Doctors' communication of trust, care, and respect

Editor—The qualitative study of Burkitt Wright et al on doctors' communication of trust, care, and respect in breast cancer provides much that is useful for both practitioner and teacher to consider about communicating and functioning well as a healthcare professional.¹ However, any form of relationship by necessity involves more than one person, so the responsibility for this relationship cannot solely rest with the doctor.

To look at a professional responsibility in isolation ignores the role that the patient has in forming a therapeutic relationship. A follow up study on this group of doctors comparing the doctors' and patients' attitudes about what made a better therapeutic relationship would be interesting. A doctor might act in a particularly useful way in response to the way a patient consults or presents.

Figure 1.

Credit: BSIP/CABY, VALENCE/SPL

The authors also cite evidence that many patients prefer to be directed about treatment rather than given choice, but this leaves the doctor in a dilemma. Patients may claim later that the “direction” they accepted was one they wouldn't have chosen had they received fuller information about alternatives.

Although discovering what patients want out of consultations is crucial, it must be balanced against professional needs. Defensive medicine should not drive the therapeutic relationship, but neither should professional vulnerabilities be ignored.