The changing face of the doctor-patient relationship

Handshake-With-DoctorThe Patient-Physician Relationship is Health Care’s Touchstone.

The patient-physician relationship is fundamental to providing and receiving excellent care in the healing process and to improve disease outcomes. The physician has always been recognized and accepted as the guardian who uses his specialized knowledge and training to benefit patients, including deciding unilaterally what constitutes a benefit. The relationship therefore resembles that between a wise and caring father and his child, hence the use of the term “paternalism”.

Key Point: The relationship between doctors and patients is changing. Patients are more informed and want to take an active role in their care, but they still need the guidance of their doctors to make the best decisions.

As we enter the 21st century, however, the nature of the patient-physician relationship appears to be far more complex. Today the “voice of the patient” has become one of the key drivers of the changing healthcare environment. Increasingly, patients are not simply recipients of care or subjects of research, but they are active and informed individuals who wish to know more about their conditions and exert greater control over their own care.

So a model advocating supremacy of individual freedom and autonomy is emerging, labeled by some as the “informative model”, where the doctor only provides the patient with relevant information, leaving the patient to make decisions on his own. The advantage of this model is that patients are empowered as active participants in the decision-making process, but the physician’s role in this medical encounter is no more than a passive information provider.

It was observed that it may be more harmful for patients to exercise their rights of autonomy to overrule doctors’ choices, as all patients might not be prepared to take up this charge of self-decision. So a “deliberative model” defines the physician as a teacher and a friend, who helps to formulate plans and take decisions that are more easily followed.

Such a model that provides for professional guidance is especially relevant in this Internet age, where patients are flooded with information, some of which is[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] unprocessed and lacks validation.

The physician needs to cultivate a partnership with the patient, in which his medical guidance is based on the patient’s concerns, feelings and expectations. There are some good examples of patients’ comments and possible responses from a doctor following this model, in the table in this article from Family Practice Management:

The patients also need to be educated on the benefits of building a good patient-physician relationship. This collaborative model is grounded in mutual respect and trust between patients and doctors.

Sources: Defining the Patient-Physician Relationship for the 21st Century. 3rd Annual Disease Management Outcomes Summit, 2003, Phoenix, Arizona.

J J Chin. Doctor – patient relationship: from Medical Paternalism to enhanced Autonomy. Singapore Med J. 2002; Vol 43(3): 152-155. Available at:

Emanuel E, Emanuel L. Four models of physician-patient relationship. JAMA. 1992; 267:2221-6.

Judith A, Greenfield RN. Medical Decision making; Models of the Doctor-Patient Relationship. Healthcare Communication Review. 2001; Vol.1. Available at:

American Academy of Family Physicians. Available at Accessed on 14-1-2010.

Journal publishers are independent from mdCurrent-India and may require a subscription or charge a fee to download the full article.

This article originally appeared in and has been republished with their permission.

shalini ratan-64 Dr. Shalini Ratan, MD, is Founder and Chief Knowledge Facilitator at Nirvan Life Sciences Pvt Ltd. Mumbai, India.


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    Posted Aug 2013 at 5:58 am | Permalink

    As prefix doctor which means educator; teacher who is supposed to educate ,guide patient in the pursuit of comforting rather than cure most of the times.There is saying treat the patient not the disease. I really appreciate this article for focusing on patient centred care. Many such articles we need to strengthen primary care physicians .
    We need mutual respect and Trust .between patient and physician. Yes we need collaborative model.

  2. Noble Zachariah
    Posted Aug 2013 at 6:05 am | Permalink

    I fully agree with you. This is especially true in case of chronic diseases like diabetes, hypertension, hyperlipidaemia and ischemic heart disease. There should be very frank and open communication between doctor and patient with due importance given to patients views, desires and suggestions without of course compromising on quality of care to achieve desired targets.
    Once this is achieved, the patients always look up to their doctor for guidance and follow the doctor even if he shifts practice from one town to another and even one country to another.

    Dr. Noble Zachariah
    Internist, International Clinic, Farwaniya, Kuwait.

  3. Shalini Ratan
    Posted Aug 2013 at 12:55 pm | Permalink

    Thanks to all for the comments.

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