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Flashcards in Patient-Doctor Relationships Deck (4)
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What is the paternalistic model?

What are the strengths and weaknesses?

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


  • 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


  • 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. 



What is the shared model?

  • 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. 


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


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


What is the informed model?

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


  • Good for expert patients
  • Respects autonomy


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


What are the benefits of shared decision making?

  • 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.