![]() ![]() Specifically, we underscore the importance of framing health care reform as an opening for a fundamental reworking of medical relationships that transcend the traditional scope of medicine, beginning with the ability of various non-medical components of communities to bring about change on the local level. In this paper, however, we use the word “practitioner” in a way that captures our argument about new medical relationships, beyond the traditional sense in which the word has been used as synonymous with “clinician.” This expanded view of who constitutes a medical “practitioner” is central to a new way of thinking about medical relationships themselves.Īccordingly, we argue that a theoretical shift is necessary. ![]() Many scholars have noted the increased importance of those actors that we broadly define as practitioners ( Browne et al., 2015, Cosgrove et al., 2014, Rosenthal et al., 2010). Beyond the clinical actors who are central to the establishment of new forms of interprofessional and team-based medical care lay a fundamentally different cast of key characters, from social workers and navigators to community health workers, and hospital-school liaisons to name a few. Yet, even this expanded scholarly focus barely captures changes afoot in medical relationships in an era increasingly focused on populations and the social determinants of health, particularly in the wake of the ACA ( Starr, 2013, Stoto, 2013). ![]() From the perspective of medical relationships, this expanded approach to medicine has required a range of strategic considerations not only to develop optimal ways for collaboration, but to overcome competitive and territorial professional dispositions ( Baker et al., 2011, Gittell et al., 2013). More recently, this scholarly focus on the relationship between practitioners and patients has expanded to include the emerging actors of an increasingly interprofessional medical workforce, such as nurse practitioners, physician assistants, behavioral health specialists, and scribes. These critiques have arisen in response to what is widely assumed to be the besieged nature of this particular relationship ( Senger, 2013, Fallowfield et al., 2014, Singer, 2014). As the most recent wave of health care reform has taken its course, marked most importantly by the passage of the Affordable Care Act (ACA) in 2010, these discussions have often centered on the fate of the traditional doctor–patient relationship. Approaching health care reform, and the focus on population health, as a fundamental reworking of relationships provides scholars with a sharper theoretical lens for understanding 21st century American health care.Īs a response to ongoing initiatives to improve American health outcomes, reduce costs, and address health disparities, many scholars have analyzed the relationships that develop in medicine – particularly between practitioners and patients. These community-based partnerships are critical to providing health care that is both relevant and appropriate for addressing problems, and sustainable. To address the upstream determinants of population health, providers must be increasingly willing and trained to collaborate with community stakeholders to address both medical and non-medical issues. Medical relationships in this era of health care are likely to include partnerships between various types of clinicians and the communities in which patients reside, as well as a host of new actors, from social workers and navigators to scribes and community health workers. For example, the move to population medicine requires that the very concept of a patient be resituated and the scope of relevant relationships expanded. This, we argue, requires a fundamental rethinking of health care reform as an opportunity to renegotiate relationships. Recent developments however have shifted the focus from individual-level outcomes to the wellbeing of populations. But what is the state of core medical relationships in the wake of these changes? Throughout ACA-era health care reform, the doctor–patient relationship was targeted as a particularly important focus for improving communication and health outcomes. American health care has undergone significant organizational change in recent decades.
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