Introduction

- Toward a Biopsychosocial Understanding of the Patient–Physician Relationship: An Emerging Dialogue

Suchman3 has argued persuasively for viewing the patient–physician relationship as constituted by complex responsive psychosocial processes of relating. Accordingly, the interaction of physician and patient can be viewed as an emergent, self-organizing process. It is established and maintained by reciprocal, iterative psychosocial responses through which each mutually influences and co-regulates the other’s interdependent behavior and personal experience. Psychosocial responses have biological concomitants4 likewise making patient–physician interactions emergent, self-organizing feedback loops comprised of mutually regulatory biopsychosocial responses. This may be labeled a complex biopsychosocial relational process. In the interest of brevity, I will refer to this throughout the paper as the biopsychosocial relational process or just the relational process.

This approach to the patient–physician relationship shifts our focus from the relationship as a context for the delivery of medical treatment to the relationship itself as a medical treatment. It also redirects our view of the function of the physician—from a provider of treatment to a co-participant in treatment, with emergent consequences for both patient and physician. Three features are highlighted:

• As cocreators of a complex self-organizing relationship, patients and physicians are engaged in a moment-to-moment mutual regulation of each other’s biopsychosocial states.
• The introduction by either patient or physician of even small changes in their interactive process can lead to large changes in their biopsychosocial outcomes.
• The emergence of empathy in the patient and physician may be viewed as a biopsychosocial relational process indicator and may also serve as a guide toward desired outcomes.