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Annals of Family Medicine 6:315-322 (2008)
© 2008 Annals of Family Medicine, Inc.
doi: 10.1370/afm.860
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Understanding Healing Relationships in Primary Care

John G. Scott, MD, PhD1,2, Deborah Cohen, PhD1,2, Barbara DiCicco-Bloom, RN, PhD1,2, William L. Miller, MD, MA3, Kurt C. Stange, MD, PhD2,4,5 and Benjamin F. Crabtree, PhD1,2,6

1 University of Medicine and Dentistry of New Jersey, Department of Family Medicine, Robert Wood Johnson Medical School, New Brunswick
2 Center for Research in Family Practice and Primary Care, Cleveland, Ohio
3 Lehigh Valley Hospital, Department of Family Medicine, Allentown, Pennsylvania
4 Case Western Reserve University, Departments of Family Medicine, Epidemiology & Biostatistics, and Sociology, Cleveland, Ohio
5 Case Comprehensive Cancer Center, Cleveland, Ohio
6 Cancer Institute of New Jersey, New Brunswick

CORRESPONDING AUTHOR: John G. Scott, MD, PhD Department of Family Medicine Robert Woods Johnson Medical School One Worlds Fair Dr Somerset, NJ 08873 scottjg{at}umdnj.edu

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.

Key Words: Physician-patient relations • communication • primary health care • healing




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TRACK Comments:

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Healing relationships are especially important for dying patients
Scott A Murray
Annals of Family Medicine, 8 Aug 2008 [Full text]
Healing: An Art or Simply an Ethic of Care
Victoria J Palmer
Annals of Family Medicine, 29 Sep 2008 [Full text]

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