The harmful consequences of elevating the doctor-patient relationship to be a primary goal of the general practice consultation

Received 6 May 2003; Revised 22 September 2003; Accepted 7 January 2004. School of Primary Care, University of Manchester, Rusholme Health Centre, Walmer Street, Manchester M14 5NP, aCentre for Health Services Research, University of Newcastle upon Tyne and bNational Primary Care Research and Development Centre, The University of Manchester, Williamson Building, Manchester, UK; E-mail: cchew@man.ac.uk and apprehending underlying pathologies, as well as securing adherence to treatment regimens.7–9 More recently, the need for GPs to reflect on their work has been recognized: Fairhurst10 describes the cognitive and affective evaluations made by doctors about their patients, and how recognition of these both positive and negative evaluations is vital for GPs in reflecting upon the consultation. The work of the GP has steadily shifted towards the management of chronic illness and incapacity in the community.11 In this editorial, we suggest that the historic emphasis on the development of ongoing relationships with patients presenting complex health problems in which psychological and social factors are implicated is confounded by doctors themselves feeling increasingly ill equipped to deal with them. Moreover, we argue that in the current context of general practice, GPs may feel increasingly powerless to resolve such problems and that they view themselves as colluding with patterns of illness behaviour that maintain, rather than resolve, chronic incapacity.