Existential medicine: Martin Buber and physician-patient relationships.

Martin Buber's (1878-1965) social existentialist thought offers a unique lens through which physician-patient relationships may be interpreted. Buber develops concepts of relationships and dialogue that provide insight into physician-patient relationships. His notions of I-Thou and I-It relationships have relevance for contemporary medical education and practice. Current medical practice is situated in the It-realm of order, objectivity, detachment, abstraction, and experience. This perspective is necessary for medical education and practice but can result in the progressive decline of the interhuman relationships that define medicine. I-Thou relationships, characterized by spontaneity, subjectivity, reciprocity, and recognition and acceptance of the unique other, are essential for humanhood. However, physicians and patients may be constrained from achieving I-Thou relationships by the very nature of their interactions, which are planned and purposive. Buber describes the possibility of a therapeutic relationship that approaches the I-Thou realm. Buber's thought suggests three conceptual shifts that facilitate the development of therapeutic relationships in medical practice and have implications for medical education: (1) from disease-centered to person-centered care, (2) from crisis to everyday management, and (3) from principles and contracts to relationships.