Patient-Doctor Relationships

Question 1

What is the paternalistic model?

What are the strengths and weaknesses?

Answer 1

• Doctor-led
• Doctor makes systematic enquiry
• Patient passive and answers questions
• Doctor makes decision on what is best for patient

Strengths:

• Appropriate in some circumstances (emergency)
• Some patients prefer this approach (e.g. overwhelming circumstances)
  
  • If patients prefer this model it should be explained that a different form of partnership exists.
• Works with beneficence and best interests

Weaknesses:

• May not facilitate autonomy
• Patients may not be able to express I.C.E
• Best interests require knowledge of patient’s personal preferences and values.

Question 2

What is the shared model?

Answer 2

• Partnership between doctor and patient
• Doctor provides expert medical knowledge
• Patient provides expertise on their personal preferences and experiences
• Each state a preference, negotiate/compromise if disagreement.
• Doctors must create environment for patients to feel comfortable to do so.

Strengths:

• Doctor and patient as equals, shares responsibility
• Gives patient autonomy

Weaknesses:

• Coercion/persuasion must be avoided
• Not always appropriate (emergencies, lack of capacity e.t.c)

Question 3

What is the informed model?

Answer 3

• Doctor presents patient with all relevant information:
  
  • Possible treatments and likely outcomes
  • Risks and benefits
• Patient makes decision

Strengths:

• Good for expert patients
• Respects autonomy

Weaknesses:

• Patients may need clinical guidance
• Information overload is possible
• Too much responsibility may = psychological harm

Question 4

What are the benefits of shared decision making?

Answer 4

• Increased patient engagement
• Increased adherence to treatments
• Improved patient outcomes
• Gives patient opportunity to express I.C.E
• In line with GMC duties: doctors must work in partnership with patients and respect patients’ right to choose.