title: Healing relationships and the existential philosophy of Martin Buber.
abstract: The dominant unspoken philosophical basis of medical care in the United States is a form of Cartesian reductionism that views the body as a machine and medical professionals as technicians whose job is to repair that machine. The purpose of this paper is to advocate for an alternative philosophy of medicine based on the concept of healing relationships between clinicians and patients. This is accomplished first by exploring the ethical and philosophical work of Pellegrino and Thomasma and then by connecting Martin Buber's philosophical work on the nature of relationships to an empirically derived model of the medical healing relationship. The Healing Relationship Model was developed by the authors through qualitative analysis of interviews of physicians and patients. Clinician-patient healing relationships are a special form of what Buber calls I-Thou relationships, characterized by dialog and mutuality, but a mutuality limited by the inherent asymmetry of the clinician-patient relationship. The Healing Relationship Model identifies three processes necessary for such relationships to develop and be sustained: Valuing, Appreciating Power and Abiding. We explore in detail how these processes, as well as other components of the model resonate with Buber's concepts of I-Thou and I-It relationships. The resulting combined conceptual model illuminates the wholeness underlying the dual roles of clinicians as healers and providers of technical biomedicine. On the basis of our analysis, we argue that health care should be focused on healing, with I-Thou relationships at its core.
authors.affiliation: University of Medicine and Dentistry of New Jersey, Department of Family Medicine, Robert Wood Johnson Medical School, One Worlds Fair Drive, Somerset, NJ 08873, USA. scottjg@umdnj.edu
authors.forename: John G
authors.initials: JG
authors.lastname: Scott
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Scott
authors.forename: William L
authors.initials: WL
authors.lastname: Miller
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
mesh_terms: D005086:Existentialism; D006801:Humans; D008962:Models, Theoretical; D010686:Philosophy, Medical; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards; D011787:Quality of Health Care
references.citation: N Engl J Med. 1998 Nov 19;339(21):1543-5
references.pmid: 9819454
references.citation: Theor Med. 1996 Jun;17(2):175-87
references.pmid: 8767644
references.citation: Med Health Care Philos. 2005;8(2):207-19
references.pmid: 16215800
references.citation: Ann Fam Med. 2008 Jul-Aug;6(4):315-22
references.pmid: 18626031
references.citation: J Contin Educ Health Prof. 2001 Summer;21(3):170-81
references.pmid: 11563223
references.citation: J Med Philos. 2001 Dec;26(6):559-79
references.pmid: 11735050