Doctor-Patient Relationships

Paul Walker ponders the best type of relationship between a doctor and a patient.

- Paul Walker

How well do you get on with your doctor? Every clinical consultation involves two people interacting, so should be seen as a relationship, and a moral encounter. The Hippocratic Oath, to do the best for the patient, and similar commitments grounded in a classical virtue ethics framework have been professed at graduation ceremonies of young doctors over centuries. Individual clinicians, however, can relate to individual patients and their families in different ways. Here I will simplify the various models of the doctor-patient relationship to three: the paternalistic model; the radical individualism model; and the shared decision-making model.

The Paternalistic Model

The ‘paternalistic model’ emphasises that the doctor’s caring is based upon long medical training and expert, specialised, and often technical knowledge. This model may be summarised as ‘doctor knows best’. Here the values important to the patient are accorded less importance than what the doctor believes is in the patient’s best interest.

This model is based predominantly upon the ethical principle of beneficence (meaning, ‘to do good to’), with patients receiving that intervention which, in the doctor’s assessment, is best suited to the patient in order to help restore them to health or to relieve their suffering. This principle requires that the doctor place the benefit of the patient above their own; and that they not make decisions for financial or other gain, and they also seek assistance from other clinicians when that is in the patient’s best interests. However, in non-emergency (‘elective’) situations, the paternalistic model brings the principle of beneficence into conflict with the principle of patient autonomy.