SUMMARY

The clinical relationship is made up of two ever-present compounds, the human one and the technical one. These compounds entwine in a more or less relevant way, but whatever the analysis ignoring one of these two poles should be considered as reductionist.

When it comes to the human aspect, both the patient and the physician try to lace a helping relationship. A doctor during his/her learning period must ponder his/her empathy and cordiality and build up some assertive habits to be supported by safe working manners. The doctor with a professional experience background must care for the patience, without which no empathy is given, and also to review the way he/she faces human suffering, periodically. Working in high-pressure clinical settings makes these features become unusually important. In such environments, an ingenuous observer would think of a paternalistic management of the relationship, although it actually exists a patient centered attitude. One of the dangers related with the lack of time spent in the doctor’s office is to get working habits that may damage the patient’s biopsychosocial integration, and lead the professional to the burn out. A good time management is also meant to be a good effort management, and both features are related to the emotional competence. The natural, basic and advanced emotional kinds are distinguished. The doctor with an advanced emotional kind will be, among other things, attentive to refocus non-proper answers derived from his/her mood, will cultivate the patience as a superior expression of the effort, and will show him/herself proactive to the patients he/she dislikes or by whom he/she is disliked, trying to keep a “positive emotional flow”.

Meanwhile, the patient tries to find a place within the doctor’s care and attention, and would like to know “who is who” in the team of professionals that are carying for him/her. He/she also wishes to get “accurate” diagnostics and treatment, and to be provided with information and sureness.

Regarding the technical aspect, the emotional-rational model of clinical action is described. This model priorizes the psychological tension that the doctor experiences while establishing the diagnosis. To avoid this psychological tension can lead the doctor to hastily accept mistaken diagnosis (“first hypothesis”). The restrictive factors of his/her emotional and cognitive capabilities have an influence on this. These restrictive factors -internal and external- reduce his/her tolerance to uncertainty, and boost conducts destined to conclude the interview.

Finally, the role of the team regarding the creation of group values that markedly influence the clinical relationship is analyzed. The group consensus establishes definitions of who must be considered a “good patient”. Perhaps, an Internal Medicine Department might call him/her an “interesting patient”, and a Surgery Department “a good sufferer”. The truth is that the resident doctor must show that he/she assimilates and accepts this group’s values and conducts, its definition of “good patient”, and the “assertive way of behaving”, if he/she wants to be taken into account, which implies a frame that is not always positive for his/her future development.

In the meantime, these team consensuses are influenced by institutional policies. Our institutions are symbolic systems that operate in succession, up-down, and very few times in an ascendant sense. This same succession effect leads the physician to treat the patient in a way that resembles the one used by the enterprise to treat him/her, an assertion that will be sharpened in this article.

The clinical relationship is not only regarded from the scientific thought perspective, but also from many anxieties, wonderings and prophecies that belong to the magical thought. The answer to these hesitations can only be given, in the same way, by suppositions, hypotheses and fantasies born from the magical thought. That is what embraces both our patients and the dialogue between Medicine and Society. Therefore, an ethical responsibility is brought about, that is, to remind the society and our patients of the limits of science and our human condition.