The Relationship-Centered Care

Introduction

Relationship-centered care (RCC) is a clinical philosophy that emphasizes partnership, careful attention to the relational process, shared decision-making, and self-awareness (Suchman, 2006). The RCC is characterized as patient-centered medicine. This philosophy defines clinician’s and patient’s areas of responsibility, their common ground, as well as exploring both the disease and illness experience (Beach & Inui, 2006).

Clinician-patient relationships, communication with patient’s communities, and interconnection between practitioners are main objectives of the RCC. This approach is aimed at helping communities to face up to manufacture and environmental changes, which appear continuously and define their functioning. The RCC approach develops the value of individual. It means concentration of attention not around a particular organ, but rather a complex person’s examination. Each person should be involved into the process of circled medical attention. Community is a target receiver of health promotion choices and information from practitioners. Individual well-being is provided through communities. The relationship with clinicians is aimed at creating a plenty of caring and healing options. Responsibility of moral, ethical, and spiritual development of an individual is also included into relationships with practitioners (Tresolini, 1994).

The RCC may be defined as a system of values for the work of health professionals. Its foundation was declared in the Pew-Fetzer Task Force’s final report, which defined the RCC as a framework for the health care process. Subsequently, population-based knowledge and skills are included into medical school education by the Association of American Medical Colleges. These subjects are considered to be valuable as the patient’s level of satisfaction and preferences should have a particular influence on the health care service provision. Furthermore, patients’ reports have to be the measure of evaluation for clinicians, groups, and the delivery system (Beach & Inui).

Clinicians practicing the RCC approach should follow four issues. They are: self-awareness and continuing self-growth, patient’s experience of health and illness, development and maintenance of relationships with patients, and clear and effective communication (Tresolini, 1994). The RCC approach is based on four principles, including dimensions of personhood, affect and emotions as basic components, reciprocal influence, and moral foundation. The RCC is structured by clinician-patient, clinician-community, and clinician-clinician relationships. The main benefit of the RCC is the use of the human-oriented approach. The main problem of the RCC philosophy is practitioner’s perception of the equal role of a patient.

The Relationship-Centered Care Constitution

Options relating to health care relationships include information exchange, resources allocation, diagnoses, choice of treatment, and assessment of outcomes. Therefore, patients, clinicians, teams, organizations, and the community are target stakeholders in terms of quality of the relationships.

The first principle of the RCC includes dimensions of personhood as well as roles. The RCC approach considers both the patient and the clinician as equal parts of the health care process. They are treated as individuals and only after that they are distinguished by their roles. It means that either physician’s or patient’s experiences, values, and perspectives matter in the organization of the health care process. This principle presents doctor as a person who should monitor his or her behavior in light of patient-clinician equality awareness. Authenticity is also important in the RCC. It means that physicians should not only demonstrate respect to their patients, but sincerely feel it internally with respect to each particular client (Beach & Inui, 2006).

The second principle marks affect and emotion as important components of the RCC. This issue means that a clinician is expected to react emotionally. It is supposed that a neutral attitude towards a patient as a client does not promote necessary medical care processes and outcomes. Meanwhile, a clinician who develops and maintains affect and emotions shows his or her support (Beach & Inui, 2006).

The third principle postulates that all health care relationships occur in the context of reciprocal influence. Interactional exchange is considered to be the smallest unit of measurement in the RCC. Even though a physician has more opportunities to know the patient, the RCC approach encourages clinicians to be result-oriented. Relationships between physicians and patients should not be similar to friendship between elder and younger brothers. Clinicians should not lead this communication. Conversely, it is encouraged to develop patient’s impact on the clinician. At the same time, this impact should not limit physician’s activity or mark patient’s goals as an undeniable priority (Beach & Inui, 2006).

Moral basis of the RCC formulates its fourth principle. Moral foundation is an important component of the RCC model as it differs from the market one and is considered to be more valuable. A well-known fact is that humans are more open to people they are familiar with. The position of being acquainted with the patient’s lifestyle helps more in the clinician’s practice than performing some other role during communication. Being morally honest is a desirable feature for the RCC approach (Beach & Inui, 2006).

General Description of Connections within the RCC Structure

The RCC’s explicit focus is placed not only on patient-clinician connection, but also on clinician-clinician, clinician-community, and clinician-self relations as a source of health care (Beach & Inui, 2006).

The Clinician-Patient Relationship

The central concept of the clinician-patient relationship is treating each patient as unique and individual. Medical care should be given according to patients’ psychosocial, emotional, and lifestyle features and distinctions in values, preferences, and expectations have to be considered. The main value of clinician-patient connection is demonstration of respect to patients through finding out about their values, background, and discussing their expectations. Unconditional positive attention should be paid to patients. In the process of communication with physicians, patients should feel confident that they are treated by an expert. Affective engagement, acknowledgment of provider’s biases, and orientation at avoidance of disagreements will create a strong and trustful bond between patients and practitioners. It will develop provider-patient relationship as a therapeutic vehicle. It is necessary to highlight the fact that both clinicians and patients are humans. Hence, unsuspected behavioral influence expressed through feelings or personal attitudes should be expected. The expected outcome of such approach can be defined as the patients’ confidence. In such a way, patients will be honored and respected. It means that patients will be satisfied with health care services provider and, as a result, they will follow prescribed treatment, remember advices, and take into account obtained information. Meanwhile, clinician’s benefits are represented by occupying a position of a social and emotional supporter. Thus, patients and physicians make informed decisions as if they are attuned mutually in a harmonious way. Patients also become a source of professional reward for clinicians (Beach & Inui, 2006).

The Clinician-Clinician Relationship

Clinicians’ relationship chain is built on the value of power of understanding alternative perspectives as power inequity is often present in health disciplines. Respective issues include healing approaches of different health disciplines and sharing leadership through dynamic implementation of the team-building approach. In this connection, the most important purpose is to compose clinicians’ self-awareness with teamwork. It is necessary to learn continually from personal experience, be cooperative, and think about personal and professional needs. These issues are important for physicians’ identification as individuals who can be trusted. In order to reach appropriate results in the process of clinician-clinician effective communication, active listening to team members, collaboration, as well as recognition and solution of conflicts have to be present. In addition, continuous examination whether team values are still topical and shared by everyone is required. Finally, the whole team should be oriented towards avoidance, recognition, and reconciliation of errors (Beach & Inui, 2006).

The Clinician-Community Relationship

The clinician-community relationship is based on principles of the community model construction. First of all, it is important to be aware of such community’s perceptions of healthcare as myths and misconceptions. In order to avoid misunderstandings with the local community, demographic, economic, and political factors, as well as history of land use, migration, and occupation have to be explored. Consequently, social, political, economic, occupational, physical, educational elements and impact of public safety on the community’s health have to be covered. To develop a proper practitioner-community model, original history of this relationship should be learned through a public dialogue. The next step of the clinician-community chain installation is separation of the target community from the external one and implementation of a relevant health policy. Hence, various health determinants and medical limits should be explored when developing a proper approach to a particular community. In order to achieve target goals, active promotion of health strategies in the community is necessary. It includes active dialogue, activities that construct the provider-community model, as well as development of a health-enhancing community policy, strategies, teams, and organizations. Realization of all steps of the clinician-community chain organization will lead to collaboration between formal and informal health care systems within the local community, magnification of organizational policies of the community health promotion, and personnel participation in civil services (Beach & Inui, 2006).

The Role of Independent Duty Corpsman in Relationship-Centered Care

Clinicians who practice the RCC approach should develop self-awareness, self-knowledge, and self-care. First of all, being self-aware means for practitioners to take care of the relevance of service quality they are providing. Self-knowledge is realized in practice as avoidance of uncanny situations. Personal communication is one of the steps that may cause problems during treatment and a clinician is responsible for his or her own emotional responses to patient’s needs. Physician’s aim is to provide effective health care through comfortable communication. Since an Independent Duty Corpsman is frequently the only health care option in fleet departments, it is important to build a trustful communicative model with the US Navy officers. Self-awareness is a basis for setting the platform for understanding military’s health and illness background. The specificity of the I.D.C.’s work consists in focus on the military marine community. In such conditions, it is especially important for clinicians to be trusted. An I.D.C. has to be aware of patient’s individuality, life, and illness history, thus being able to solve the puzzle of the patient’s life and determine the family’s role. Inasmuch as an I.D.C. works with the U.S. Navy and U.S. Marine Corps, he/she is accustomed to the military culture. It means availability of information about common family structure and values. The main role of an I.D.C. is recognition of marine fleet militaries’ health and well-being conditions, including emotional, physical, social, and spiritual. The I.D.C.’s work conditions are determined by continuous stay on a submarine. Therefore, it is especially important for clinicians to show that they stand on positions of patients’ dignity. Caring and respectful conditions of the practitioner-patient relationship are the first priority in the RCC. An I.D.C. has to share values of human dignity, right to self-determination, and respect shown to the person’s power and self-healing processes, ethics, and appreciation of the patient as a unique person (Tresolini, 1994).

Benefits and Problems of the Relationship-Centered Care

The RCC is more an ideology than a theory. It offers a set of values and methods to follow (Suchman, 2006). Whereas the RCC concept is based on promotion of human interaction, the main benefits of using this approach are observed on the individual level. Moreover, the term “individual level” is included into a wider one that is community interests. The RCC values take into account the balance of the clinician-patient relationship.

Counting benefits of the RCC approach, defining linear causality and communication as information transfer, and distinguishing stable determinants of patient-practitioner communication may be deemed valid. However, a weak side of the RCC is generalization of common observations into a traditional framework. Meanwhile, such perspective of the process leads to appearance of certain patterns, while the capacity of individuals working in a partnership to produce results, value of the collaborative process and, and importance of self-awareness and personal authenticity are not accounted for. The central place in the RCC approach is occupied by an explanation that relationships are essential for good care. This is followed by the problem of lack of explanation of the relationship’s nature (Suchman, 2006).

When implementing   the RCC approach, the main challenge a practitioner is facing is internal following of moral and ethical principles. As known, the RCC is based on trust and treatment of each particular patient as an individual and an equal partner in the health care process. Therefore, it is especially important and difficult to evoke a sincere feeling of treating a patient as a partner (Tresolini, 1994).

Conclusion

To conclude, the RCC philosophy regulates relationships between clinicians and their patients, as well as communities that patient belongs to and inner-clinicians relationships. The specificity of the RCC approach consists in treating each patient both as individual and within the cultural framework of the community that this person belongs to.  Functions of physicians and physician-community connections are spread an promotion of well-being and health care options among the target population. Additionally, clinician-clinician connection realizes the option of moral, ethical, and spiritual support of patients.

The RCC approach is based on four fundamental principles. Firstly, relationships in a health care setting consist of both dimensions of personhood and roles. Secondly, affect and emotions greatly influence relationships in the health care setting. Thirdly, all health care relationships are subject to the reciprocal influence. Fourthly, the RCC has a moral basis.

The RCC structure is divided into three relationship chains: clinician-patient, clinician-community, and clinician-clinician connections. In the clinician-patient relationships, physician’s duties include awareness of health, illness, cultural, family, individual, and biomedical information about a patient. The practitioner has to know patient’s values and preferences. The community-clinician relationship is expected to be developed in such a way as to avoid possible misconceptions and misunderstandings caused by local community’s features. It is founded on principles of the community model. Therefore, demographic, economic, and political factors, as well as history of the land use, migration, and occupation factors have to be explored by clinicians. Relationships between clinicians are determined by the value of the power of understanding alternative perspectives. It means promotion of the team-building approach in order to be trusted by patients.

Hence, the I.D.C.’s role in the RCC implementation consists in acquiring military patients’ trust. Since an I.D.C. is the only option of medical service provision in the U.S. Navy and U.S. Marine Corps, it is important for clinicians to comply with the RCC’s requirements. It means that an I.D.C. has to share values of human dignity, right to self-determination, and respect to the person’s own power and self-healing processes, ethics, as well as appreciation of the patient as a whole person.

The strong side of the RCC consists in the fact that it is a human-oriented philosophy. Each individual is treated as an equal participant of the health care process. The weak side of this approach is the possibility to miss the nature of relationships in the process of generalizing common observations.

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