Doctor-patient relationships form the cornerstone of preventative healthcare, acting as the site where the social determinants of patient backgrounds intersect with the constructed systems of insurance, pharmaceuticals, and commercialized biomedicine that make up the modern healthcare industry. At this crucial juncture, a patient’s health depends as much on the social interactions within this relationship as on the biomedical science involved. As a result, this essay attempts to compile rigorous research and critical oral accounts of doctor-patient relationships (DPRs) to provide insight into the importance of a healthy DPR, the components of building one, and the challenges of maintaining an effective relationship within a vortex of socially determined factors.
Trust, Talk, and Treatment: Why Doctor-Patient Relationships Matter
Trust, while elusive and difficult to measure, plays a foundational role in shaping any relationship. This is especially true for those relationships between doctors and their patients, where trust has been found to be strongly and positively associated with improved patient health outcomes.[1]
Maria Torres, a Certified Nursing Assistant Interpreter at CommWell Health clinic in Dunn County, NC, provides a firsthand account on the impact of trusting DPRs on patient confidence in preventative health. Especially for her rural community where folks are reluctant and apathetic about healthcare in general, Torres notes that feeling dismissed or ignored by your provider can discourage a patient from returning to the doctor. Consequently, she emphasizes the necessity of having a doctor who “listens to you and who believes you when you say, ‘My stomach hurts and this isn’t normal for me.’”[2] Here, Torres highlights the importance of doctors respecting the embodied knowledge of their patients—the intimate understanding of one’s own symptoms against a record of personal experience—suggesting that this respect forms the foundation for a positive DPR that can encourage even reluctant patients to invest in their health through preventative care. The science supports Torres’s observations: valuing patients’ experiential knowledge has been found to build trust within DPRs both ways, improving health outcomes as doctors personalize treatment plans and patients become more likely to adhere to those plans.[3] Additionally, research published by the American Physiological Society finds that open conversations about a patient’s socioeconomic status, lifestyle practices, and values enhance doctors’ understanding and improves treatment personalization.[4] As a result, it’s no surprise that doctor-patient relationships characterized by consistency and honesty have been explicitly linked with improved patient health.[5]
Much of this positive impact comes from the effect a healthy DPR has on a patient’s use of preventative care. Hostetter et al. observe that more primary care visits correlate with an increased use of preventative health measures, while Taksler et al. add that the personalized care provided by a healthy DPR increases patient interest in and adherence to preventative care mechanisms.[6] Rural North Carolinian William Sessions speaks to this positive feedback loop of preventative care in his interview with Joanna Ramirez, sharing how his relationship to health and healthcare improved once he was able to establish a stable, one-on-one relationship with his provider.[7] Despite William’s anti-healthcare upbringing, the positive DPRs he proactively established throughout his adolescence and early adulthood strengthened his belief in the value of preventative care. As a result, when he had his son, William made sure to get him “all his shots” and “a doctor, a dentist… on a regular basis,” a decision that enabled his son’s eye issues to be caught and treated early. The preventative care and improved health outcomes that William’s son received were only possible because of the stable and positive relationships that William had established with his doctors and the subsequent trust and value he placed in the healthcare system because of them.
The Doctor, the Patient, and the System: Building Healthy Medical Relationships
Given the socially dependent nature of doctor-patient interactions, measuring and controlling for all factors involved in building this relationship can be a daunting task. However, extensive research continues to be conducted on the multitude of crucial behaviors from both patients and providers that contribute to an effective DPR.
Lerch et al. finds that physicians who display competence, communication, care, professionalism, and interest in the patient and their health education tend to maintain more trusting relationships with said patients.[8] Similarly, Smith et al. report that the effectiveness of modern DPRs depends on the physician’s compliance with a certain standard of empathy, communication, consent, and boundaries.[9] They argue that it is especially important for providers to take responsibility for encouraging open communication and true patient consent because of the imbalance of power and knowledge between physicians and patients.[10] Specifically, Kowalski et al. note the anxiety caused by many doctor’s appointments, the inaccessible medical jargon and limited time patients are given to fully understand their treatment options, and the pressure that many patients may feel to agree with a doctor’s recommendations despite their own instincts, reasoning that without providers actively bridging this divide, DPRs will fail to be sites of true equal communication and partnership.[11] Jane “Sabra” Hammond, a physician working at CommWell health clinic, agrees. Because of her personal experience bridging language, cultural, and knowledge gaps between herself and her patients, she firmly believes that it is up to the provider to ensure that patients feel heard and their preferences are respected.[12]
Nevertheless, patient behavior also plays a role in developing a healthy DPR. Street et al. find that patients who ask questions and actively communicate their preferences and concerns tend to form better DPRs, because physicians generally become more empathetic and communicative with patients that they perceive as “good communicators” who will “fully adhere to their recommendations.”[13] This becomes problematic, however, because socially dependent identity and environmental factors including psychology, health literacy, and social environments can significantly impact a patient’s ability to communicate effectively with their doctor or may cause patients to have value systems or life circumstances that prevent compliance with their doctor’s recommendations.[14] Additionally, so-called “external contributors” to DPRs can include everything from how payments are made to the amount of time spent together, meaning that systemic socioeconomic, racial, and institutional barriers also influence the success of any DPR, shaping the preventative care those patients do or do not receive.[15]
Challenges in Care: Barriers, Biases, and Bridging the Doctor-Patient Gap
Just as trusting doctor-patient relationships improve health, poor DPRs have been found to worsen patient health, and there are countless social factors that can impede the development of a healthy DPR.[16] A comprehensive health literature review conducted by Elayyan et al. finds that pressure on physicians at work, daily moods and emotions, and especially cultural and occupational differences between the patient and doctor all can influence the formation of a doctor-patient relationship.[17]
However, bridging those differences can prove challenging. The aforementioned Jane Hammond finds that cultural differences in education and healthcare expectations between her and the rural patients she serves often makes it difficult to communicate about critical healthcare subjects.[18] However, even though she intentionally modifies her language and behaviors to match each patient’s level of understanding and cultural background, the institutional structure of the healthcare system means that she often doesn’t get to see the same patients at regular intervals. Without time allotted for consistent and personal relationships, Jane struggles to measure her success in building trust with patients and feels unable to provide them with the healthcare they deserve.
Evidently, despite the critical role doctor-patient relationships play in preventative care and patient well-being, numerous identity-based and institutional barriers continue to hinder the consistent and equitable developments of healthy DPRs. As a result, the related essays from my peers examine how socioeconomic, linguistic, and racial/cultural determinants alongside the modern commercialization of the healthcare industry shape and influence DPRs and the preventative healthcare they provide. Analyzed together, our research uncovers how patient health is affected by far more than just medical science, and it furthermore identifies strategies for dismantling these social barriers to foster a more equitable and just healthcare system for all.
[1] Birkhauer, Johannes, et al. “Trust in the Health Care Professional and Health Outcome: A Meta-Analysis.” PLoS ONE, vol. 12, no. 2, 2017, e0170988.
[2] Torres, Maria. Interview with Joanna Ramirez. 28 Month Year (Y-0056). Southern Oral History Program Collection (#2007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill, 34–36.
[3] Duffy, F. Daniel, et al. “Assessing Competence in Communication and Interpersonal Skills: The Kalamazoo II Report.” Academic Medicine, vol. 79, no. 6, June 2004, 495–507, doi:10.1097/00001888-200406000-00002.
[4] Benedetti, Fabrizio. “Placebo and the New Physiology of the Doctor-Patient Relationship.” Physiological Reviews, vol. 93, no. 3, American Physiological Society, 1 July 2013, 1207–1246, https://doi.org/10.1152/physrev.00043.2012..
[5] Olaisen, R. H., et al. “Assessing the Longitudinal Impact of Physician-Patient Relationship on Functional Health.” Annals of Family Medicine, vol. 18, no. 5, 2020, 422–429, https://doi.org/10.1370/afm.2554..
[6] Hostetter, J., et al. “Primary Care Visits Increase Utilization of Evidence-Based Preventative Health Measures.” BMC Family Practice, vol. 21, no. 151, 2020, https://doi.org/10.1186/s12875-020-01216-8; Taksler, G. B., et al. “Effect of Individualized Preventive Care Recommendations vs Usual Care on Patient Interest and Use of Recommendations: A Pilot Randomized Clinical Trial.” JAMA Network Open, vol. 4, no. 11, 2021, e2131455, doi:10.1001/jamanetworkopen.2021.31455.
[7] Sessions, William. Interview with Joanna Ramirez. 27 June 2018 (Y-0049). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill, 32:40.4–33:45.4.
[8] Lerch, Seraina Petra, et al. “A Model of Contributors to a Trusting Patient-Physician Relationship: A Critical Review Using a Systematic Search Strategy.” BMC Primary Care, vol. 25, no. 194, 2024, https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-024-02435-z
[9] Smith, Yolanda. “Doctor-Patient Relationship.” News Medical. 30 April 2025 https://www.news-medical.net/health/DoctorPatient-Relationship.aspx
[10] Konda, Meghana, et al. “The Doctor-Patient Relationship: A Bibliometric Analysis.” Health Psychology Research, vol. 11, 90429, 9 Dec. 2023, doi:10.52965/001c.90429.
[11] Kowalski, Charles J., et al. “The Doctor-Patient Relationship, Partnership Theory, and the Patient as Partner: Finding a Balance Between Domination and Partnership.” Health Care Analysis, vol. 32, 2024, 205–223, https://doi.org/10.1007/s10728-023-00473-9..
[12] Hammond, Jane “Sabra.” Interview with Maddy Kameny. 27 June 2018 (Y-0028). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill, 10, 23.
[13] Street, Richard L., et al. “Physicians’ Communication and Perceptions of Patients: Is It How They Look, How They Talk, or Is It Just the Doctor?” Social Science & Medicine, vol. 65, no. 3, 2007, 586, https://doi.org/10.1016/j.socscimed.2007.03.036..
[14] Lerch et al. 3, 8.
[15] Lerch et al. 1.
[16] Olaisen et al. 422.
[17] Elayyan, Muntaha, Janet Rankin, and M. W. Chaarani. “Factors Affecting Empathetic Patient Care Behaviour among Medical Doctors and Nurses: An Integrative Literature Review.” Eastern Mediterranean Health Journal, vol. 24, no. 3, 2018, 311–318
[18] Hammond, Jane “Sabra.” 8–9.