and clinician together agree on goals and the ways to reach them. It also implies that ideally the patient is treated as a whole person whose values and preferences are taken into account.

The committee that developed the 1978 IOM definition viewed the primary care clinician as a manager for a specific episode of care. The current IOM committee broadens that view considerably. It emphasizes the need for the primary care clinician not only to manage a given health concern and address issues of preventive health care, but also to act as an agent for the patient in a larger health system so that the patient knows who is making decisions and coordinating his or her care.

This personal relationship is more important to some people in some circumstances than it is to others. Although in many circumstances patients may feel quite comfortable knowing that information is in their medical record where all those involved in their care can find it, patients often prefer (when they can) to see a particular clinician. Challenges remain about how to structure a team so that personal relationships are supported, and the full IOM report will address these issues.

Use of the term partnership is also intended to convey the idea that both clinicians and patients have responsibilities. Clinicians are accountable as described below; patients are responsible for helping to sustain the relationship, for conveying complete and timely information to the primary care clinician, for aspects of their health that are affected by obtaining preventive care, for lifestyle choices, and for seeking care as appropriate, for following instructions, and observing treatment effects and side effects.

Health Care Needs and Health Care Services

The term personal health care needs includes reference to physical, mental, emotional, and social concerns that involve the functioning of an individual. The term health care services refers to an array of services that are performed by health care professionals or under their direction, for the purpose of promoting, maintaining, or restoring health (Last, 1988). The term refers to all settings of care (e.g., hospitals, nursing homes, clinicians ' offices, community sites, schools, and homes). Health care services address physical, mental and emotional, and social functioning. The last concept pertains to any health conditions that impede an individual 's ability to fulfill his or her social roles, such as ability to attend school, work at gainful employment, or perform as a parent.



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