The doctor-patient relationship: an exploration of trainee doctors’ views

Greater understanding of the ways in which medical trainees perceive the doctor-patient relationship could inform future developments in educational provision. A qualitative study was conducted, using a case study approach to explore the perceptions of postgraduate trainees in two medical specialties, general practice (GP) and otolaryngology (ear, nose and throat surgery, ENT), in the West Midlands region of the United Kingdom. Following a scoping exercise in 2002, interviews with 20 trainees (10 GP and 10 ENT) in 2004 and questionnaires from 16 ENT and 89 GP trainees in 2007 explored trainees’ views of the doctor-patient relationship, including perceptions of the nature of that relationship and how they had learnt to develop relationships with patients. Five conceptual frameworks that participants drew upon when talking about the doctor-patient relationship were identified: paternalism; guided decision-making; partnership; clinical and consumerism. Trainees described a fluid doctor-patient relationship which adapts to differing contexts, taking different forms in different situations and influenced by factors outside the doctor’s control, including time and the patient’s personality. Personal experience and observing senior colleagues were considered to have had the greatest impact on learning. Higher Specialist Training which acknowledges the complexity of the doctor-patient relationship and encourages reflective practice is recommended