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Clearly not everybody sees the importance of relationship to healing. Here are some typical responses from those who don't:

• "Relationship? Show me science!"
• "Relationship in healing? Relationship doesn't improve access, outcomes and lower costs."
• "That might work in the backwoods of Maine but has no place in the big city."
• "We have a budget to meet. We are focusing on reducing our cost-structure while increasing our volumes. We don't have time for relationship in healing."
• "Relationship is not fundable and sexy. Technology is fundable and sexy."
• "Relationship in healing? There is no evidence-base to support the importance of relationship in healing. The system requires evidence-based medicine for true advancement and improvement."

This type of feedback always fascinates me. It also makes me wonder what is meant by "patient-centered" in the context of "patient-centered care." Can care really be patient-centered if the patient is not truly known? Can you know a patient without having a relationship with him or her? A physician can know a diagnosis and can know a standard of care based on a diagnosis, but is knowing a diagnosis the same as knowing a patient?

That sure seems to be the belief in the current healthcare system. I continue to hear in hospitals and health clinics such things as "I will see the diabetic next" and "so you're the ACL." I also see patients cringe at being considered a non-person. Would having a relationship with a patient change these statements to "I will see Mrs. Jones next" and "Nice to see you Mr. Smith. I understand you hurt your knee. Please tell me about it."

Real "patient-centered" care without relationship? I don't believe it is actually possible. "Diagnosis-centered" care without relationship? Absolutely, and unfortunately it happens every day.

My mind began processing a dilemma ... is it possible to reach those healthcare leaders who do not value relationship in the context of the healing process?

By nature, I tend to go back to the basics when I am befuddled, so I turned to the Hippocratic Oath to reassess. Is relationship a component of the Oath and should it be valued in the context of healing by those who have sworn to this very oath?

From the Hippocratic Oath (modern version):

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

Can a physician (or other healthcare provider) have warmth, sympathy AND true understanding of a patient without having developed an authentic relationship with the patient? Can a physician understand "all related problems" without developing relationship, trust, and hearing the patient's whole story?

Of course this raises another question about whether the Hippocratic Oath, which originated in antiquity, is still held sacred by doctors to this day.

According to PBS's NOVA in March 2001, "Some physicians claim what they call the 'Hypocritic Oath' should be radically modified or abandoned altogether."

Abandoned all together?

The American Medical Association reportedly has no version of the Hippocratic Oath that it espouses, and not all medical schools require graduating doctors to take the Hippocratic Oath. In fact, a study conducted by Drs. Robert Orr and Norman Pang found the following:

• Only 43 percent of schools used versions of the original Hippocratic Oath.
• Similarly, only 43 percent of the Oaths taken include the vow for doctors to be accountable for their actions.
• On the bright side, 100 percent of current oaths pledge a commitment to patients.

Based on these data (the AMA not espousing the Hippocratic Oath, some physicians claiming the oath should be abandoned, some medical schools not requiring doctors to take the oath), pointing to the Hippocratic Oath alone is not enough to convince healthcare leaders how important relationship is to healing.

Clearly I need to find a different path.