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# 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.

Updated Nov 5, 2026

## Key points

- Paternalistic: the doctor decides what they think is best and the patient assents; the doctor acts as guardian.
- Informative: the doctor gives technical facts and the patient chooses alone; it assumes the patient's values are already clear.
- Interpretive: the doctor helps the patient clarify what they value, then the patient decides.
- Deliberative: doctor and patient discuss which health values are worth pursuing; the doctor may recommend and persuade, never coerce.
- Szasz and Hollender: active–passive (unconscious patient in an emergency), guidance–cooperation (acute illness) and mutual participation (chronic illness).
- Patients do not all want the same role: ask each one how much they wish to take part.

## 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.

## Memory aid

From ‘I decide for you’ to ‘let us decide together’: Parent, Informant, Interpreter and Deliberator, in order of more dialogue about values.

## 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.

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## Elsewhere in DurgiPedia

- [The medical interview: rapport, open questions and listening](https://durgical.com/en/clinical-exam/the-medical-interview-rapport-open-questions-and-listening/)

## Connections

## Related 6

- [Shared decision-making](https://durgical.com/en/behavioral-science/shared-decision-making/)
- [Communication skills: open questions, empathy and teach-back](https://durgical.com/en/behavioral-science/communication-skills-open-questions-empathy-and-teach-back/)
- [Culture, explanatory models and interpreters](https://durgical.com/en/behavioral-science/culture-explanatory-models-and-interpreters/)
- [Difficult encounters: anger, demands and boundaries](https://durgical.com/en/behavioral-science/difficult-encounters-anger-demands-and-boundaries/)
- [The reaction to illness: sick role, illness behavior and hospitalization](https://durgical.com/en/behavioral-science/the-reaction-to-illness-sick-role-illness-behavior-and-hospitalization/)
- [Adherence: what it is and why it fails](https://durgical.com/en/behavioral-science/adherence-what-it-is-and-why-it-fails/)

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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](https://www.cancer.gov/about-cancer/coping/adjusting-to-cancer/communication-hp-pdq) (National Cancer Institute (US), 2025); [Talking With Your Doctor: MedlinePlus](https://medlineplus.gov/talkingwithyourdoctor.html) (National Library of Medicine (US), 2025).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/behavioral-science/models-of-the-doctor-patient-relationship-and-patient-centred-care/