship as an ideological construct whereby general practitioners gain a sense of professional identity, and as a means of exercising and maintaining medical power. Health economists suggest it may prove to be an efficient means of rationing scarce health care resources.