The term clinician refers to an individual who uses a recognized scientific knowledge base and has the authority to direct the delivery of personal health services to patients. A clinician has direct contact with patients and might or might not be a physician. The committee's recommendations about who should provide primary care will be addressed in the full IOM report. Additionally, primary care clinicians might turn to other individuals both with and without health care training for their assistance and skill in particular areas. Examples of individuals other than primary care clinicians who can contribute to primary care might be physical therapists, nutritionists, and social workers. In Hispanic communities, primary care clinicians might turn to layworkers known as a promotoras for outreach and community education.
This committee has chosen to use the term clinician in contrast to other familiar terms such as provider. Provider is commonly used not only to refer to individuals who deliver care but also to denote facilities or organizations that provide health care, such as hospitals or health plans. In medical centers, a clinician refers to someone with direct patient care responsibilities; in using the term clinician, then, this report underscores the importance of a relationship between a patient and an individual who uses judgment, science, and legal authority to evaluate and diagnose patient problems and to manage them.
The term sustained partnership refers to the relationship established between the patient and clinician with the mutual expectation of continuation over time. It is predicated on the development of mutual trust, respect, and responsibility. As an ideal, primary care occurs within the context of a personal relationship between a patient and clinician that extends beyond an episode of illness. Such a relationship, developed over time, fosters a sense of trust and confidence. The partnership relation facilitates tailoring a specific intervention or specific advice to the needs and the circumstances of a particular person. A bond to someone you trust may be healing in and of itself. This relationship is essential when guiding patients through the health system.
Although it denotes participation by both clinician and patient, the term partnership does not necessarily imply equal roles for clinicians and patients. In some cases patients desire and should have a large role in identifying health problems to be addressed or deciding how they should be addressed. In other cases a patient may prefer a relatively small role and delegates most decisionmaking to a clinician. A dependent relationship may be reassuring and even healing in some circumstances. The term partnership means that the patient