Three stages of medical dialogue

Theoretical Medicine and Bioethics 17 (2) (1996)
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Abstract

The negative consequences of physicians' failure to establish and maintain personal relationships with patients are at the heart of the humanistic crisis in medicine. To resolve this crisis, a new model of doctor-patient interaction is proposed, based on the ideas of Martin Buber's philosophy of dialogue. This model shows how the physican may successfully combine the personal (I-Thou) and impersonal (I-It) aspects of medicine in three stages. These Three Stages of Medical Dialogue include:1. An Initial Personal Meeting stage, which initiates the doctor-patient relationship and involves mutual confirmation; 2. An Examination stage, which requires a shift from a personal to an impersonal style of interaction; 3. An Integration Through Dialogue or Healing Through Meeting Stage, which involves the integration of the impersonal medical data into the ongoing dialogue between doctor and patient, as a basis for shared decision-making. The use of the model, as well as common failures of doctor-patient dialogue are discussed.

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