About the Book

"Breaking the Cycle" focuses on resolving doctor-patient conflicts

Doctors want to help their patients. Patients want their doctors to help. But when conflicts arise and lead to an impasse over issues as simple as prescribing antibiotics for a cold or as complicated as end-of-life care physicians can be left feeling frustrated and helpless. As their relationship deteriorates, both doctor and patient feel misunderstood and cut-off.

Inspired by the authors' experience with a twelve-year-old girl who struggled to take life-saving medication and based on principals and proven techniques from the field of family therapy, the authors present a unique approach to the problem of doctor patient conflict. This practical guide focuses on how changes in a physician's thinking can improve challenging interactions.

Breaking the Cycle features: A wealth of real-life experiences and case studies that show how impasses arise and how best to respond. A systematic approach that helps readers overcome impasses by building relationships with their patients, not withdrawing from them. The knowledge, insights, and experience of an internist, health psychologist, and family therapist.

Breaking the Cycle explains how physicians can understand, approach, and resolve doctor patient conflict in a way that breaks down barriers and builds stronger, more gratifying relationships.

Table of Contents

Part I: Seeing the Cycle
Doctor Knows Best (Sometimes): The "Physician-as-Expert" Model
Part II: Understanding Unproductive Cycles in Relationships
The Harder I Try, the Worse it Gets: The Symptomatic Cycle
How to Begin: Building Collaborative Relationships
An Ounce of Prevention: How to Avoid Impasses with Patients and their Families
Part III: Responding to Difficult Relationships
When All You Know Isn't enough: Dealing With Chronic Illness
"You Are Not Helping Me!"
Pediatrics: Little People, Big Problems
"You Have to Save My Little Girl": Crisis in The Intensive Care Unit
Ethical Dilemmas in Medicine: Or Are They?
It's All in Your Head: Patients Seeking Medical Solutions to Non-Medical Problems


October 2009 - The Patriot-News: "Doctor, patient need to listen"
April 2009 - Wall Street Journal: "The Importance of Trying to Be a Good Patient"

Editorial Reviews

Breaking the Cycle will be of enormous help to physicians of every stripe. The authors present important lessons about shifting from conflict to collaboration gleaned from Salvador Minuchin and other family therapists. They analyze cases in depth to make these lessons vivid, real, and compelling. A special feature of this book is the presentation of both physicians and patients in a narrative, biographical context, which provides more complete psychological insights for problem solving. This humanizes physicians and is also especially respectful to patients. The cases beautifully show us something fundamental about caring for patients: effective care begins with genuine interest in building relationships with patients, and is sustained by genuine curiosity about the patient s perspective. — Jodi Halpern, MD, PhD, author of From Detached Concern to Empathy: Humanizing Medical Practice

As medical paternalism has declined over the past 50 years, doctors have increasingly encountered the refusing patient, both in ambulatory and inpatient settings. Often, such patients frustrate doctors, polarize health care teams, and drive a wedge between the doctor and patient. The authors have developed a practical approach that actually helps physicians, patients and families reduce conflict and power struggles in order to provide the best care for patients. Their creative and original model, amply described with many real case examples from internal medicine and pediatrics, applies a systems approach from family therapy to resolve the kind of real-world challenges that patients and physicians face every day. Speaking as one of the frustrated physicians who has tried to resolve these issues in practice, I am delighted to report that this book by Blackall, Simms and Green is just what I've been waiting for! — Mark Siegler, MD, Author of Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine

Blackall, Simms, and Green provide a valuable map for those of us striving to navigate the murky waters of challenging physician patient interactions. Their model is clearly presented, lucid, and practical. — Dan Shapiro, PhD, author of Delivering Doctor Amelia

Review in Family Medicine, February 2010

Review in Families, Systems, & Health, June 2010

Reader Reviews

Click here to read reviews from Amazon.com.


The Introduction and Chapter 1 are available in PDF format.


Chapter 1: Doctor Knows Best (Sometimes): The "Physician-as-Expert" Model


Get Adobe Reader

Breaking the Cycle Book

Publisher: American College of Physicians
Pub. Date: April 2009
ISBN-13: 9781934465189
Format: Paperback, 154 pages
Edition Number: 1