The doctor patient relationship in team-based patient care

Is the doctor-patient relationship really more sacrosanct than the nurse-patient relationship?

That’s the provocative question asked by Theresa Brown in a recent column from Well, the New York Times’ health blog.

She discusses an instance when she had a disagreement with a physician over a patient care issue.

I couldn’t believe that this doctor, who had always worked well with the nurses on my floor, had just suggested, at least in my mind, that a nurse’s opinion on patient care matters less because patients don’t directly make appointments with us.

And she has a point. In a hospital setting, nurses spend significantly more patient contact time than doctors. Smart doctors will seek out a patient’s nurse and ask his or her’s opinion on how the patient is doing.

So, when she asks whether a doctor-patient relationship takes priority over the relationship between a patient and a nurse, the answer is clearly no:

Physicians have the ultimate responsibility for treatment decisions, but because nurses spend so much more time with hospital patients than doctors do, we have a unique view of how the patient is really doing. And at times, patients present very different faces to nurses and to doctors — complaining to a nurse in a way they never would to a doctor.

We are shifting away from a paternalistic model of care, and more towards a team-based approach. This is especially true in the hospital, where not only a doctor takes care of a patient, but also nurses, social workers, physical therapists, dietitians and discharge planners, to name a few.

Primary care, of course, is heading towards a team-based model as well — especially as accountable care organizations and medical homes become more prevalent.

So, instead of asking whether a patient has a good relationship with his doctor, it’s going to be more important to know whether he has a good partnership with his team.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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