It seems doctors and patients no longer share a commitment to the same vows. At least that is what a recent European study is suggesting after taking a robust look at whether patients and doctors are congruent in their views about what should happen during the consultation. Studies of the GULiVer-1 type of research are not new. However, the way the researchers assessed the congruence is.

Patients were given a list of dos and don’t’s that ranged from not using their doctor as a substitute for a social life to respecting the doctor’s privacy. Doctors were encouraged to engage patients in their care by posting messages such as “what do you expect from this consultation?” on the surgery wall and not to use the receptionist as triage. None of these strategies appeared in my medical pre-nuptial agreement: the Hippocratic Oath that requires doctors to uphold specific ethical standards. Just as a marriage can’t be dissected through one observation in which the relationship is measured by a series of constructed indicators, neither can the unique relationship between doctors and patients.

What we need to incorporate in doctor patient engagement is an appreciation of the fluctuating biorhythms of cares.

A static assessment is just that, static. And we know relationships are never fixed; the doctor patient relationship evolves over time and changes with the ebb and flow of illness issues and familiarity. These evolutions cannot be covered over with motherhood platitudes because the sophistication and subtlety of the doctor patient relationship operates on more complex levels. What we need to incorporate in doctor patient engagement is an appreciation of the fluctuating biorhythms of cares. When patients shift from having acute and fair weather consultations for immunisations, preventive check ups and the flu to more sustained care for chronic illnesses, such as diabetes and heart disease, a shift occurs – most obviously when a condition can no longer be cured and this opens the way for irreconcilable differences to arise.

Like any relationship the doctor patient relationship can benefit from some couples counselling. We have ample evidence that communication skills are now being taught effectively in medical schools and even some emerging evidence about the potential benefit of shared decision making between doctor and patient through new strategies such as co production of health. However, all these approaches rely on the two parties to sort things out between themselves. We know that this is not always possible and that worst case scenarios are destructive. Blame and retribution are lethal to any relationship; everyone knows that if we don’t learn to resolve our issues our baggage becomes carry on.