title: The "Handling" of power in the physician-patient encounter: perceptions from experienced physicians.
abstract: BACKGROUND
  Modern healthcare is burgeoning with patient centered rhetoric where physicians "share power" equally in their interactions with patients. However, how physicians actually conceptualize and manage their power when interacting with patients remains unexamined in the literature. This study explored how power is perceived and exerted in the physician-patient encounter from the perspective of experienced physicians. It is necessary to examine physicians' awareness of power in the context of modern healthcare that espouses values of dialogic, egalitarian, patient centered care.
  
  
  METHODS
  Thirty physicians with a minimum five years' experience practicing medicine in the disciplines of Internal Medicine, Surgery, Pediatrics, Psychiatry and Family Medicine were recruited. The authors analyzed semi-structured interview data using LeCompte and Schensul's three stage process: Item analysis, Pattern analysis, and Structural analysis. Theoretical notions from Bourdieu's social theory served as analytic tools for achieving an understanding of physicians' perceptions of power in their interactions with patients.
  
  
  RESULTS
  The analysis of data highlighted a range of descriptions and interpretations of relational power. Physicians' responses fell under three broad categories: (1) Perceptions of holding and managing power, (2) Perceptions of power as waning, and (3) Perceptions of power as non-existent or irrelevant.
  
  
  CONCLUSIONS
  Although the "sharing of power" is an overarching goal of modern patient-centered healthcare, this study highlights how this concept does not fully capture the complex ways experienced physicians perceive, invoke, and redress power in the clinical encounter. Based on the insights, the authors suggest that physicians learn to enact ethical patient-centered therapeutic communication through reflective, effective, and professional use of power in clinical encounters.
authors.affiliation: Centre for Health Education Scholarship, Vancouver, Canada. laura.nimmon@ubc.ca.|Department of Occupational Science and Occupational Therapy, 429 - 2194 Health Sciences Mall, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada. laura.nimmon@ubc.ca.
authors.forename: Laura
authors.initials: L
authors.lastname: Nimmon
authors.affiliation: Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 17177, Stockholm, Sweden.
authors.forename: Terese
authors.initials: T
authors.lastname: Stenfors-Hayes
mesh_terms: D001291:Attitude of Health Personnel; D001955:British Columbia; D003142:Communication; D006801:Humans; D010358:Patient Participation; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D011209:Power, Psychological
keywords: Patient-centred care; Physician-patient relationship; Qualitative research