Doctor patient relationship paternalistic model

Medical paternalism - Wikipedia

doctor patient relationship paternalistic model

In this paternalistic model of the doctor-patient relationship, the doctor utilises his skills to choose the necessary interventions and treatments most likely to. Paternalistic model of doctor- patient interaction and problematic situation in the clinic. J Health Sci relationship over a patient's life world Generally. In the patient-doctor relationship, paternalistic model refers to the act in which decisions are taken by a health care professional in order to benefit the patient or .

Retina Today - Informed Consent and the Physician-Patient Relationship (April )

These practices also treated patients as unique, instead of simply being a collection of symptoms to be fixed by a paternalistic doctor.

InSzasz and Hollender [4] introduced three models of paternalism to the medical community, thereby legitimizing the view that doctors did not necessarily have to dominate patients. The models are as follows: Activity—passivity refers to the traditional version of paternalism, in which the doctor treats the patient as one who cannot or should not make decisions.

doctor patient relationship paternalistic model

This relationship is similar to that of a parent and child. Treatment is performed "irrespective of the patient's contribution and regardless of outcome. Guidance—co-operation is a relationship used in more long-term situations.

The doctor provides instructions to the patient, to which the patient is expected to comply. The name comes from the expectation that the physician will guide the patient, who will co-operate, but who retains their individuality. Mutual participation involves the physician making it clear that he or she is not infallible and does not always know what is best.

doctor patient relationship paternalistic model

This model is more of a partnership, in which the doctor helps the patient to help him or herself. This model is often employed in cases of chronic disease or pain, in which the patient can have a higher degree of freedom and be more independent of the doctor. The fundamental difference lies in the patient's capacity to make well-informed decisions for themselves.

As such, even if the doctor disagrees with the patient's desire, he or she will not intervene as long as the patient is of sound mind.

Strong or extended paternalism involves a doctor superseding a patient's requests in cases where the doctor has determined a better course of action, even when the patient's requests are made voluntarily. These cases typically arise when the physician has determined that a patient's decision is unreasonable because of the risks involved, or potential costs to the patient's well-being.

Four models of the physician-patient relationship.

Throughout history there have been many cases in which a patient is reported to have made a well-informed choice while of sound mind to opt for a medically improper treatment, or one that is very costly to their well-being. If the doctor does not take a paternalistic stance, and instead goes through with the patient's wishes, the question arises as to whether malpractice occurred.

This creates a difficult legal situation in which a decision has to be made about what the correct amount of information is, and how best to present it. As such, in cases in which things go awry it is the courts' responsibility to determine whether the physician is at fault, and whether he or she should have ignored the patient's requests.

There are contrasting views on whether this constitutes weak or strong paternalism. One argument is that weak paternalism allows the physician to stay completely hands-off. By contrast, the patient—physician interaction models currently used to teach medical trainees have little capacity to address these twin challenges. We developed a new model of patient—physician interaction to explicitly address these problems.

doctor patient relationship paternalistic model

Unfortunately, this does not adequately represent patients such as 1 the highly educated non-medical specialist who possesses little familiarity with health-related values but is highly autonomous, and 2 the patient from a non-Western background who may have well-established health care-related values but a low sense of personal independence.

In addition, it is evident to us that the assumption that all patients possess little medical knowledge can create alienation between patient and physician, e.

We propose a paradigm that models autonomy, health care-related values formation, and medical knowledge as varying from patient to patient.

Four examples of patient types are described within the context of the model based on clinical experience. We believe that adopting this model will have implications for optimizing patient—physician interactions and teaching about patient-centered care. Further research is needed to identify relevant patient types within this framework and to assess the impact on health care outcomes.

By contrast, the models used for teaching medical students about the patient—physician interaction have remained relatively static.

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Thus, young physicians are struggling to efficiently incorporate a modern patient dynamic within an old conceptual framework and desperately need a new model of patient—physician interaction that embodies the current realities of medical practice.

Construction of the model is described in two phases: Several examples illustrating the use of these factors to promote efficient medical practice are presented.

doctor patient relationship paternalistic model

We begin by briefly reviewing the evolution of traditional models of patient—physician interaction and establishing necessary definitions. Consequently, the physician usually played a dominant role in clinical encounters, and patients abided by physician decisions, while sometimes suppressing their own inclinations.

However, with the reshaping of ideals in society, patients became decreasingly satisfied with this stereotypical interaction, and many began seeking greater involvement in the clinical encounter.

Consequently, medical educators developed tools to assist young medical students in understanding the dynamic nature of the patient—physician interaction. What emerged was a series of clinical models that formalize the clinical encounter. The physician independently decides the interventions to be taken, providing the patient with minimal medical information. Indisputably, there are important medical scenarios where paternalistic care is still necessary, especially in the setting of acute or trauma care where immediate treatment must be rendered and, barring non-resuscitation orders, there is little room for negotiation.

Representing a degree of increased patient involvement is the deliberative scenario. The patient in this scenario has minimally formed values, but the physician works with the patient to discover and develop these values.