• Jasmine Blake Hollywood, MS, HHP

Patient-Practitioner Relationship

Updated: Jan 31

The purpose of Complementary and Integrative Health (CIH), is to bring the conventional and complementary practices together in a synchronized approach. Part of this is having a solid patient-practitioner relationship. Part of this relationship is to have enough trust from the patient so the patient can feel comfortable enough, to be honest with the practitioner. Thus, the patient will follow the advice given by the practitioner, and eventually, the patient will get better.


Earning Trust


While it is the duty of the practitioner to be trusted by their client, clients are finding it harder to receive the optimal care they deserve. Part of this is many clients feel their practitioner:

  • Refuses to listen

  • Doesn't give the client enough time to discuss issues

  • Doesn't make an effort to evaluate the initial complaint thoroughly

  • Has too much power

  • Makes the client feel unjustified

Ultimately, these perceptions reduce the client's ability to trust their practitioner.


Trust in the patient-practitioner relationship is important because clients deserve quality care from a trustworthy practitioner. Also, it is the client's desire to have this trust in addition to the practitioner's sincerity. When these two aspects are combined, they help facilitate guidance and client cooperation. Thus, producing a mutual relationship between power and responsibility.


For providers to portray a truthful, loyal, and caring relationship with their client they must find value in what the client is trying to say, spend more time with the client, and thoroughly evaluate the client's health status. This in turn will produce a mutual relationship, as the client feels justice is being served. As a result, it will increase the client's understanding of their personal responsibility, while synchronously improving their health status.


Practitioner's Goal is to Build a Foundation


The goal of the patient-practitioner relationship in CIH, means, "To provide the client with biomedical sciences, that give alternative approaches." This means finding another way to heal disease without using conventional approaches. Also, the purpose is to take away the focus of disease and illness, and focus more on integrating appropriate lifestyle changes. However, to be successful in the practice of CIH requires stability, and to have stability is to provide a foundation. Building a foundation requires the practitioner to develop the client relationship through education, provide the client with evidence and affirmation, create structure and boundaries within their practice, and make these mandates their policy. Furthermore, they must do this while still providing trust.


Patient-Practitioner Relationship Models


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].

Mutual participation is considered to be practitioner and client-centered. [1].


Mutual Participation Model


In the mutual participation model, practitioners and patients both share power and responsibility. Both the practitioner and the patient need each other, and both individuals will work together towards choices that satisfy each other. [2].

Activity-passivity and Guidance-co-operation Models


In 1937 Edelstein and colleagues suggested that the patient-practitioner relationship may have actually developed in Ancient Egypt. The researchers proposed that the activity-passivity model existed within Egyptian Medicine, where doctors assumed the dominant role over the patient. [1]. In other words, the practitioner made the choices.


Then, in the 5th century, researchers proposed that the Greeks may have begun practicing the guidance-co-operation model within their culture. It has been stated in numerous articles of literature that during this time, Greek physicians used the Hippocratic Oath for physician ethics, which in turn, helped decline the self-interest of physicians and started to force the physicians to adopt the 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. It should be noted that both activity-passivity and guidance-cooperation models are practitioner centered. Furthermore, these two models continued into the more advanced period of the 1700s when the clients were categorized into the class of upscale and privileged individuals. [1].


Since clients were predominantly upper class, practitioners thought it 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. However, 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. Thus, 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 is a Must in Integrative Health


Although the patient-practitioner relationship is defined as the providers' obligation to serve the clients' needs, in Integrated Health (IH), the patient-practitioner relationship must be utilized for both the benefit of the provider and the client. The practitioner must accept that the client is their responsibility at all times. While the client must accept they have a responsibility to comply.


Using this activity-passivity model is where the relationship begins in IH. With this type of focus, the practitioner 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 sincerity emerge. [1].


Whole Person Approach


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 and their concerns about 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 that is coming from the practitioner begins to initiate 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


Trust Barrier</