TOPIC 3.

BASIC MODELS OF
RELATIONSHIPS IN THE
DOCTOR-PATIENT SYSTEM.
INTERNATIONAL DOCUMENTS
GOVERNING PATIENT
RIGHTS.
• “Why do doctors so often make mistakes? Because they are not sufficiently individual
in their diagnoses or their treatment. They class a sick man under some given
department of their nosology, whereas every invalid is really a special case, a unique
example.”
• This quote (by Amiel, 1889), taken from Henri-Frédéric Amiel’s journal (a 19th
Century Swiss philosopher), epitomizes the crisis physicians face in a society impacted
by globalization and a target-orientated business one could call medicine.
• Society was perceived by Talcott Parsons as a living organism, with sociological
ideologies such as functionalism and social constructionism paving the way to restore
order to the art of medicine and medical practice. Parsons was one of the first
sociologists to describe the doctor-patient relationship, and his work formed the
foundation for many others to determine the ideal doctor (Hughes, 1994).
 BASIC MODELS OF
RELATIONSHIPS IN THE DOCTOR-PATIENT SYSTEM
The doctor-patient relationship has been adapted and altered for a long time
throughout history. Global societal changes over millennia have seen a shift in
medical practice from magic to logic and religion to egalitarianism. Doctors have a
role in guiding patients in a caring manner by exploring values and promoting
independence. There currently lies various models for how a doctor-patient
relationship can come across, ranging from a paternalistic, or ‘priest-like’ approach
to a deliberative model which encourages conversation. Flaws of the doctor-patient
relationship vary based on the model, however, poor education and training to
doctors remains a problem and is a cause of medical malpractice suits in various
medical institutions/hospitals.
 A doctor–patient relationship (DPR) is
considered to be the core element in the
ethical principles of medicine. DPR is
usually developed when a physician (doctor)
tends to a patient’s medical needs via check-
up, diagnosis, and treatment in an agreeable
manner. Due to the relationship, the doctor
owes a responsibility to the patient to
proceed toward the ailment or conclude the
relationship successfully. In particular, it is
essential that primary care physicians
develop a satisfactory DPR in order to
deliver the prime health care to patients.
There are 4 main models of the doctor-patient relationship; the paternalistic model, the informative model,
the interpretive model, and the deliberative model (Emanuel and Emanuel, 1992).
1) Paternalistic model: In this model, the doctor generally dominates the interrogation and the patient is
expected to comply without questioning and answer the doctor’s questions. Here, the physician acts as a
guardian, because he/she independently promotes the patient’s health condition without the latter’s
consent. This autocratic model of DPR (doctor patient relationship) is usually advocated in emergency
situations, as obtaining consent from the patient in such a situation might alter his/her medical condition.
2) Informative model: This model is also called the consumer model. Here, the physician acts as a proficient
technical expert by defining appropriate factual information about possible treatments provided for the
patient and implementing the patient’s selected intervention. In this model, the patient is in charge of the
decision making for his medical condition. This kind of model is justified in a patient-centered medical
location.
 3) Interpretive model: In this model, the
physician plays an advisor by explicating and
interpreting the appropriate medical status of
the patient. The doctor acquires the consent
from patient and uses the patient’s decided
intervention.
4) Deliberative model: In deliberative
approach of DPR, the doctor is a teacher or
friend toward his patient. The doctor
enunciates the treatment measures and
convinces his/her patient of the more valuable
medical measures. The patient’s consent is also
important for implementation of treatment.
 Fundamentals for Dynamic DPR
Several medical reviews have covered ways to form a relationship between a
physician and a patient. Some essential features important for maintaining a
healthy DPR are:
-Good communication skills: are essential to establish DPR. Studies have revealed
that effective communication between physician and patient has resulted in
multiple impacts on various aspects of health consequences such as: improved
medical, functional, and emotional condition of patients; better patient compliance
with medical treatment; enhanced fulfillment of patient toward healthcare services;
lesser risks of medical misconduct.
-Trust: Trust in doctors allows patients to effectively discuss their health issues.
 -Professional boundaries: This deals with any
behavior on the part of the doctor that transgresses
the limits of the professional relationship, or
boundary violations.
-Doctor empathy: Empathy is vital to ensure the
quality of DPR. This enables the physician to
understand the symptomatic experiences and needs
of individual patients. Studies have suggested that
the physician empathy improves the therapeutic
effect and the patient’s quality of life.
-Informed consent: the physician needs to be honest
with the patient and his family to provide a genuine
assessment of favorable and unfavorable outcome
probabilities, along with the suggested therapy.
 HISTORY OF THE DOCTOR-
PATIENT RELATIONSHIP
Kaba and Sooriakumaran described ancient human kind as, ‘[Attempting] to master nature
through his fears of helplessness, sickness and death, by means of magic and mysticism,
theology and rationality’. In Ancient Egypt, disease was supposedly sent to people as
punishment from the gods or from evil spirits, as a result, there were many rituals, spells and
charms. The first doctors were priests of the Goddess Sekhmet and they were trained in both
practical medicine and magic. Although this would now be considered unsophisticated, at
that time, this was the best known way to treat both the physiological and psychological side
of diseases. As it was often priests who were at the forefront of medicine, there was an
activity-passivity type of relationship, where the priests treated patients the same way a
parent treats a child.
The International Covenant on Economic,
Social, and Cultural Rights is widely
considered as the central instrument of
protection for the right to health, recognizes
‘’the right of everyone to enjoyment of the
highest attainable standard of physical and
mental health’’.
 International documents governing patient
rights
The Patient's Rights Law -it's objective is to regulate the relationship between people who require
medical treatment and members of the medical staff who provide it. The law has established norms and codes of
conduct concerning patient's rights, in a binding way on all those practicing medicine. The medical staff and the
patient are partners in the medical treatment. The law is based on the assumption that the patient is a cognitive person
capable to demand his right to proper medical care. The opening paragraph of the law states: "This Act aims to
establish the rights of every person who requests medical care or who is in receipt of medical care, and to protect his
dignity and privacy"..

The Right to Medical Care: The right to receive medical treatment is assured to all. Neither the medical
facility nor the clinician administering the treatment may discriminate between patients on grounds of religion, race,
sex, nationality, origin etc.

Proper Medical Care: The patient is entitled to proper medical care, which should be provided in the best
professional standards and quality.
 Right to a second opinion
Right to dignity of the patient
The privacy of the patient
Right to informed consent
The Right to Access to Medical Information: The patient is entitled to receive
from his clinician or from the medical facility information concerning him obtained from
the medical records, including a copy of his medical records.

Medical Confidentiality: a clinician or any other staff member of a medical facility

may not disclose any information concerning a patient which came to their knowledge
during their services or in the course of the treatment.
 Med. Student
Okhaigbe David
Alugbe
Group 111