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August 22, 1994

The Consultant and the Patient-Physician Relationship: A Trilateral Deliberative Model

Author Affiliations

Division of Medical Ethics Harvard Medical School 641 Huntington Ave Boston, MA 02115; Boston

Arch Intern Med. 1994;154(16):1785-1790. doi:10.1001/archinte.1994.00420160016003

The RELATIONSHIP between the patient and the doctor is central in the practice of medicine, and writing about the subject goes back to ancient medicine.1 Analysis of the relationship commonly assumes two people, one patient and one doctor.2 However, especially in contemporary Western medicine, there is often more than one physician taking care of the patient. Medical care is increasingly specialized, and the number of consulting physicians for each patient is higher than ever before.3 It is also not always clear who is the consulting physician and who the primary physician, and the roles may change with the patient's needs. Problems of role definition,4 fragmentation of the patient's care, and communication5 are correspondingly complex. Our focus will be on understanding the ideal underlying structure of the therapeutic relationship when two or more physicians are caring for a patient.

Consultant physicians (physicians with special expertise asked

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