| Life-threatening illness presents special issues in the relationship between physicians and patients. Because so much is at stake, both medical and emotional issues are often complex and highly charged. However, we know very little about this relationship, particularly from the patient's point of view. This study explored how adults with metastatic cancer, amyotrophic lateral sclerosis, or HIV describe their relationships with their physicians, and what is important to them about those relationships. Twenty-two participants who were outpatients at a major academic medical center were interviewed.;First, this study found that participants' goals for treatment, which ranged from hope for cure to relief of symptoms, had significant effects on their relationships with their physicians. Second, participants' descriptions of these relationships could be grouped into three domains: technical, technical-interpersonal, and personal. Differences in goals for treatment had ramifications for which elements of the domains that participants emphasized. For participants with cancer or ALS who hoped for a cure, the theme of prognostication was particularly salient, and complex, and involved the related issues of information control, honesty, and the maintenance of hope. Participants with HIV who were receiving HAART emphasized their physician's knowledge, experience, and effort in prescribing treatment. Participants with HIV who were not on HAART, who had low SES and a history of illegal drug use, were less informed about their care, and were less involved in it.;Third, participants' most important concern was that their physician act in their best interest, which involved primarily participants' perceptions of the effort made by their physicians in applying their technical expertise for their benefit. Fourth, participants attached significant emotional meaning to physician behaviors, particularly the interpersonal aspects of the relationship connected to providing medical care. Finally, in almost all cases, participants' conceptions of trust reflected what emerged from their interviews as important to them in their relationships with their physicians.;That participants attached strong emotions to their relationships with their physicians, creates a special duty for physicians to recognize these emotions, and to understand how their behavior contributes to them. Training of physicians from medical school on should address this issue. |
