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December 17, 1997

A Clinimetric Approach to the Components of the Patient-Physician Relationship

Author Affiliations

From the Departments of Psychiatry (Dr Sledge) and Internal Medicine and Epidemiology (Dr Feinstein), Yale University School of Medicine, New Haven, Conn.

JAMA. 1997;278(23):2043-2048. doi:10.1001/jama.1997.03550230019007

Although patient-physician relationships have been expressed with diverse concepts and models, we have formulated a clinimetric classification derived from several years of observation and discussions at weekly housestaff conferences devoted to "difficult" patients. The observed phenomena are classified into the following components: (1) background factors intrinsic to patient and physician before they meet, (2) individual anticipations and hopes for what may happen, (3) extrinsic features of the setting, (4) individual reactions during the encounter, and (5) the consequences thereafter. These interacting components are usually too complex for characterizations based on single models for the relationship or single titles (such as "hateful" or "noncompliant") for the patient. The components can serve as a "review of systems" for identifying manifestations, sources, and solutions to such common problems as discordant hopes, the physician's unawareness of the patient's pertinent extramedicai status, psychiatric and mental-status challenges, and cogent factors in chronic illness.