In suggesting that an explicit focus of care ought to be on relationships, we embrace and expand the principles of patient-centeredness within the patient-clinician relationship, and we also consider the relationships of clinician-clinician, clinician-community, and clinician-self as foundational and intrinsic to health care. Below, we provide a general description of these dimensions of RCC. A more detailed description of the relationship-centered clinician's knowledge, attitudes/approach, and behaviors, as well as the anticipated outcomes of RCC, is presented in . In the table, we have highlighted the areas of RCC that we also consider to be part of patient-centered care.
Clinician Knowledge, Attitudes, Behaviors, and Anticipated Outcomes of Relationship-Centered Care*,†
The elements listed in are those that we consider to be integral to RCC. There are many other variables (attitudes, behaviors, personal characteristics, outcomes) that might be correlated with RCC, but are not central to their definition. For example, future research might explore the question of what kinds of life experiences and educational approaches lead to the adoption of an RCC outlook, or under what circumstances RCC-related behaviors have the best impact (race- or gender-concordant dyads, or routine vs emergent care, for example). Whatever those experiences or circumstances are, they are correlates of RCC and not part of the definition. Similarly, the anticipated outcomes of RCC are not included among its defining elements. Whether, and under what circumstances, RCC leads to favorable outcomes is an important empirical question for future investigation, but the achievement of favorable outcomes is not its defining feature.
The elements described in are also intended to be illustrative rather than comprehensive, in that there are many more attitudes and behaviors that could be added. Some omitted variables may be nested under the more general elements listed, meaning that they are not so much left out as simply embedded in the higher-order concepts listed. While each bullet may appear to be a static category, we recognize that thinking, feeling, and action are interactive processes. For example, we value partnership with patients and we show this by reflecting on what matters most to them. One final point is to acknowledge that it is not possible to dictate by definition how much of a given attitude or behavior is optimal in practice. For many of the elements listed below, the optimal amount or intensity would depend on the circumstances, and we assume that the reader will understand that the notions of “to an appropriate degree” and “in an appropriate manner” are implicit throughout, with the determination of what is appropriate being an empirical matter left for later investigation.