Expanding the patient-centered clinical method: doctor-patient relationship and attachment theory

• Main Author: Pessoa, Ingrid Gonçalves
• Publication Date: 2022
• Other Authors: Guimarães, Samuel Carvalho, Guimarães , Emanoella Pessoa Angelim, Carleial, Germana Maria de Alcântara
• Format: Article
• Language: por; eng
• Source: Revista Brasileira de Medicina de Família e Comunidade (Online)
• Download full: https://rbmfc.org.br/rbmfc/article/view/3071
• topic: Physician-patient relation; Patient-centered care; Primary health care.; Relação Médico-Paciente; Cuidado centrado no paciente; Atenção primária.; Relaciones médico-paciente; Atención dirigida al paciente; Atención primaria de salud.

Introduction: The Attachment Theory can be useful to complement the Patient-Centered Clinical Method, especially in its fourth component, "enhancing the patient-doctor relationship. Objective: To perform an integrative review of studies that associate the Attachment Theory with the doctor-patient relationship and extract its applicability in the routine of family physicians. Methods: Integrative review in the United States National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO) databases using the terms "doctor-patient relationship" and "attachment theory". Results: In February 2021, we retrieved 184 articles in PubMed and one in SciELO, reducing them to 11 articles. Their settings involved oncology/palliative care or general primary care, considering the vulnerabilities of each context and how they can activate the attachment system. The impact of Attachment Theory principles on several aspects of the doctor-patient relationship and even on clinical outcomes was evident. Correlating attachment styles with Emanuel and Emanuel's (1992) doctor-patient relationship models can help us understand which model is best for each style. People with "secure" attachment benefit from deliberative relationships; those with "anxious-preoccupied" attachment need the physician to be more active to compensate for their low self-confidence, as in the paternalistic model; in the "dismissing" attachment, the patient needs to feel independent, and the informative model contributes to strengthening the relationship; and individuals who have "anxious-fearful" attachment tend to share negative feelings with the physician, who needs to understand this and reaffirm the bond despite the person's counterproductive attitudes, and the interpretive model has a way of dealing with the situation. Conclusion: The Attachment Theory can potentially address many anxieties that plague the daily practice of the family physician and that the Patient-Centered Clinical Method cannot solve alone. We can infer that the Attachment Theory complements the method, providing tools to continue applying it with its four components.