To the Editor.
—If I had the opportunity to edit the excellent article by Drs Balint and Shelton1 on the patient-physician relationship, I would have suggested that they apply the same case scenario used to illustrate existing models to their new alliance model. I will take the liberty of doing so to emphasize a few crucial points.They describe a 52-year-old man who has lower abdominal pain exacerbated by stress and a positive family history of colon cancer. He has had symptoms for 20 years, a normal barium enema and sigmoidoscopy at age 50 years, and negative annual fecal occult blood testing. He now demands a colonoscopy.In the alliance model proposed by Balint and Shelton, the patient would have an ongoing relationship with a generalist physician. This physician would know if such demands for tests were typical or unusual for this patient. If typical, the physician would already
Hensel WA. The Patient-Physician Relationship: Time to Reimburse What We Preach. JAMA. 1996;276(1):27. doi:10.1001/jama.1996.03540010029014