• Jasmine Blake Hollywood, MS, HHP

Patient-Practitioner Relationship

Updated: Sep 8, 2020

Why is the Patient-Practitioner Relationship Important?

While it is the duty of the practitioner to be trusted by their patient, clients are finding it harder to receive the optimal care they deserve. The patient-practitioner relationship is important because clients deserve quality care from a trustworthy practitioner and to improve their health status. The purpose of Complementary and Integrative Health (CIH), is to bring the conventional and complementary practices together in a synchronized approach.

The goal of the patient-practitioner relationship (PPR) in CIH, is to provide the client with biomedical sciences, that give alternative approaches. Also, it is to take away the focus of disease and illness in modern medicine. All the while, still providing trust. Clients desire to trust and ask for sincerity from their practitioners. These two aspects help facilitate guidance and cooperation. Thus, producing a mutual relationship between power and responsibility.

For providers to portray a truthful, loyal, and caring relationship with their client and be successful in the practice of CIH, they first must provide stability. Such stability is to provide a foundation, develop their relationship through education, provide the patient with evidence and affirmation, create structure and boundaries within their practice, and make these mandates their policy.

History of Patient-Practitioner Relationship

In the year 1956, two men named Szasz and Hollender created three models that describe the responsibilities of the patient-practitioner relationship. [1].According to Misau (2010), these models are activity-passivity, guidance and cooperation, and mutual participation. [2].

  • The Activity Passivity Model refers to the practitioner assuming complete responsibility for the clients' treatment. [2].

  • The Guidance and Cooperation Model refers to instructions given by the practitioner, and the client responds by following through with the advice given. [2].

  • The Mutual Participation Model refers to both individuals, the practitioner, and the client. [2].

In the mutual participation model, practitioners and patients both share power and responsibility, they need each other, and both individuals will work together towards choices that satisfy each other. [2]. Activity-passivity and guidance-cooperation are practitioner centered, and mutual participation is practitioner and client-centered. [1].

In 1937 Edelstein and colleagues suggested that the patient-practitioner relationship may have developed in Ancient Egypt. Edelstein and his colleagues proposed that the activity-passivity model existed within Egyptian Medicine, where doctors assumed the parent-figure role over the patient. [1]. In the 5th century, the Greeks may have been practicing the guidance-co-operation model within their culture. It was said that Greek physicians used a Hippocratic Oath for physician ethics. Which, in turn, helped decline the self-interest of physicians and forced physicians to adopt a code of ethics. [1].

Activity-passivity and guidance-co-operation techniques in the physician world soon followed into the Medieval era, and shortly after followed into the French Revolution era. Furthermore, these two models continued into the more advanced period of the 1700s when the clients were the class of upscale and privileged individuals. [1].

Since clients were upper class, practitioners thought is was only righteous to put the clients' needs first while assuming complete responsibility for their treatment. In like, they gave their patients adequate instructions and advice. These practitioners followed up with their clients, and both the practitioner and the client felt they shared power and responsibility. As trends grew, so did medical care. Shortly after the 17th century during the 18th century, hospitals began to surface to supply the needs of the people, giving practitioners an integrated class of privileged and underprivileged clients. From there, practitioners continued these practices, and since then, they still do today. [1].

Patient-Practitioner Relationship a Must in Integrative Health

Although the patient-practitioner relationship is defined as the practitioners' obligation to serve the clients' needs, in Integrated Health (IH), the patient-practitioner relationship must be utilized for both the benefit of the practitioner and the client. The practitioner must accept that the client is their responsibility at all times. Using this activity-passivity model is where the relationship begins in IH. With this type of focus, the practitioner, whether using biomedical sciences or complementary care, can show the client that their loyalty lies with them. This loyalty will bring forth trust, and with confidence, the client will begin to see a sincerity emerge. [1].

Integrative Medicine is based on a whole-person approach. The whole-person approach focuses on every part of the client. This includes how the client feels concerning the practitioner. As the bond builds, the client is more likely to comply, which benefits the practitioner. At this point in the relationship, the guidance coming from the practitioner begins to enable progress. As guidance-co-operation prevails, the trust barrier diminishes; and a foundation starts to build, allowing the practitioner to provide optimal care. This formula of trust is direct and creates positive health outcomes for the client.

Challenges Practitioners Face

The most significant barrier most practitioners face is the trust barrier. It is virtually impossible to succeed in this area if the practitioner is unable to perform the other duties of the patient-practitioner models. For example, developing the relationship through education, can not only bind trust, but this trust will flourish throughout the length of the patient-practitioner relationship. As we envision the client, we see that the client will not see a sincere, trustworthy practitioner. We see a client in an office nodding their head, but in reality, they have no concept of what is being discussed. We know the client is confused. Using the activity-passivity model, the practitioner must assume all responsibilities, including the understanding that clients are not familiar with physician lingo.

Explaining the evidence that practitioners find and learning if the client thoroughly understands this information, is relevant to facing this challenge. [1].What are the tests practitioners are giving to their clients, what are the results, what does this evidence point to, and what do other clinical trials say about this information? These questions create structure in the relationship. The more practitioners dedicate themselves to explaining the evidence, the better the clients begin to understand the boundaries and what the relationship entails.

As well, the affirmation the client will feel through the educational guidance will enable the client to become co-operative. [1]. Through this process, the practitioner will be allowed to complete the step of the guidance-co-operative model. Finally, the client begins to oversee trust as a barrier, and a mutual relationship will emerge. Thus, giving the power and responsibility that both practitioner and client need to have, completing the mutual participation model of the patient-practitioner trifecta. [1].


  1. Kaba, R. & Sooriakumaran, P. (2007). The evolution of the doctor-patient relationship. International Journal of Surgery, (5 )1, pp. 57 - 65. Retrieved from https://www.journal-surgery.net/action/showCitFormats?pii=S1743-9191%2806%2900009-4&doi=10.1016%2Fj.ijsu.2006.01.005

  2. Misau. Y. (2010). Doctor patient relationship. In Linkedin. Retrieved from https://www.slideshare.net/misau/doctor-patient-relationship-yusuf-misau

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