A prescription for protecting the doctor-patient relationship.

The relationship between patients and their physicians is fundamental to high-quality care, yet this relationship is under stress in the current healthcare environment. Health plans have instituted a variety of policies to contain costs, not fully appreciating the adverse effect these decisions have on the doctor-patient interaction. Legislators have responded to the public's concern about managed care with "patient protection" bills that fail to address the fundamental causes of tension between doctors and patients. This paper presents a model describing how the need to contain costs affects the doctor-patient interaction and proposes a prescription for protecting the relationship. The model highlights how the healthcare environment affects patients' and physicians' expectations before a medical visit, the nature of their interaction during a visit, and patients' health outcomes. This prescription for protecting the doctor-patient relationship contains 4 key ingredients: (1) definition and promulgation of evidence-based standards for the doctor-patient relationship; (2) joint doctor-patient advocacy on behalf of the relationship; (3) positive incentives for exemplary doctor-patient relationships; and (4) expanded training and assessment of physicians' communication skills, both in general and related to discussing cost containment with patients. These measures will help restore the essential element of superb healthcare: a strong doctor-patient relationship.