The BMJ Today: Relationships in medicine

jose_merinoRelationships are at the heart of medical practice. These relationships are built on trust and shared clinical, academic, personal, or economic goals. Two articles just published on explore ways to strengthen these relationships at the two ends of the spectrum of clinical practice: the clinical relationship between a doctor and his (the author is a man) patients, and between academic researchers and healthcare entities.

In a Personal View, James Munro tells us that a respectful relationship with patients is necessary to counteract “the arrogance of medicine,” and that medical knowledge by itself does not bring insight into the challenges that our patients face. Using examples from Patient Opinion, a web forum to share patients’ experiences, he describes how, in the end, patients value the personal connection with their health professionals more than their technical expertise.

The relationship between patients and doctors, he reminds us, is built on trust that is fostered by physicians’ attention to “small things” (how we listen, how we behave). Social web platforms are giving a voice to patients—letting them share their concerns, fears, and aspirations—and as health professionals we will learn much by listening attentively to what they say.

The value of strong relationships in medicine goes beyond the patient-doctor dyad. Pragmatic trials—clinical comparative effectiveness studies that seek to answer questions relevant to patients, clinicians, and healthcare systems—require close collaboration between academics, funders of research, clinicians, and administrators of healthcare systems.

While these “stakeholders” often have different goals, they can work together to answer relevant questions that directly affect patient care and clinical outcomes using existing infrastructure. Programs that foster such collaboration are important to ensure a shared vision by all players.

In a Research Methods and Reporting paper, Karin Johnson and colleagues describe practical strategies that have led to several successful pragmatic trials, using examples of studies funded by the Health Care Systems Research Collaboratory of the US National Institutes of Health. These trials built upon strong partnerships, and have led to sustained scientific and clinical collaborations.

These articles remind me that despite modern medicine’s scientific discoveries, therapeutic advances, and technical wizardry, its success depends on human interactions. I find this comforting.

José G. Merino, US clinical research editor, The BMJ.