MODELS OF DOCTOR PATIENT RELATIONSHIP

MODELS OF DOCTOR PATIENT RELATIONSHIP

THERE ARE THREE DIFFERENT KINDS:

1. PATERNALISTIC
2. CONTRACTUAL
3. FIDUCIARY

 

1. Paternalistic model: The doctor is the professional. He/she gives the order, the patient obeys.

Strengths:	· Emphasizes the expertise and knowledge of the doctor
Weaknesses:	· Ignores the autonomy of [disenfranchises] the patient · Ignores non-health related but morally legitimate values of the patient

2. Contractual model: The doctor and patient "contract" for each other's mutual benefit; the patient determines or agrees to the doctor’s decisions.

Strengths:	· Highlights the autonomy of both patient and physician · acknowledges cooperative/shared aspects of medical decision-making
Weaknesses:	· No "contracts" developed or signed in real doctor/ patient relationships · Model doesn’t allow for at trusting relationship

3. Fiduciary model: The patient confidently entrusts his/her health care to the doctor, who takes on the obligation of working for the benefit of the patient (without necessarily sacrificing his/her own legitimate obligations.) (Fiduciary: relates to a holding of something in trust for another)

Strengths:

· Preserves the freedom and autonomy of both patient and physician · The legitimate role of physician knowledge · The important role of trust in the doctor/patient relationship

CRITICISMS OF THE FIDUCIARY MODEL:

1. Engendering patient trust is pure manipulation for further economic gain.

2. Patient trust undermines consumer self-protection

3. Serious illness and fear of death diminish patient autonomy and power to contract any relationship.

Why the fiduciary model is best.

FOUR REASONS....

1. Purpose of medicine: Doctor: "my job is save lives" – No. The doctor’s job is to cure disease. Curing disease is not something a doctor can do alone. Patients are not just biological and chemical, anatomical and physiological, but also persons. Intelligent, free, social, artistic, symbolic beings. You can’t cure that without its cooperation.

2. Nor is curing something that the doctor has "control" over. It has principles and a reality that even the doctor must learn and get right. Translation: just because Dr. Kevorkian says what he is doing is good medicine that does not automatically make it good medicine. The Hippocratic Oath speaks of healing as a source of wonder.

3. The doctor/patient relationship is a relationship where the medical needs of one person and the technical ability of another come together—should be understood as a humane partnership.

4. Medicine is also a social good. Everyone has a something a stake in its practice, not just the doctor nor the patient.