Understanding Healing Relationships in Primary Care

• Published in: Annals of family medicine 2008-07, Vol.6 (4), p.315-322
• Main Authors: Scott, John G., MD, PhD, Cohen, Deborah, PhD, DiCicco-Bloom, Barbara, RN, PhD, Miller, William L., MD, MA, Stange, Kurt C., MD, PhD, Crabtree, Benjamin F., PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Female; Health Behavior; Holistic Health; Humans; Internal Medicine; Male; Middle Aged; Models, Psychological; Original Research; Physician-Patient Relations; Primary Health Care - methods; Primary Health Care - standards; Quality of Health Care
• ISSN: 1544-1709; 1544-1717
• DOI: 10.1370/afm.860

Abstract Purpose Clinicians often have an intuitive understanding of how their relationships with patients foster healing. Yet we know little empirically about the experience of healing and how it occurs between clinicians and patients. Our purpose was to create a model that identifies how healing relationships are developed and maintained. Methods Primary care clinicians were purposefully selected as exemplar healers. Patients were selected by these clinicians as having experienced healing relationships. In-depth interviews, designed to elicit stories of healing relationships, were conducted with patients and clinicians separately. A multidisciplinary team analyzed the interviews using an iterative process, leading to the development of case studies for each clinician-patient dyad. A comparative analysis across dyads was conducted to identify common components of healing relationships Results Three key processes emerged as fostering healing relationships: (1) valuing/creating a nonjudgmental emotional bond; (2) appreciating power/consciously managing clinician power in ways that would most benefit the patient; and (3) abiding/displaying a commitment to caring for patients over time. Three relational outcomes result from these processes: trust, hope, and a sense of being known. Clinician competencies that facilitate these processes are self-confidence, emotional self-management, mindfulness, and knowledge. Conclusions Healing relationships have an underlying structure and lead to important patient-centered outcomes. This conceptual model of clinician-patient healing relationships may be generalizable to other kinds of healing relationships.