Four Models of the Physician-Patient Relationship

Four models of the doctor-patient interaction are outlined, emphasizing the different understandings of the goals of the physicianpatient interaction, the physician's obligations, the role of patient values, and the conception of patient autonomy, which constitute Weberian ideal types.

Abstract

DURING the last two decades or so, there has been a struggle over the patient's role in medical decision making that is often characterized as a conflict between autonomy and health, between the values of the patient and the values of the physician. Seeking to curtail physician dominance, many have advocated an ideal of greater patient control.1,2Others question this ideal because it fails to acknowledge the potentially imbalanced nature of this interaction when one party is sick and searching for security, and when judgments entail the interpretation of technical information.3,4Still others are trying to delineate a more mutual relationship.5,6This struggle shapes the expectations of physicians and patients as well as the ethical and legal standards for the physician's duties, informed consent, and medical malpractice. This struggle forces us to ask, What should be the ideal physician-patient relationship? We shall outline four models of the