An analytic review of the doctor-patient relationship (part II)

Abstract

This is the second part of an analytic review of doctor-patient relationship (DPR) from an ethical point of view. In the previous part I have described and analysed the goals of and processes in different bioethics models of doctor-patient relationship. I have argued that the bioethics models of doctorpatient relationship are normative and prescriptive in nature and that the effectiveness of different models to promote their assumed goals is not assessed empirically. In this part of the review, I analyse different clinical models of doctor-patient relationship with the aim of understanding the relation between the theoretical and philosophical arguments behind different models of doctor-patient relationship with the empirical evidence on the effectiveness of different models to promote their goals if implemented at the level of health care. The process in the DPR is at the core of the clinical models of DPR, namely patient-centred care model (PCC) and relationship-centred care model (RCC) [1]. Since its inception more than fifty years ago through the early work of Balint [2] and Engel [3] clinical models of DPR have gained a high profile in general practice and are considered a central feature of quality practice [4].In this section, I analyse through an ethical lens the concepts and ideas that are commonly described and empirically studied in the literature surrounding the clinical models of DPR. I argue that clinical models of DPR, similarly to bioethical models of DPR, are prescriptive and normative in nature. First, I describe and analyse from an ethical point of view the patient-centred care (PCC) model of DPR. I argue that some of the ethical meanings of the different dimensions of this model are not made clear by its proponents. Second, I describe and outline the relation-centred care (RCC) model of DPR and the empirical research surrounding the process in DPR. I describe the communication patterns that characterize RCC and outline the empirical research on their effectiveness to promote beneficence and patients’ autonomy. I argue that there is some evidence that a process in DPR characterized by these communication patterns could promote both benefice and patients’ autonomy. Third, I compare the clinical and bioethics models of doctor-patient relationship. I argue that the similarities between Brody’s relational model of doctor-patient relationship and RCC model of doctor-patient relationship may suggest that the implementation of this model at the level of care could be effective to promote both beneficence and patient autonomy.