Introduction
This topic covers the main models that describe how a physician and a patient share information, values and decision-making authority during care. A good answer explains the historical shift from physician-centred to patient-centred care, defines the four models proposed by Emanuel and Emanuel, compares their strengths and risks, and links the choice of model to the clinical situation, the patient's capacity and ethical principles.
Historical background
For most of medical history the relationship was built on the Hippocratic tradition, in which the physician, as the one who knows, decides what is good for the patient. Beneficence was the main value, and patients were often not told the full truth. After the Second World War, the abuses revealed at Nuremberg and later scandals in research and care led to a stronger emphasis on the patient's right to self-determination, informed consent and autonomy.
In 1956 Szasz and Hollender described three basic patterns of the relationship, which remain a useful starting point:
- Activity-passivity: the physician acts on a passive patient, as in unconscious patients, infants or emergencies.
- Guidance-cooperation: the physician directs and the patient follows instructions, typical of acute illness.
- Mutual participation: the patient is an active partner, typical of chronic illness, where the patient manages the disease daily.