Models of the doctor–patient relationship and patient-centred care
- Theory
There are several ways to share power and decisions between doctor and patient; today the preferred one talks things through and decides together.
What it is
Relationship models describe who brings the information, whose values guide the decision and who decides. The most cited scheme is Emanuel and Emanuel (1992), with four models: paternalistic, informative, interpretive and deliberative. An older scheme, Szasz and Hollender (1956), orders them by how much the patient can take part. Patient-centred care joins the biological disease with the person's experience of it and seeks common ground for the plan.
Key facts
- Patient-centred care: explore both the disease and the illness experience (ideas, concerns, expectations, effect on life), understand the person in context, and agree on the plan.
- Engel's biopsychosocial model (1977) is the theoretical basis: biological, psychological and social factors act together.
- The relationship is asymmetric: the clinician holds knowledge, power and access to intimate information, which is why professional boundaries are required.
- In a meta-analysis cited by the US National Cancer Institute, about a quarter of patients preferred an active role, half a collaborative one and a quarter a passive one.
Emanuel and Emanuel's four models
| Model | Doctor's role | Patient's values | Who decides |
|---|---|---|---|
| Paternalistic | Guardian: picks the best option by their own judgment | Assumed to match the doctor's | The doctor; the patient consents |
| Informative | Technical expert: hands over all the facts | Fixed and known to the patient | The patient, without guidance |
| Interpretive | Counsellor: helps uncover and order values | Unclear; clarified in conversation | The patient |
| Deliberative | Teacher or friend: talks it through and recommends | Open to reflection and change in dialogue | Together, with the patient having the last word |
Clinical notes
- About 4 in 10 patients experienced a decision role different from the one they preferred; those who took part less than they wished reported more regret.
- A better relationship goes with better adherence and satisfaction; physician empathy goes with more shared decision-making.
- Extreme paternalism and the pure informative model fail for opposite reasons: one ignores the patient's values, the other leaves the patient alone with data.
Test yourself
Think of the answer, then tap the question to see it.
In which of Emanuel's models does the doctor only give facts and the patient choose without guidance?
The informative model. The doctor acts as a technical expert and assumes the patient's values are already clear.
What separates the deliberative model from the interpretive one?
In the deliberative model the doctor also discusses which health values are worth pursuing and may recommend or persuade; in the interpretive model the doctor only helps clarify the patient's values.
In Szasz and Hollender's scheme, which model fits an unconscious patient in the emergency department?
Active–passive: the doctor acts and the patient cannot take part.
Besides the disease, what does patient-centred care explore?
The patient's illness experience: their ideas about what is happening, their concerns, expectations and the effect on their life, to reach an agreed plan.
Elsewhere in DurgiPedia
Connections
Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.
Sources: Communication in Cancer Care (PDQ®)–Health Professional Version (National Cancer Institute (US), 2025); Talking With Your Doctor: MedlinePlus (National Library of Medicine (US), 2025).
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Representative model, for educational purposes only.