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The conference is free and open to faculty, students, and the public. You are invited to attend all or some of the sessions. All conference sessions will take place at the Great Hall, Trent Semans Center for Health Education at Duke University Medical Center.

For more information, please contact trent-center@duke.edu

Subject to a variety of social and economic forces, relationships between health practitioners and their patients continue to evolve. Over the past half-century, changing cultural and social mores have shifted practitioner-patient relationships from paternalism (clinician directs, patient obeys) to shared decision-making (clinician and patient jointly choose the course) to patient autonomy (patient requests, clinician provides). An expansive literature has chronicled, queried, and critiqued these shifts. Many have celebrated the new freedom for patients to guide the care they receive. Others have worried that clinicians are being reduced to mere providers of health care services.

Those debates continue, but the present conference takes a different approach. Rather than focusing on shifting social expectations regarding authority, choice, and shared decision-making, this conference asks how recent changes in the structures and institutions that govern the health care system change the ways nurses, physicians, and other health practitioners relate to their patients. As a result of shifts in health care financing, policy, and information, health practitioners are increasingly organized into large bureaucratic institutions, assessed on the basis of abstracted quantitative data, managed using industrial norms, and regulated by the state and other impersonal third parties.

How do these changes shape and constrain the relationships of practitioners to their patients?
Which changes in the structures of health care should be resisted?
Which should be embraced, and why?

The conference takes up these questions with an eye to identifying constructive ways forward. Data indicate that changes in the health care system are accompanied by declines in the satisfaction of both patients and practitioners. Nurses and physicians in particular are burning out and giving up on their practices at an unprecedented rate. There are institutions that buck the trend, however. Institutions in which patients are satisfied their needs are being met and practitioners are grateful that they can do their work as they believe they should. What can be learned from such organizations? What are their secrets? How do they adapt to and overcome dynamics that in other settings seem to result in frustration and fatigue?