As I was growing up, I had the opportunity to visit many doctors. Before becoming a doctor myself, there were times when I was a patient, probably like all of you. The question that comes to mind is: who did we consider to be a good doctor? And which doctor did we find unfavorable?

For me, and I believe for many of you as well, a good doctor was someone who displayed kindness. It was the one who genuinely listened to me and took the time to explain the treatment plan clearly. These attributes formed the basis of the trust I had in him. Strangely, I never really pondered about academic achievements or whether he excelled in their exams. It was the relationship he built with me that shaped my perception of whether he was good or not-so-good.

Studies have indicated that an improved doctor-patient relationship doesn’t just enhance aspects like medication adherence, coping mechanisms, and emotional well-being. It also leads to positive changes in physiological variables such as blood pressure, glucose levels, and triglyceride levels.

With that understanding let’s talk about consultation styles as that play a important role in developing a good relationship with our patients. These can be understood based on who has more control in the interaction, typically it can be of 3 types, paternalistic, consumeristic or deliberative.

This can be further elucidated by the table below

Let’s first discuss the different models.

Paternalistic Model: –

The paternalistic model, also known as the parental or priestly model, involves the physician determining the patient’s condition, disease stage, and necessary medical tests or treatments. The patient is presented with specific information to encourage consent to the recommended intervention. This model assumes objective criteria for determining what’s best, allowing the physician to make decisions with limited patient input. The focus is on health over autonomy. Here, the physician acts as the patient’s guardian, implementing the best course of action.

Advantages of this model

1. Efficient Decision-Making: This model allows for quicker decision-making, as the physician takes on the responsibility of determining the best course of action based on their expertise.This extremely important when it comes to emergencies and when other peoples lives are involved.
2. Reduced Patient Stress: Some patients prefer not to be burdened with making complex medical decisions and find relief in trusting the physician’s judgment.

Disadvantages of this model

1. Lack of Autonomy: Patients may feel disempowered and frustrated when their preferences and values are not considered in the decision-making process.
2. Communication Gap: The limited patient involvement can lead to misunderstandings and a lack of clarity about the treatment plan.
3. Disregard for Patient Values: The paternalistic model may overlook the patient’s personal values and cultural beliefs that could impact their treatment choices.
4. Abuse of Power: The physician’s authoritative role may lead to instances of abusing their power, where decisions are made without genuine consideration of the patient’s well-being and preference

Consumer Model

In this approach, the physician’s goal in interacting with the patient is to furnish all pertinent information. The patient then selects the desired medical interventions, which the physician carries out. The physician informs the patient about their condition, potential diagnostic and treatment options and associated risks and benefits.

In this model, the physician serves as a conveyor of technical expertise, empowering the patient to exert control. Physicians have responsibilities to offer accurate information, maintain expertise, and seek consultation when necessary. Patient autonomy, in this context, means granting patients control over medical decisions.

Advantages of the consumer model in the doctor-patient relationship:

1. Empowerment: Patients are actively involved in their healthcare decisions, leading to a sense of empowerment and ownership over their well-being.
2. Choice: Patients have the opportunity to explore various treatment options and make decisions that align with their preferences, values, and beliefs.
3. Informed Decision-Making: Patients receive comprehensive information about their condition and treatment choices, enabling them to make informed decisions based on their individual circumstances.
4. Patient-Centered Care: The consumer model promotes patient-centered care, where treatments are tailored to the patient’s unique needs and preferences.

Disadvantages of the consumer model in the doctor-patient relationship:

1. Limited Medical Expertise: Patients may lack the medical knowledge to fully comprehend complex treatment options, leading to potential misconceptions or misunderstandings.
2. Overemphasis on Consumerism: Placing too much emphasis on the consumer aspect might lead to a focus on patient demands rather than medically appropriate interventions.
3. Unequal Information: Patients might not always have equal access to accurate medical information, potentially resulting in suboptimal decisions.
4. Time and Resources: Extensive information-sharing and decision-making processes might consume more time and resources for both patients and healthcare providers.
5. Risk of Over-Testing and Treatment: Patient demands might lead to unnecessary tests or treatments, driven by consumer desires rather than medical necessity.

6.Harm to Others: If patients do not adhere to proper treatments due to their preferences, it could                lead to harm to others in cases of contagious diseases or conditions that require collective                            responsibility.

Deliberative Model

The third  model is the deliberative model. Here, the focus of the doctor-patient interaction is to assist the patient in identifying and selecting the most suitable health-related values applicable to their clinical situation. The physician must present information about the patient’s condition and then help clarify the values associated with available options. The physician’s goals include explaining why particular health-related values are more valuable and should be pursued.

Within the deliberative model, the physician acts as an educator or confidant, engaging the patient in dialogue to determine the best course of action. The physician not only provides suggestions but, knowing the patient and desiring their well-being, also recommends what the patient should do in terms of medical therapy.

In this approach, the physician aims to persuade rather than coerce, allowing the patient to define their life and choose the prioritization of values. Patient autonomy, in this context, is about moral self-development, enabling patients not only to consider their preferences or examined values but to explore alternative health-related values through dialogue, assessing their worth and implications for treatment.

Advantages

1. Patient-Centered Decision-Making: The deliberative model emphasizes open dialogue and encourages patients to actively engage in decision-making, ensuring that their preferences and values are considered.
2. Enhanced Understanding: Patients gain a deeper understanding of their health situation and the available options through discussions with their physician, leading to informed decisions.
3. Shared Decision-Making : Physicians provide guidance and recommendations based on their expertise, while patients have the autonomy to choose from a range of health-related values.
4. Holistic Approach: The deliberative model takes into account a broader range of health-related values beyond medical factors, considering the patient’s overall well-being and life goals.

Disadvantages of the deliberative model in the doctor-patient relationship:

1. Time-Consuming: Engaging in extensive discussions and moral deliberation might require more time during appointments, potentially impacting the efficiency of healthcare delivery.
2. Varying Patient Preferences: Some patients might not feel comfortable engaging in in-depth ethical discussions or might prefer quicker, directive decision-making.
3. Potential for Bias: The physician’s influence on the patient’s decision-making process could introduce bias, consciously or unconsciously.

What model should you finally choose:

Like many decisions, the answer to this question varies based on the person involved and the context in which the situation arises.

In critical scenarios such as emergencies or within certain patient populations, the paternalistic model can prove to be the most effective approach. This is especially evident during times like the COVID pandemic, where immediate and coordinated action is important. During a pandemic like COVID, when lives are at stake, healthcare professionals must be assertive with individuals to take actions such as getting vaccinated or wearing masks.

On the other hand, in cases involving end-of-life scenarios, a different approach might be more fitting. Here, it’s often appropriate for the physician to take a step back and allow the patient to have a more active role in determining the course of their management.

In situations characterized by chronic conditions necessitating prolonged treatment and strict adherence, the deliberative model is the most suitable choice. Chronic illnesses require continuous management and collaboration between the patient and the physician. Engaging in dialogue, exploring different treatment options, and considering the patient’s values becomes paramount to ensure that the chosen treatment plan aligns with the patient’s lifestyle and long-term goals.

In summary, the choice of which model to employ depends on the nature of the medical situation, the patient’s preferences, and the urgency of the context. Having a in dept understanding of this is crucial. You could be the best mind in the field, studied from the best institute, have the ability to write the best of prescriptions but if the patient does not take the medication, then what the point?

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