Communication and relationships cannot be taken for granted, particularly in the physician-patient relationship, where life-altering diagnoses may be given. With one diagnosis, someone’s life may be changed, and both physicians and patients need to be cognizant of the importance of a strong relationship and clear communication.
In the current US health care system, both physicians and patients often are not getting their needs met, and studies that include factors of race, ethnicity, and socioeconomic status suggest that physician-patient relationship barriers contribute to racial disparities in health care.1,2 Although patient-centered care is a widely recognized and upheld model, relationship-centered care between physician and patient involves focusing on the patient and the physician-patient relationship through recognizing personhood, affect (being empathic), and reciprocal influence.3,4 Although it is not necessarily intuitive because it can appear to be yet another task for busy physicians, relationship-centered care improves health care delivery for both physicians and patients through decreased physician burnout, reduced medical errors, and better patient outcomes and satisfaction.5,6
Every physician, patient, and physician-patient relationship is different; unlike the standard questions directed at a routine patient history focused on gathering data, there is no one-size-fits-all relationship-centered conversation.7-10 As with any successful interaction between 2 people, there is a certain amount of necessary self-awareness (Table 1)11 that allows for improvisation and appropriate responsiveness to what is seen, heard, and felt. Rather than attending solely to disease states, the focus of relationship-centered care is on patients, interpersonal interaction, and promoting health and well-being.15
This review summarizes the existing literature on relationship-centered care, introduces the use of metacognition (Table 1), and suggests creating simple habits to promote such care. The following databases were searched from inception through November 23, 2020, using the term relationship-centered care: MEDLINE (Ovid), EMBASE (Ovid), APA PsycInfo (Ovid), Scopus, Web of Science Core Collection, CINAHL Complete (EBSCO), Academic Search Premier (EBSCOhost), and ERIC (ProQuest). A total of 1772 records were retrieved through searches, and after deduplication of 1116 studies, 350 records were screened through a 2-part process. Articles were first screened by title and abstract for relevance to the relationship between physician and patient, with 185 studies deemed irrelevant (eg, pertaining to the relationship of veterinarian to animal). The remaining 165 studies were assessed for eligibility, with 69 further studies excluded for various reasons. The screening process resulted in 96 articles considered in this review.
Definitions/key terms, as used in this article, are listed in Table 1.
Background of Relationship-Centered Care
Given time constraints, the diagnosis and treatment of medical problems often are the focus of physicians. Although proper medical diagnosis and treatment are important, and their delivery is made possible by the physician having the appropriate knowledge, a physician-patient relationship that focuses solely on disease without acknowledging the patient creates a system that ultimately neglects both patients and physicians.15 This prevailing physician-patient relationship paradigm is suboptimal, and a proposed remedy is relationship-centered care, which focuses on relationships among the human beings in health care interactions.3 Relationship-centered care has 4 principles: (1) the personhood of each party must be recognized, (2) emotion is part of relationships, (3) relationships are reciprocal and not just one way, and (4) creating these types of relationships is morally valuable3 and beneficial to patient care.16
Assessment of the Need for Relationship-Centered Care
Relationship-centered care has been studied in physician-patient interactions in various health care settings.17-23 For at least 2 decades, relationship-centered care has been set forth as a model,4,24,25 but there are challenges. Physicians tend to overrate or underrate their communication skills in patient interactions.26,27 A given physician’s preferences often still seem to supersede those of the patient.3,28,29 The impetus to develop relationship-centered care skills generally needs to be internally driven,4,30 as, ultimately, physicians and patients have varying needs.4,31 However, providing physicians with a potential structure is helpful.32
A Solution: Metacognition in the Physician-Patient Interaction
Metacognition is important to integrating basic science knowledge into medical learning and practice,33,34 and it is no less important in translating interpersonal knowledge to the physician-patient interaction. Decreased metacognitive effort35 may underpin the decline in empathy seen with increasing medical training.36,37 Understanding how metacognitive practices foster relationship-centered care is important for teaching, developing, and maintaining that care.