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April 22, 1992

Four Models of the Physician-Patient Relationship

Author Affiliations

From the Division of Cancer Epidemiology and Control, Dana-Farber Cancer Institute, Boston, Mass (E.J.E.); Program in Ethics and the Professions, Kennedy School of Government, Harvard University, Cambridge, Mass (EJE. and L.L.E.); and Division of Medical Ethics, Harvard Medical School, Boston, Mass (L.L.E.). L.L.E. is also a Teaching and Research Scholar of the American College of Physicians.

JAMA. 1992;267(16):2221-2226. doi:10.1001/jama.1992.03480160079038

DURING the last two decades or so, there has been a struggle over the patient's role in medical decision making that is often characterized as a conflict between autonomy and health, between the values of the patient and the values of the physician. Seeking to curtail physician dominance, many have advocated an ideal of greater patient control.1,2 Others question this ideal because it fails to acknowledge the potentially imbalanced nature of this interaction when one party is sick and searching for security, and when judgments entail the interpretation of technical information.3,4 Still others are trying to delineate a more mutual relationship.5,6 This struggle shapes the expectations of physicians and patients as well as the ethical and legal standards for the physician's duties, informed consent, and medical malpractice. This struggle forces us to ask, What should be the ideal physician-patient relationship?

We shall outline four models of the

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