Hospitality and the Patient-Clinician Relationship: Comparing Models and Terminology
Michael Balboni, PhD, Instructor, Harvard Medical School
Since terminology shapes what we see and how we act, what terms should we use in relationship to the patient-clinician relationship? Beneath our language are metaphorical concepts based on a dominant social force that controls the practice of medicine. The social force of science produces an object-observer relationship where patients are “cases” and clinicians are “scientists/specialists.” Economic forces shape a buyer-seller relational model in which patients are “customers" and medical personnel are "providers.” A bureaucratic social force produces a user-manager relationship so that patients are “users” and doctors/nurses are “professionals.” Finally, medical care driven by the tradition of hospitality conceives of a guest-host relationship, producing the language of “patient” and “clinician.” This final model grounded in hospitality is both the most longstanding view and it remains the most fitting when caring for the sick within contemporary medicine.
The concept of hospitality uniquely fits and describes the patient-clinician relationship since both parties in this interaction are strangers, meeting in circumstances with vastly distinct levels of power, and called upon to be guided by an implicit covenant of care and compassion, despite human limits. The social expectations that guide hospitality in general are the same expectations that provide deep guidance to medicine. Unlike other descriptive models proposed for the patient-clinician relationship, which tend to be theoretical or fail to adequately account for basic human concerns in the contemporary patient-clinician relationship, hospitality is universally understandable as a cross-culturally experienced human expression toward strangers in need. Although it is a practice under siege because of American individualism and the tendency to isolate ourselves from those we do not know, hospitality remains a model that is understandable across time and culture. Hospitality remains the best model for today’s medicine.
Since terminology shapes what we see and how we act, what terms should we use in relationship to the patient-clinician relationship? Beneath our language are metaphorical concepts based on a dominant social force that controls the practice of medicine. The social force of science produces an object-observer relationship where patients are “cases” and clinicians are “scientists/specialists.” Economic forces shape a buyer-seller relational model in which patients are “customers" and medical personnel are "providers.” A bureaucratic social force produces a user-manager relationship so that patients are “users” and doctors/nurses are “professionals.” Finally, medical care driven by the tradition of hospitality conceives of a guest-host relationship, producing the language of “patient” and “clinician.” This final model grounded in hospitality is both the most longstanding view and it remains the most fitting when caring for the sick within contemporary medicine.
The concept of hospitality uniquely fits and describes the patient-clinician relationship since both parties in this interaction are strangers, meeting in circumstances with vastly distinct levels of power, and called upon to be guided by an implicit covenant of care and compassion, despite human limits. The social expectations that guide hospitality in general are the same expectations that provide deep guidance to medicine. Unlike other descriptive models proposed for the patient-clinician relationship, which tend to be theoretical or fail to adequately account for basic human concerns in the contemporary patient-clinician relationship, hospitality is universally understandable as a cross-culturally experienced human expression toward strangers in need. Although it is a practice under siege because of American individualism and the tendency to isolate ourselves from those we do not know, hospitality remains a model that is understandable across time and culture. Hospitality remains the best model for today’s medicine.