Question

Define and discuss the four ethical models of a physician-patient relationship

Answer 1

The doctor–patient relationship is a central part of health care and the practice of medicine. The doctor–patient relationship forms one of the foundations of contemporary medical ethics. A patient must have confidence in the competence of their physician and must feel that they can confide in him or her. For most physicians, the establishment of good rapport with a patient is important. The quality of the patient–physician relationship is important to both parties. The doctor and patient's values and perspectives about disease, life, and time available play a role in building up this relationship. A strong relationship between the doctor and patient will lead to frequent, quality information about the patient's disease and better health care for the patient and their family. Enhancing the accuracy of the diagnosis and increasing the patient's knowledge about the disease all come with a good relationship between the doctor and the patient. Where such a relationship is poor the physician's ability to make a full assessment is compromised and the patient is more likely to distrust the diagnosis and proposed treatment, causing decreased compliance to actually follow the medical advice which results in bad health outcomes. In these circumstances and also in cases where there is genuine divergence of medical opinions, a second opinion from another physician may be sought or the patient may choose to go to another physician that they trust more.

The four models are analyzed as follows:

Model	Patient Values	Physician's Duty	Concept of Patient autonomy	Concept of Physician's Role
Paternalistic	Objective, shared by physician and patient	Promote patient's well-being regardless of patient's current preferences	Assenting to objective values	Guardian
Informative	Fixed and known to patient	Provide factual information	Choice of, control over medical care	Competent technical expert
Interpretive	Vague, conflicting, requires elucidation	Provide factual information and help to elicit and interpret patient's values	Self-understanding relevant to medical care	Counselor or adviser
Deliberative	Open to development and revision true dialogue	Provide information, elicit and interpret values, articulate and persuade. Most admirable values	Moral self-developemnt relevant to medical care	Friend or teacher