The patient-doctor relationship: a synthesis of the qualitative literature on patients' perspectives.
BACKGROUND
The patient-doctor relationship is an important but poorly defined topic. In order to comprehensively assess its significance for patient care, a clearer understanding of the concept is required.


OBJECTIVE
To derive a conceptual framework of the factors that define patient-doctor relationships from the perspective of patients.


METHODS
Systematic review and thematic synthesis of qualitative studies.


METHODS
Medline, EMBASE, PsychINFO and Web of Science databases were searched. Studies were screened for relevance and appraised for quality. The findings were synthesised using a thematic approach.


RESULTS
From 1985 abstracts, 11 studies from four countries were included in the final synthesis. They examined the patient-doctor relationship generally (n = 3), or in terms of loyalty (n = 3), personal care (n = 2), trust (n = 2), and continuity (n = 1). Longitudinal care (seeing the same doctor) and consultation experiences (patients' encounters with the doctor) were found to be the main processes by which patient-doctor relationships are promoted. The resulting depth of patient-doctor relationship comprises four main elements: knowledge, trust, loyalty, and regard. These elements have doctor and patient aspects to them, which may be reciprocally related.


CONCLUSIONS
A framework is proposed that distinguishes between dynamic factors that develop or maintain the relationship, and characteristics that constitute an ongoing depth of relationship. Having identified the different elements involved, future research should examine for associations between longitudinal care, consultation experiences, and depth of patient-doctor relationship, and, in turn, their significance for patient care.
Ridd
Matthew
M
Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Bristol. m.ridd@bristol.ac.uk
Shaw
Alison
A
Lewis
Glyn
G
Salisbury
Chris
C