doctor – patient relationship

I've just started building this page, so bear with me while resources are added.

The relationship that exists between the doctor and the patient is an essential part of the therapeutic process in all specialities.

When I trained to be a GP in the 1990's I was encouraged to care for my patients, but  'patient-centred care' was not a term used by my experienced and wise trainers. It is now the focus of GP Training. It's easy to assume that everyone, including the patient, knows what this term means, but I'm not sure it's that easy. So here are some resources to provoke thought and discussion.

All the resources on the website are ultimately about improving the care doctors provide patients and so could be used to discuss the doctor-patient relationship, resources in the sections including, 'Being a Doctor'  'Compassion' and 'The lives of others' should be particularly useful. 

The most famous western painting about the doctor-patient relationship hangs in The Tate in London.

picture of 'The Doctor'
The Doctor 1891 Sir Luke Fildes
Presented by Sir HenryTate 1894

Fildes son, Phillip, died from typhoid fever on Christmas morning 1877. The painting was commissioned in 1890 by Henry Tate as a work of ‘social realism’. It is said to have been inspired by the compassionate care Dr Murray, the family doctor gave to Filde’s son and family. Fildes wanted "to put on record the status of the doctor in our time". 

Take a look at the whole picture and describe what you see.

What story does the picture paint about the family?

Most importantly what is happening in the space between the doctor and the child?

This next painting is by Picasso and was inspired by the death of the painter's sister, Conchita. It's an allegorical picture, the doctor taking the pulse represents science and the nun offering the sick patient soup represents charity.

I'm not able to reproduce this painting in the UK so here is the link to view it.

Science and Charity

Consider the picture from the perspective of the doctor and the patient.  

These paintings are of very sick patients whose capacity to take part in any decision making is clearly compromised.

It might be helpful to consider the doctor-patient relationship in terms of the roles each plays in the consultation. (I'm going to stick with the word consultation but if you work in secondary care you could substitute a word that best reflects the relationship you have with your patient in their care)

Let's start by looking at this 19th Century lithograph by the French artist Delacroix.

La Consultation Delacroix Image in Public Domain

Questions you might ask are;

  • What is happening in the picture?
  • Who are the people in the picture?
  • How are they positioned in the picture?
  • Why has Delacroix put a skeleton in the picture?
  • What role are the doctors playing in this 'consultation and what about the patient?

What thoughts do you have about this price of text from Aphorisms by Hippocrates c.460-357 BC?

Life is short, science is long; opportunity is elusive, experience is dangerous, judgement is difficult. It is not enough for the physician to do what is necessary, but the patient and the attendants must do their part as well, and the circumstances must be favourable. 

The poem A note of warning to patients when all else fails by Glenn Colquhoun put's the patient back in the centre of the picture.

Think now about your last consultation:

  • How would you describe the role you played?
  • What role did the patient play?

Can you think of the scene in theatrical terms, was it a duet, and duel, a soliloquy, a carefully scripted and rehearsed play?

All the world’s a stage,
And all the men and women merely players;
They have their exits and their entrances;
And one man in his time plays many parts,

As you like it Shakespeare

In essence, the consultation is very simple, the doctor enables the patient to share their agenda, the doctor then discusses his agenda and a decision about what happens next is agreed upon. This all works better when there is a relationship between the doctor and the patient.

In what ways do you think the doctor-patient relationship has evolved over the last century? 

Is the doctor-patient relationship different in other cultures and countries?

Please let me know if you have any art resources to help explore these two questions.

page created July 2021