title: Developing a psychiatrist-patient relationship when both people are doctors: a qualitative study.
abstract: To better understand the complexities of developing an effective psychiatrist-patient relationship when both people involved are doctors.
  
  
  
  In-depth, semistructured interviews were conducted with 11 doctors with experiences as patients of psychiatrists (DPs) and eight psychiatrists with experience of treating doctors (TPs). A thematic analysis was undertaken.
  
  
  
  The medical culture of unrealistically high standards with limited room for vulnerability and fallibility, vigilance for judgment and valuing clinical over personal knowledge affected both people in the relationship. DPs struggled with the contradictions involved in entering the patient role but tried hard to be good patients. They wanted guidance but found it hard to accept and seldom communicated dissatisfaction or disagreement to their TPs. They described widely varying responses to diagnosis and treatment within the biomedical model. TPs described enjoyment and satisfaction and extreme challenge in engaging with TPs. Despite focusing on providing ordinary care they described providing extra care in many ways.
  
  
  
  This study brings forward important issues when a psychiatrist is building a therapeutic relationship with another doctor. These are also likely to arise with other people and contribute to making truly patient-centred 'ordinary care' a hard ideal to fulfil. They include: (1) doctors' sense of ourselves as invincible, (2) TPs' sense of personal connection to, and identity with, DPs, (3) having extensive medical knowledge and (4) striving to be good patients. We need to make these issues explicit and enable the DP (or other patients) to tell their story and speak about their experience of the consultation so that any potential rupture in the therapeutic relationship can be addressed early.
authors.affiliation: Child and Family Unit, Auckland City Hospital, Auckland Mail Centre, Auckland, New Zealand.
authors.forename: Josephine
authors.initials: J
authors.lastname: Stanton
authors.affiliation: Hamilton, New Zealand.
authors.forename: Patte
authors.initials: P
authors.lastname: Randal
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011570:Psychiatry; D036301:Qualitative Research; D012649:Self Concept; D012933:Social Identification
keywords: MENTAL HEALTH; attitude of health personnel; organisational culture; physician impairment; physician-patient relations