The last decades have been marked by the conflict between the autonomy of the patient and his values, and the values of the doctor. This confrontation encompasses both the expectations of doctors and patients as well as the ethical and legal criteria of medical codes, which raises questions about the ideal doctor-patient relationship.
In ancient civilizations, the medical figure was related to the mystical and religious, the doctor was even considered a representative of the gods on earth. Medicine was free and linked to the temples. In them, special care was given to the sick and doctors were specifically trained through practices controlled by the priests.
However, in current medicine we see more and more integrative approaches under which decision-making is not done unidirectionally, but rather bilaterally, favoring shared decision-making. The patient goes from being a passive element to an active one, thus allowing him to take greater responsibility for his state of health.
Currently, four models of the doctor-patient relationship have been postulated, emphasizing the conceptions that each model privileges in it, the patient’s obligations, and the way of conceiving his autonomy. These models highlight the different views on the basic characteristics of the doctor-patient relationship.
Let’s look at these models:
1. The Paternalistic model
This model presupposes the existence of an objective criterion that allows discerning what is best for the patient, without his opinion being the determining factor. It is based on the assumption that the disease places the patient in a situation of need and moral incompetence since excessive pain or anxiety and other manifestations of the disease disturb the patient’s good judgment and his ability to make decisions. Therefore, the doctor acts as the patient’s guardian, like a good father who knows what is best for the patient, without the need for his participation, but taking care to place the patient’s interests above his own, an expression of pure altruism.
2. The informative model
Also called a scientific model or technical model. In it, the doctor must provide the patient with relevant information so that, within the possible courses of action, he selects the one that best fits his system of values. In this model, the role of the doctor seems to be reduced to that of a provider of truthful information and a technically competent subject in his specialty.
3. The interpretive model
In this model, the doctor helps the patient to determine the values, which are often not well defined. To do this, the doctor works with the patient to clarify their objectives, aspirations, and responsibilities, so that those courses of action that fit better within the framework of the patient’s values become evident, who is then in a better position to make their own decisions. In this model the doctor acts as a counselor, assuming a consultative role.
4. The deliberative model
In this model, the doctor helps the patient to determine and choose from among all the values that are related to their health, those that best serve as a basis for making the most appropriate decision within the different possible alternatives. In this, the doctor and patient work together, without the doctor – who acts as a teacher or a friend – going beyond moral suasion, avoiding any form of coercion. The final decision will be the result of an authentic dialogue, marked by mutual respect and consideration.
At present, it is considered that the deliberative model is the one that best fits an ideal relationship, emphasizing that a humanist doctor in the course of his professional work must be not only an agent with technical scientific capacity in his discipline but also a capable person. to establish an interpersonal relationship that respects the dignity of the human person and his values, and with whom he can –via trans subjective dialogue– make it possible to make a decision that best suits the value systems at stake.