Four Models of the Physician-Patient Relationship | JAMA | JAMA Network
Section 4 explores the implications that various aspects of this relationship have on health policy, Review of theoretical models on doctor-patient relationship. Four Models of the Physician-Patient Relationship . A 4-Step Framework for Shared Decision-making in Pediatrics. Article March · Theoretical Medicine. The physician-patient relationship is becoming more and more a universalistic .. Ezekiel and Linda's work () described four models of physician-patient.
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. The physician presents carefully selected medical information to the patient.
Decision-making is a shared effort, but the physician encourages specific recommendations based on an interpretation of established health-related values. Continuing in the direction of greater patient involvement is the interpretive scenario, in which the patient has inchoate values regarding the situation which the physician helps to elucidate.
Substantial dialogue regarding the condition and interventions is exchanged between physician and patient. Once presented with the pertinent information, the patient makes the decision, with the physician acting mainly as a counselor. Lastly is the informative scenario, where patient autonomy is high and the patient has well-formed values; the patient alone takes on decision-making responsibilities.
In the Emanuel and Emanuel system of understanding the patient—physician interaction, the prior formation of patient values, the extent of autonomy, and the amount of medical information provided to the patient by the physician are all coupled and change simultaneously. Thus the paternalistic model is characterized by low values formation, low autonomy, and low information disclosure, while high values formation, high autonomy, and high information delivery are found in the informative model.
In the intervening decades, additional models of patient—physician interaction have examined aspects more or less addressed in the Emanuel and Emanuel model. To this end, Charles and colleagues created a model examining the interplay of patient autonomy and information exchange, stressing that the combination of these and other variables exists on a continuum, rather than at the discrete points suggested by Emanuel and Emanuel.
To assist in understanding exactly why this is the case, and to facilitate further discussion, it would be helpful to first consider definitions of these terms. The term value itself is generally defined as the beliefs or principles of a person or group that are used to guide decisions and way of life.
Health-related values include the extent to which a person values life versus lifestyle, personal health versus preservation of family assets, and unpleasant physical symptoms versus potential health benefits.Reaffirming the Doctor-Patient Relationship - Stephen Sanders - TEDxSaintLouisUniversity
This leads to constant communication with the patients. This form of communication between a physician and patients, in turn, creates an intimacy that it is called a sense of family relationship. Doctors show their commitment to their patients through care activities.
Some of these activities, in our current medical context, are extraordinary, like home visiting or phone calls. Others fit in the context of routine daily actions; however, in their opinion these activities are signs of respect for the patient.
A conceptual model of physician-patient relationships: a qualitative study
For example, one participant noted: This results in them trusting me. This self-confidence is an important component of the healing relationship.
In this regard, one of the participants stated: Finally, expert knowledge is important in building an effective communication. Trust Trust will form as a result of the process of valuation and commitment over time.
One of the participants stated: This does not always mean that cure is possible, but sometimes it means that there is hope of a few more good days, and provides opportunity for gratitude and forgiveness.
In difficult situations, physicians act differently. They do not seek false hope; however, the patient will have a pleasant experience unless there was no effective treatment. They could understand where they were going and what was going on. In this regard, a physician stated: Accordingly, in the Iranian society, mentioning the Islamic concepts of human relationship can improve the quantity of health relationship and can enrich the components of the physician-patient relationship.
In this context, a basic element and a prerequisite to respecting human dignity is viewing every human being as a creation of God. This means that it is your intent that shapes the relationship].
These components will form the three relational elements of trust, peace and hope, and being acknowledged. The present study tried to propose a model for therapeutic relationship based on the experiences of the research participants. In order to determine the effect of this model in the current situation of medical practice, we can evaluate it at three levels. Mutual trust, peace, and being acknowledged as the results of this relationship are equally important for both patients and physicians.
Third, the healing relationship affects both parties patients and physicians. A number of physicians who participated in this study had experienced working in difficult situations such as the battlefield or severely deprived areas and they were satisfied with memorizing them. This indicates that such an enriched experience and relationship left its positive impact on their life and work.
A conceptual model of physician-patient relationships: a qualitative study
It could be proposed that the solution to some health system problems could be found in redefining the physician-patient healing relationship. Conclusion It can be concluded that the structure of the physician-patient healing relationships is comprehensible and may lead to valuable patient-centered outcomes.
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- Four Models of the Physician-Patient Relationship
- Four models of the physician-patient relationship.
Moreover, this discernible and understandable structure has important impacts on treatment. Furthermore, this conceptual model can be generalized to other therapeutic relations in the health system.
Evidently, this study had some limitations. First, the participants were chosen selectively and are not considered significant indicators of the population of physicians. Nevertheless, it can be explained that the intention of this study was to provide a preferred model of doctor-patient communication, and for this purpose, it was necessary to choose a targeted selection of participants. Accordingly, the proposed model of the study does not explain the current situation, but if experimental studies confirm its effectiveness, it could be a standard to achieve.