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September 16, 1992

Models of the Physician-Patient Relationship

Author Affiliations

Portland, Ore

JAMA. 1992;268(11):1412. doi:10.1001/jama.1992.03490110048021

To the Editor.  —Although the labels are different, Emanuel and Emanuel's models of the physician-patient relationship1 are almost identical to Hersey and Blanchard's situational leadership styles: telling, selling, participating, and delegating.2 The similarity is not just a coincidence.When analyzing any categorization of human behavior, one finds that each model or style is supported by a school of philosophy.3 One of the three basic questions of philosophy is, "What is true?" Epistemology is the study of the various answers and the models of human behavior are restatements of those answers.Idealism and the related classical school neo-Thomism (derived from the writings of Saint Thomas Aquinas) both contend that truth or knowledge exists apart from our perceptions. Since one acquires knowledge through memorization, drill, and reasoning, there is little need to seek input from others.4 Physicians who hold these philosophies are authoritarian, parental, and "paternalistic." They "tell"