The Therapeutic Relationship

The relationship between the physician and patient has long been considered sacred but today’s high-tech medicine often replaces the warm touch of a hand with the cold steel of machinery. And managed care, with its emphasis on speed and productivity, has further eroded the therapeutic relationship and created a crisis in doctor-patient relationships.

“Health care providers are frustrated by the pressures of managed care and its ramifications; most importantly, by the lack of time to do what brought them to the profession in the first place: caring for patients,” write Ralph Snyderman, MD, Chancellor Emeritus, Duke University, and Andrew T. Weil, MD, in an essay called, Integrative Medicine: Bringing Medicine Back to its Roots. “The health care system must be reconfigured to restore the primacy of caring and the physician-patient relationship, to promote health and healing as well as treatment of disease, and to take account of the insufficiency of science and technology alone to shape the ideal practice of medicine.”

Recognizing the power that exists in simple actions—such as listening, caring, and the act of witnessing—integrative medicine teaches the importance of the therapeutic relationship in health and healing. “About 50% of my patients are in chronic pain,” says David Reilly, MD, a medical researcher from the United Kingdom. “They’ve seen surgeons and had injections, x-rays and drugs, and they’ve also seen psychiatrists, yet often no one has ever let them tell their story. But allowing patients to speak about the stresses that have come to their lives, where things went off the rails and how that touched their inner world, the fears that developed, and the inner fragmentation and conflicts that grew up is very healing,” Reilly says. “To me, being with the person to help piece that back together is the heart of medicine.”

This approach to doctor-patient communication not only deepens the partnership between the patient and the physician, it can increase self-awareness on the part of the patient. “What commonly occurs is that by raising a particular issue, the patient becomes aware of underlying concerns. It may be about relationships or work or exercise,” says Victoria Maizes, MD, executive director of the Center for Integrative Medicine at the University of Arizona. “And of course, more important than the questions are the answers they evoke. Listening attentively, empathically and without interruption may be more valuable than any particular question. Allowing someone to hear his or her own thoughts on intimate matters constitutes a potent medicine in itself.”

“As doctors, we don’t recognize our power as human beings to affect another person,” explains Rachel Naomi Remen, MD, a professor of clinical medicine at the University of California, San Francisco. “We think only our expertise matters … but we have given away a great deal of our power to make a difference in this world because we have narrowed ourselves in this way. Technical skill, intellectual ability, is highly valued. The emotional life, the intuitive life, the subjective world, and the spiritual life are not respected as expertise because they can’t be quantified or replicated or proved. In science, the mysterious, the emotional are seen as less valid than the numerical. We have been talked into seeing the most powerful parts of ourselves as soft. But my life experience after all these years is such that I know what real strength looks like.”

Thanks to the work of many, medical schools are now beginning to teach students the art of caring. The Healer’s Art, a course developed by Dr. Remen, is now offered at 40 medical schools across the country.