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PubMed2006

Using relationship styles based on attachment theory to improve understanding of specialty choice in medicine.

BACKGROUND: Patient-provider relationships in primary care are characterized by greater continuity and depth than in non-primary care specialties. We hypothesized that relationship styles of medical students based on attachment theory are associated with specialty choice factors and that such factors will mediate the association between relationship style and ultimately matching in a primary care specialty. METHODS: We determined the relationship styles, demographic characteristics and resident specialty match of 106 fourth-year medical students. We assessed the associations between 1) relationship style and specialty choice factors; 2) specialty choice factors and specialty match, and 3) relationship style and specialty match. We also conducted mediation analyses to determine if factors examined in a specialty choice questionnaire mediate the association between relationship style and ultimately matching in a primary care specialty. RESULTS: Prevalence of attachment styles was similar to that found in the general population and other medical school settings with 59% of students rating themselves as having a secure relationship style. Patient centeredness was directly associated, and career rewards inversely associated with matching in a primary care specialty. Students with a self-reliant relationship style were significantly more likely to match in a non-primary care specialty as compared to students with secure relationship style (OR = 5.3, 95% CI 1.8, 15.6). There was full mediation of the association between relationship style and specialty match by the specialty choice factor characterized by patient centeredness. CONCLUSION: Assessing relationship styles based on attachment theory may be a potentially useful way to improve understanding and counsel medical students about specialty choice.

Adult↗

PubMedDate not supplied

Contraceptive use and consistency in U.S. teenagers' most recent sexual relationships.

CONTEXT: Most U.S. teenage pregnancies are unintended, partly because of inconsistent or no use of contraceptives. Understanding the factors associated with contraceptive use in teenagers' most recent relationships can help identify strategies to prevent unintended pregnancy. METHODS: Data on 1,468 participants in Waves 1 and 2 of the National Longitudinal Study of Adolescent Health who had had two or more sexual relationships were analyzed to assess factors associated with contraceptive use patterns in teenagers' most recent sexual relationship. Odds ratios were generated through logistic regression. RESULTS: Many relationship and partner characteristics were significant for females but nonsignificant for males. For example, females' odds of ever, rather than never, having used contraception in their most recent relationship increased with the duration of the relationship (odds ratio, 1.1); their odds were reduced if they had not known their partner before dating him (0.2). The odds of consistent use (vs. inconsistent or no use) were higher for females in a "liked" relationship than for those in a romantic relationship (2.6), and for females using a hormonal method instead of condoms (4.5). Females' odds of consistent use decreased if the relationship involved physical violence (0.5). Among teenagers in romantic or "liked" relationships, the odds of ever-use and of consistent use were elevated among females who had discussed contraception with the partner before their first sex together (2.9 and 2.1, respectively), and the odds increased among males as the number of presexual couple-like activities increased (1.2 for each). CONCLUSIONS: Teenagers must use contraception consistently over time and across relationships despite pressure not to. Therefore, they must learn to negotiate sexual and contraceptive decisions in each relationship.

Adolescent↗

PubMed2006

Predictors of partner abuse in a nationally representative sample of adolescents involved in heterosexual dating relationships.

This article's goals are to identify the characteristics of abusive heterosexual dating relationships among adolescents. Using the National Longitudinal Study of Adolescent Health dataset, an analysis of 4,441 heterosexual relationships was completed using logistic regression models (SAS PROC GENMOD). The associations between being verbally and physically abused were examined with respect to the following relationship characteristics: involvement in sexual intercourse or pregnancy with the relationship partner, description of the relationship as a "special romantic relationship," duration of the relationship, age at relationship initiation, and age difference between partners. The findings indicate that involvement in a sexual or "special romantic" relationship was associated with greater likelihood of being abused in both genders. Increased length of time in the relationship was associated with verbal abuse in both genders. Involvement in a pregnancy was associated with being verbally and physically abused among males. It is thus concluded that relationship characteristics play an important role in the development of abusive relationships among adolescents.

Adolescent↗

PubMed1981

Women's perceptions of their important dyadic relationships during pregnancy.

This study examined women's perceptions of important relationships during pregnancy. Fourteen women were interviewed at approximately monthly intervals from the third through the last month of their pregnancies. During these interviews, each woman (a) identified relationships which were important to her; (b) described each important relationship as either changing or stable; and (c) evaluated each important relationship as either satisfactory or unsatisfactory. Study results indicate that the women identified important relationships with their husbands, children, parental figures, and peers. Important relationships were described as more changing than stable throughout pregnancy. These relationships were experienced, over all, as more satisfactory than unsatisfactory. An analysis of the perceived satisfactory and unsatisfactory relationships reveals the woman's expectations for important relationships and indicates major considerations for the acceptance and accommodation process. The woman's expectations for her important relationships indicate the presence of two major systems of relationships within her social space. Each of these systems is characterized by a dominant function. One system of relationships has as its primary function, differentiation; the other, support. Within the differentiation system, the woman helps important others to reorganize for the addition of the expected baby to the family system. Within the supportive system, the pregnant woman is the recipient of the nurturing and caring actions of others. The interplay between these interdependent systems reflects the workings of the task of accommodation and acceptance.

Adult↗

PubMed1991

Negotiating commitment and involvement in the nurse-patient relationship.

The relationship that is established between the nurse and the patient is the result of interplay or covert negotiations until a mutually satisfying relationship is reached. Depending on the duration of the contact between the nurse and the patient, the needs of the patient, the commitment of the nurse and the patient's willingness to trust the nurse, one of four types of mutual relationship will emerge: a clinical relationship, a therapeutic relationship, a connected relationship or an over-involved relationship. If the nurse is unwilling or unable to be committed to the patient, a unilateral relationship will develop, with the patient continuing to use manipulative or coercive behaviours, attempting to increase the nursing involvement in the relationship. If the patient is unwilling to trust the nurse and accept his or her illness situation, she or he will manifest 'difficult' behaviours, be withdrawn or elope. The changing nature of the relationship, and the conditions and consequences of each type of relationship are discussed.

Attitude of Health Personnel↗

PubMed2004

Nurse-patient relationships in palliative care.

AIM: The aim of this paper is to report a study exploring aspects of nurse-patient relationships in the context of palliative care. BACKGROUND: Although there are numerous studies addressing nurse-patient relationships, little research has focused on these in the context of palliative are. Furthermore, no previous study has examined the relationship in the Chinese context. METHODS: Qualitative data were collected from 10 hospice nurses and 10 terminally ill patients by means of open ended unstructured interviews. Respondents were asked to reflect on practices and incidents that would allow an understanding of the meaning of nurse-patient relationships in palliative care. RESULTS: Four major categories emerged from the perspectives of patients and nurses: (1) forming a relationship of trust; (2) being part of the family; (3) refilling with fuel along the journey of living and dying; and (4) enriched experiences. Responses revealed that a relationship of trust is formed, and that nurses are not only regarded as health professionals, but also become part of the family or a good friend. Nurses who develop trusting relationships demonstrate a holistic approach to caring, show their understanding of patients' suffering, are aware of their unvoiced needs, provide comfort without actually being asked, and are reliable, proficient, competent and dedicated in their care. CONCLUSION: Trust, the achievement of the goals of patients and nurses, caring and reciprocity are important elements of nurse-patient relationships in palliative care. Such relationships not only improve patients' physical and emotional state, but also facilitate their adjustment to their illness, ease pain and can ultimately lead to a good death experience. It is nurses' personal qualities and skills, which are embedded in these relationships, that constitute excellence in nursing care. Nurses also derive satisfaction and are enriched through the relationships.

Adult↗

PubMed2006

Relationship-centered care. A constructive reframing.

All illness, care, and healing processes occur in relationship--relationships of an individual with self and with others. Relationship-centered care (RCC) is an important framework for conceptualizing health care, recognizing that the nature and the quality of relationships are central to health care and the broader health care delivery system. RCC can be defined as care in which all participants appreciate the importance of their relationships with one another. RCC is founded upon 4 principles: (1) that relationships in health care ought to include the personhood of the participants, (2) that affect and emotion are important components of these relationships, (3) that all health care relationships occur in the context of reciprocal influence, and (4) that the formation and maintenance of genuine relationships in health care is morally valuable. In RCC, relationships between patients and clinicians remain central, although the relationships of clinicians with themselves, with each other and with community are also emphasized.

Delivery of Health Care↗

PubMed1987

The role of attributions in the development of dating relationships.

In this study, we examine the role of attributions in the context of dating relationships. A large sample completed a questionnaire comprising structured ratings and a free-response relationship description. As expected, cognitive or attributional activity was more frequent within relationships when they were in the early stages, when important choice points or changes were occurring, and when the relationships were perceived as unstable. Also as predicted, subjects who reported higher relationship happiness, commitment, and love for their partners tended to describe the relationship in more interpersonal terms, to rate the causal inputs of the partners as equal, and to attribute lower external attributions for relationship maintenance. Finally, some evidence was obtained that attributions for relationship maintenance are causally related to relationship happiness over a 2-month period. The results are discussed in terms of the relationship between cognitive processing and the development of dating relationships.

Adult↗

PubMed1994

Sexual adjustment after spinal cord injury-comparison of partner experiences in pre- and postinjury relationships.

This study compared the emotional and sexual aspects of relationships before and after spinal cord injury, from the partner's point of view. In addition, the personality characteristics of the partners were investigated. Twenty-six relationships were established before the injury and 23 after. The couples in preinjury relationships had been married or cohabiting for 3.5-51 years (median 24 years), while postinjury relationships ranged from 1 to 8 years (median 2 years). There were substantial differences in age between preinjury and postinjury partners, 21-79 years (median 51 years) and 18-45 years (median 28 years), respectively. Data collection included an 80-item questionnaire, designed to determine different aspects of sexuality, a visual analogue scale Quality of Life (VAS QL) measure and an established inventory of personality characteristics, the Karolinska Scales of Personality (KSP). Eighty-eight per cent of the partners in preinjury and 86% in postinjury relationships considered their overall relationship to be satisfactory. Concerning the sexual aspects of the relationships, several differences were revealed, all favouring postinjury relationships. Some of these held true even when age was treated as a significant factor and statistically controlled. Although the frequency of sexual activity and the variety of sexual expressions used were lower in the preinjury relationships, and perceived deterioration of sex life due to the injury was higher among preinjury partners, there was no significant difference between the two groups in satisfaction with current sex life. Thus, age seems to be a more important factor for sexual adjustment after a spinal cord injury, rather than whether the relationship is established before or after injury. The partners' personality characteristics differed only slightly from those of a sex and age matched reference group and not at all between partners in pre- and postinjury relationships.

Adaptation, Psychological↗

PubMed2005

Periconceptional nutrition and the relationship between maternal body weight changes in the periconceptional period and feto-placental growth in the sheep.

Recent studies in the sheep have shown that maternal undernutrition during the periconceptional period, when the nutrient demands of the embryo are minimal, can alter the subsequent development of the metabolic, endocrine and cardiovascular systems and that these effects may, in part, depend on embryo number. We have tested the hypotheses that there are relationships between maternal weight or body condition at the time of conception and feto-placental growth during the first 55 days of pregnancy, and that periconceptional undernutrition has a differential effect on these relationships in singleton and twin pregnancies. We have investigated the effect of periconceptional undernutrition in the ewe (control n= 24, restricted at 70% of control feed allowance, PCUN n= 21) from 45 days prior to mating until 7 days after mating on placental and fetal weight and on placental histology in singleton and twin pregnancies at 53-56 days' gestation, i.e. during the period of maximal placental growth. In control, but not PCUN ewes carrying singleton pregnancies, there were direct relationships between maternal weight gain during the periconceptional period and uteroplacental weights at 53-56 days' gestation. There were direct relationships, however, between placental and fetal weights in both control and PCUN singleton pregnancies. In contrast to the singletons, in control twin pregnancies, there was no effect of maternal weight gain in the periconceptional period on any measure of uteroplacental growth, and there was also no relationship between placental and fetal weight. This lack of a relationship may be related to the increased uteroplacental weight and mean placentome weight in the twin pregnancies (control singletons: 2.45 +/- 0.18 g; control twins: 4.10 +/- 0.62 g). In the PCUN group, however, a greater weight loss between the start of the feeding regime and post mortem at approximately day 55, was associated with a larger placenta and fetus, and the direct relationship between placental and fetal mass was restored. In summary, the present study has demonstrated that there are important relationships between maternal weight gain during the periconceptional period and feto-placental growth during the first 56 days of pregnancy, and that periconceptional undernutrition has a differential effect on these relationships in singleton and twin pregnancies. In singleton pregnancies, periconceptional undernutrition disrupts the relationship between maternal weight gain during the periconceptional period and uteroplacental growth, and in twin pregnancies periconceptional undernutrition results in the emergence of an inverse relationship between maternal weight gain during early pregnancy and uteroplacental growth and a dependence of fetal growth on placental growth. These changes highlight the importance of the periconceptional environment in setting the placental and fetal growth trajectories, and have implications for the programmed development of the metabolic, cardiovascular and endocrine systems of the fetus and adult.

Animals↗

PubMed1990

Distensibility and pressure-flow relationship of the pulmonary circulation. I. Single-vessel model.

To ascertain the relative contributions of vascular distensibility and nonhomogeneous behavior within the pulmonary circulation to the distinctive nonlinear relationship between inflow pressure (Pin) and flow [pressure-flow (P-F) relationship] and between Pin and outflow pressure (Pout) at constant flow (Pin-Pout relationship), we developed a multibranched model in which the elastic behavior of, and forces acting on, individual branches can be varied independently. The response of the multibranched model is described in the companion article (J. Appl. Physiol. 68: 1514-1527, 1990). Here we describe the methods used and the responses of single components of the larger model. Perivascular pressure is modeled as a function of intravascular and transpulmonary pressures (Pv and Ptp, respectively) and vessel length as a function of lung volume. These and the relationship between vascular area (A) and transmural pressure (Ptm) were modeled primarily from the dog data of Smith and Mitzner (J. Appl. Physiol. 48: 450-467, 1980). Vasomotor tone is modeled as a radial collapsing pressure (Pt) in the same plane as Ptm. In view of lack of information about the relationship between Pt and A for a given active state, different patterns were assumed that span a wide range of possible relationships. The P-F and Pin-Pout relationships of single vessels were very similar to those reported for the entire intact circulation. Of note, the slope of the Pin-Pout relationship in the low Pout range (0-5 Torr) was very low (less than 0.25) and increased gradually with Pout toward unity. Vasomotor tone caused an apparent parallel shift in the P-F relationship in the physiological flow range of the dog (2-8 l/min) regardless of the pattern used to model the Pt vs. A relationship; different patterns affected the P-F relationship only over the low flow range before the parallel shift was established.

Animals↗

PubMed1985

Simultaneous determination of left ventricular end-systolic pressure-volume and pressure-dimension relationships in closed-chest dogs.

The left ventricular end-systolic pressure-volume relationship is a load-insensitive measure of left ventricular performance. The relationship at end-systole between left ventricular pressure and dimension is more easily obtained, but the conflicting results of previous studies make it unclear if it has the same properties as the left ventricular end-systolic pressure-volume relationship. To address this issue, 11 dogs were instrumented to measure left ventricular pressure and three orthogonal left ventricular dimensions. Left ventricular pressure and dimensions were varied by use of caval occlusion. Left ventricular volume was calculated as an ellipsoid. The left ventricular end-systolic pressure-volume relationship and each of the three end-systolic pressure-dimension relations were described by straight lines (r = .97 +/- .02, mean +/- SD). In six animals, dobutamine produced similar significant increases (p less than .01) in the slope of the end-systolic pressure-volume relationship (244 +/- 61% of control), the end-systolic pressure-anterior-posterior dimension relationship (248 +/- 89%), the end-systolic pressure--septal-lateral dimension relationship (211 +/- 95%), and the end-systolic pressure-basal-apical dimension relationship (210 +/- 85%). The intercepts at zero pressure were relatively unchanged by dobutamine. In contrast, occlusion of the distal left anterior descending coronary artery in five animals produced a rightward shift of the left ventricular end-systolic pressure-volume relationship and the pressure--basal-apical dimension relationship, while the pressure--anterior-posterior dimension and pressure--septal-lateral dimension relationships were relatively unaffected.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2005

Relationship structures and semantic type assignments of the UMLS Enriched Semantic Network.

OBJECTIVE: The Enriched Semantic Network (ESN) was introduced as an extension of the Unified Medical Language System (UMLS) Semantic Network (SN). Its multiple subsumption configuration and concomitant multiple inheritance make the ESN's relationship structures and semantic type assignments different from those of the SN. A technique for deriving the relationship structures of the ESN's semantic types and an automated technique for deriving the ESN's semantic type assignments from those of the SN are presented. DESIGN: The technique to derive the ESN's relationship structures finds all newly inherited relationships in the ESN. All such relationships are audited for semantic validity, and the blocking mechanism is used to block invalid relationships. The mapping technique to derive the ESN's semantic type assignments uses current SN semantic type assignments and preserves nonredundant categorizations, while preventing new redundant categorizations. RESULTS: Among the 426 newly inherited relationships, 326 are deemed valid. Seven blockings are applied to avoid inheritance of the 100 invalid relationships. Sixteen semantic types have different relationship structures in the ESN as compared to those in the SN. The mapping of semantic type assignments from the SN to the ESN avoids the generation of 26,950 redundant categorizations. The resulting ESN contains 138 semantic types, 149 IS-A links, 7,303 relationships, and 1,013,876 semantic type assignments. CONCLUSION: The ESN's multiple inheritance provides more complete relationship structures than in the SN. The ESN's semantic type assignments avoid the existing redundant categorizations appearing in the SN and prevent new ones that might arise due to multiple parents. Compared to the SN, the ESN provides a more accurate unifying semantic abstraction of the UMLS Metathesaurus.

Semantics↗

PubMed1995

Tension-frequency relationships in normal and cardiomyopathic dog and hamster myocardium.

The objective of this study was to evaluate the tension-frequency relationship in normal and cardiomyopathic myocardium from one species with a negative or biphasic relationship, the hamster, and one with a positive relationship, the dog. Left ventricular papillary muscles from 100-day-old normal Syrian and cardiomyopathic (CHF-147) hamsters and right ventricular papillary muscles or trabeculae from normal mongrel dogs and dog with pacing-induced heart failure were used for the study. Stimulation frequency was varied from 1 to 90/min and isometric contractions recorded at each frequency prior to and after the addition of phenylephrine 10 microM. A tension-frequency relationship at varying extracellular calcium concentrations (1.25, 2.5 and 5.0 mM) was also constructed in normal hamster myocardium. Ryanodine 1.2 microM was added to a bath with normal hamster muscles and a force-frequency relationship constructed prior to and after adding phenylephrine 10 microM. A calcium dose-response curve in normal and cardiomyopathic dog myocardium was also constructed. Normal and cardiomyopathic hamster myocardium had a biphasic tension-frequency relationship with the increase in tension during the second phase being greater in normal v cardiomyopathic hamster myocardium (0.66 +/- 0.19 v 0.12 +/- 0.03 g/mm2, P < 0.05). The initial decrease in tension in response to increasing stimulation frequency was markedly attenuated in normal hamster myocardium by increasing extracellular calcium concentration. Developed tension was eliminated at lower stimulation rates by ryanodine such that when developed tension did occur, it increased with increasing stimulation rates. The addition of phenylephrine to hamster myocardium modified the tension-frequency relationship of both normal and cardiomyopathic dog myocardium and their response to phenylephrine were similar. In each case, tension increased progressively with increasing stimulation rate. Although the absolute increase in tension caused by increasing extracellular calcium was less in cardiomyopathic dog myocardium, the percent increase in tension and shortening was greater. We conclude that the tension-frequency relationship of normal and cardiomyopathic hamster myocardium are biphasic, with the initial negative phase being the result of limitations of sarcoplasmic reticulum calcium handling. Phenylephrine modifies this relationship to a uniphasic positive one, likely by its effects on both the sarcolemma and the sarcoplasmic reticulum. Also, the tension-frequency relationship of normal and cardiomyopathic dog myocardium are similar and unmodified by phenylephrine.

Animals↗

PubMedDate not supplied

Dual relationships in mental health practice: issues for clinicians in rural settings.

OBJECTIVE: This paper aims to provide an overview of the literature on non-sexual dual relationships, and to discuss these in the context of rural mental health practice in Australia. METHOD: An internet-driven literature search was undertaken using OVID databases, which include MEDLINE, PsycINFO, CINAHL, and EMBASE: Psychiatry. Ethical codes of practice for the mental health professions of psychiatry, psychology, occupational therapy, social work and nursing were referred to. Searches were not limited by year of publication. Other unpublished material or information was included where relevant. RESULTS: Dual relationships are common in rural mental health practice. However, research on non-sexual dual relationship boundary issues in rural mental health is limited. Ethical codes of practice of mental health professional bodies provide little guidance regarding non-sexual dual relationships. Decision-making models addressing the ethics of dual relationships are restricted to considerations of whether to enter a dual relationship rather than how to manage such a relationship. CONCLUSIONS: Everyday' dual relationships are a predictable part of rural mental health practice. Further research is required to identify the benefits and/or problems in clinical practice resulting from non-sexual dual relationships. Responsibility for identifying and implementing ways of appropriately managing such relationships should be shared by the patient, the clinician, mental health services and professional organizations.

Australia↗

PubMed2005

Dose-incidence relationships derived from superposition of distributions of individual susceptibility on mechanism-based dose responses for biological effects.

Dose-response relationships for incidence are based on quantal response measures. A defined effect is either present or not present in an individual. The dose-incidence curve therefore reflects differences in individual susceptibility (the "tolerance distribution"). At low dose, only the more susceptible individuals manifest the effect, while higher doses are required for more resistant individuals to be recruited into the affected fraction of the group. Here, we analyze how such dose-incidence relationships are related to mechanism-based dose-response relationships for biological effects described on a continuous scale. As an example, we use the quantal effect "cell division" triggered by occupancy of growth factor receptors (R) by a hormone or mitogenic ligand (L). The biologically effective dose (BED) is receptor occupancy (RL). The dose-BED relationship is described by the hyperbolic Michaelis-Menten function, RL/Rtot = L / (L + K(D)). For the conversion of the dose-BED relationship to a dose-cell division relationship, the dose-BED curve has to be combined with a function that describes the distribution of susceptibilities among the cells to be triggered into mitosis. We assumed a symmetrical sigmoid curve for this function, approximated by a truncated normal distribution. Because of the supralinear dose-BED relationship due to the asymptotic saturation of the Michaelis-Menten function, the composite curve that describes cell division (incidence) as a function of dose becomes skewed to the right. Logarithmic transformation of the dose axis reverses this skewing and provides a nearly perfect fit to a normal distribution in the central 95% incidence range. This observation may explain why dose-incidence relationships can often be described by a cumulative normal curve using the logarithm of the administered dose. The dominant role of the tolerance distribution for dose-incidence relationships is also illustrated with the example of a linear dose-BED relationship, using adducts to protein or DNA as the BED. Superimposed by a sigmoid distribution of individual susceptibilities, a sigmoid dose-incidence curve results. Linearity is no longer observed. We conclude that differences in susceptibility should always be considered for toxicological risk assessment and extrapolation to low dose.

Disease Susceptibility↗

PubMed2000

How clinical teachers perceive the doctor-patient relationship and themselves as role models.

PURPOSE: Teachers must be good role models. In order to act the part, however, they must reflect on and articulate the attitudes and behaviors they wish to convey. The aim of this study was to describe how clinicians who teach clerks and residents represent the doctor-patient relationship and how they see themselves as role models for this relationship. METHOD: In the fall of 1997, 28 clinical teachers in family medicine and various medical and surgical specialties at Laval University Faculty of Medicine participated in individual semistructured interviews regarding their perceptions of the doctor-patient relationship and how it is taught. The interviews were conducted by a trained research assistant and the content of the interviews was coded by three independent observers, who then performed a qualitative analysis. RESULTS: The clinical teachers identified competencies associated with the doctor-patient relationship that differed in complexity and specificity. Paramount among these competencies were the ability to conduct interviews effectively and politely, the ability to understand and involve the patient, and, in some cases, the ability to handle emotionally-charged situations. The clinical teachers tended to demand more of their students in doctor-patient relationships than they did of themselves. Lack of time and a negative attitude toward the doctor-patient relationship, on the part of both teachers and students, were obstacles to teaching and learning this essential competency, even to the point of making it difficult for teachers to demonstrate and supervise these competencies during their daily clinical activities. CONCLUSIONS: Most of the teachers had difficulty describing situations or behaviors in which they modeled the doctor-patient relationship. Being a role model requires a fairly precise idea of what one is modeling and accomplishing, and what one wants trainees to understand about the relationship. Efforts must be made to help clinical teachers to integrate the doctor-patient relationship into their clinical supervision and to provide them with tools to demonstrate this relationship effectively.

Attitude of Health Personnel↗

PubMed2001

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.

Education, Medical, Continuing↗