ABSTRACT
The primary care visit is becoming increasingly complex and increasingly frustrating for many physicians. Paternalistic forms of patient-practitioner relationships are those in which the physician dominates the encounter in all respects, and devalues the patient's illness story. The nature of the patient-physician relationship has been described from antiquity to modern and postmodern times. Advanced access scheduling models carefully match supply and demand, eliminating the backlog for both routine and urgent care that is the norm in most US primary care offices. Access and communication with others that contribute to the plan and its execution is guided by the primary care team in the interests of the patient, and is coordinated and responsive. The primary care team acts as a steward of resources, ensuring that the patient's resources and those of the larger system that finances and delivers care are used efficiently and effectively, being mindful of costs but not avoiding essential care because of cost.
