Skip to main content
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1994 Jul 15;151(2):171–176.

Physicians in health care management: 7. The patient-physician partnership: changing roles and the desire for information.

R B Deber 1
PMCID: PMC1336877  PMID: 8039062

Abstract

Historical views of the patient-physician relationship assumed that the physician's role was to act in the best interests of the patient and to direct care and make decisions about treatment on the patient's behalf. However, under current legal and ethical principles, beneficence is no longer sufficient; respect for autonomy is paramount, necessitating patient participation. None the less, physicians question whether patient participation is realistic in actual clinical situations. This first of two articles reviews models of the patient-physician relationship and the literature about barriers to participation, the effect of participation on patient outcome and the extent to which patients want to be informed. The image of a dependent patient who prefers to be sheltered from harsh truths is not supported. It appears that most patients wish to have information, although there is an identifiable proportion who do not. To be understood, health information must be presented in a way that is appropriate to the patient. Format, content and timing of the material are all important. Mechanisms for incorporating such information into busy clinical practices are crucial.

Full text

PDF
174

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alder E., Templeton A. A. Patient reaction to IVF treatment. Lancet. 1985 Jan 19;1(8421):168–168. doi: 10.1016/s0140-6736(85)91940-3. [DOI] [PubMed] [Google Scholar]
  2. Barry M. J., Mulley A. G., Jr, Fowler F. J., Wennberg J. W. Watchful waiting vs immediate transurethral resection for symptomatic prostatism. The importance of patients' preferences. JAMA. 1988 May 27;259(20):3010–3017. [PubMed] [Google Scholar]
  3. Beisecker A. E., Beisecker T. D. Patient information-seeking behaviors when communicating with doctors. Med Care. 1990 Jan;28(1):19–28. doi: 10.1097/00005650-199001000-00004. [DOI] [PubMed] [Google Scholar]
  4. Ben-Sira Z. The function of the professional's affective behavior in client satisfaction: a revised approach to social interaction theory. J Health Soc Behav. 1976 Mar;17(1):3–11. [PubMed] [Google Scholar]
  5. Blanchard C. G., Labrecque M. S., Ruckdeschel J. C., Blanchard E. B. Information and decision-making preferences of hospitalized adult cancer patients. Soc Sci Med. 1988;27(11):1139–1145. doi: 10.1016/0277-9536(88)90343-7. [DOI] [PubMed] [Google Scholar]
  6. Boyd N. F., Sutherland H. J., Heasman K. Z., Tritchler D. L., Cummings B. J. Whose utilities for decision analysis? Med Decis Making. 1990 Jan-Mar;10(1):58–67. doi: 10.1177/0272989X9001000109. [DOI] [PubMed] [Google Scholar]
  7. Brody D. S., Miller S. M., Lerman C. E., Smith D. G., Lazaro C. G., Blum M. J. The relationship between patients' satisfaction with their physicians and perceptions about interventions they desired and received. Med Care. 1989 Nov;27(11):1027–1035. doi: 10.1097/00005650-198911000-00004. [DOI] [PubMed] [Google Scholar]
  8. Brody D. S. The patient's role in clinical decision-making. Ann Intern Med. 1980 Nov;93(5):718–722. doi: 10.7326/0003-4819-93-5-718. [DOI] [PubMed] [Google Scholar]
  9. Cassileth B. R., Zupkis R. V., Sutton-Smith K., March V. Information and participation preferences among cancer patients. Ann Intern Med. 1980 Jun;92(6):832–836. doi: 10.7326/0003-4819-92-6-832. [DOI] [PubMed] [Google Scholar]
  10. Christensen-Szalanski J. J., Boyce W. T., Harrell H., Gardner M. M. Circumcision and informed consent. Is more information always better? Med Care. 1987 Sep;25(9):856–867. [PubMed] [Google Scholar]
  11. DILLON H., LEOPOLD R. L. Children and the post-concussion syndrome. JAMA. 1961 Jan 14;175:86–92. doi: 10.1001/jama.1961.03040020012003. [DOI] [PubMed] [Google Scholar]
  12. EGBERT L. D., BATTIT G. E., WELCH C. E., BARTLETT M. K. REDUCTION OF POSTOPERATIVE PAIN BY ENCOURAGEMENT AND INSTRUCTION OF PATIENTS. A STUDY OF DOCTOR-PATIENT RAPPORT. N Engl J Med. 1964 Apr 16;270:825–827. doi: 10.1056/NEJM196404162701606. [DOI] [PubMed] [Google Scholar]
  13. Eisenthal S., Lazare A. Evaluation of the initial interview in a walk-in clinic. The patient's perspective on a "customer approach". J Nerv Ment Dis. 1976 Mar;162(3):169–176. doi: 10.1097/00005053-197603000-00003. [DOI] [PubMed] [Google Scholar]
  14. Ende J., Kazis L., Ash A., Moskowitz M. A. Measuring patients' desire for autonomy: decision making and information-seeking preferences among medical patients. J Gen Intern Med. 1989 Jan-Feb;4(1):23–30. doi: 10.1007/BF02596485. [DOI] [PubMed] [Google Scholar]
  15. Forrow L., Wartman S. A., Brock D. W. Science, ethics, and the making of clinical decisions. Implications for risk factor intervention. JAMA. 1988 Jun 3;259(21):3161–3167. [PubMed] [Google Scholar]
  16. Fowler F. J., Jr, Wennberg J. E., Timothy R. P., Barry M. J., Mulley A. G., Jr, Hanley D. Symptom status and quality of life following prostatectomy. JAMA. 1988 May 27;259(20):3018–3022. [PubMed] [Google Scholar]
  17. Gray R. E., Doan B. D., Church K. Empowerment and persons with cancer: politics in cancer medicine. J Palliat Care. 1990 Summer;6(2):33–45. [PubMed] [Google Scholar]
  18. Greenfield S., Kaplan S. H., Ware J. E., Jr, Yano E. M., Frank H. J. Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988 Sep-Oct;3(5):448–457. doi: 10.1007/BF02595921. [DOI] [PubMed] [Google Scholar]
  19. Greenfield S., Kaplan S., Ware J. E., Jr Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985 Apr;102(4):520–528. doi: 10.7326/0003-4819-102-4-520. [DOI] [PubMed] [Google Scholar]
  20. Henriques B., Stadil F., Baden H. Cancer. A prospective study of patients' opinion and reaction to information about cancer diagnosis. Acta Chir Scand. 1980;146(5):309–311. [PubMed] [Google Scholar]
  21. Herman J. M. The use of patients' preferences in family practice. J Fam Pract. 1985 Feb;20(2):153–156. [PubMed] [Google Scholar]
  22. Lerman C. E., Brody D. S., Caputo G. C., Smith D. G., Lazaro C. G., Wolfson H. G. Patients' Perceived Involvement in Care Scale: relationship to attitudes about illness and medical care. J Gen Intern Med. 1990 Jan-Feb;5(1):29–33. doi: 10.1007/BF02602306. [DOI] [PubMed] [Google Scholar]
  23. McNeil B. J., Weichselbaum R., Pauker S. G. Fallacy of the five-year survival in lung cancer. N Engl J Med. 1978 Dec 21;299(25):1397–1401. doi: 10.1056/NEJM197812212992506. [DOI] [PubMed] [Google Scholar]
  24. Novack D. H., Plumer R., Smith R. L., Ochitill H., Morrow G. R., Bennett J. M. Changes in physicians' attitudes toward telling the cancer patient. JAMA. 1979 Mar 2;241(9):897–900. [PubMed] [Google Scholar]
  25. Pauker S. G., McNeil B. J. Impact of patient preferences on the selection of therapy. J Chronic Dis. 1981;34(2-3):77–86. doi: 10.1016/0021-9681(81)90053-9. [DOI] [PubMed] [Google Scholar]
  26. Quill T. E. Partnerships in patient care: a contractual approach. Ann Intern Med. 1983 Feb;98(2):228–234. doi: 10.7326/0003-4819-98-2-228. [DOI] [PubMed] [Google Scholar]
  27. Robinson E. J., Whitfield M. J. Improving the efficiency of patients' comprehension monitoring: a way of increasing patients' participation in general practice consultations. Soc Sci Med. 1985;21(8):915–919. doi: 10.1016/0277-9536(85)90148-0. [DOI] [PubMed] [Google Scholar]
  28. Roter D. L. Patient participation in the patient-provider interaction: the effects of patient question asking on the quality of interaction, satisfaction and compliance. Health Educ Monogr. 1977 Winter;5(4):281–315. doi: 10.1177/109019817700500402. [DOI] [PubMed] [Google Scholar]
  29. Schulman B. A. Active patient orientation and outcomes in hypertensive treatment: application of a socio-organizational perspective. Med Care. 1979 Mar;17(3):267–280. doi: 10.1097/00005650-197903000-00004. [DOI] [PubMed] [Google Scholar]
  30. Seeman M., Seeman T. E. Health behavior and personal autonomy: a longitudinal study of the sense of control in illness. J Health Soc Behav. 1983 Jun;24(2):144–160. [PubMed] [Google Scholar]
  31. Speedling E. J., Rose D. N. Building an effective doctor-patient relationship: from patient satisfaction to patient participation. Soc Sci Med. 1985;21(2):115–120. doi: 10.1016/0277-9536(85)90079-6. [DOI] [PubMed] [Google Scholar]
  32. Stiles W. B., Putnam S. M., James S. A., Wolf M. H. Dimensions of patient and physician roles in medical screening interviews. Soc Sci Med. 1979 May;13A(3):335–341. [PubMed] [Google Scholar]
  33. Strull W. M., Lo B., Charles G. Do patients want to participate in medical decision making? JAMA. 1984 Dec 7;252(21):2990–2994. [PubMed] [Google Scholar]
  34. Veatch R. M. Models for ethical medicine in a revolutionary age. What physician-patient roles foster the most ethical realtionship? Hastings Cent Rep. 1972 Jun;2(3):5–7. [PubMed] [Google Scholar]
  35. Wasserman R. C., Inui T. S., Barriatua R. D., Carter W. B., Lippincott P. Pediatric clinicians' support for parents makes a difference: an outcome-based analysis of clinician-parent interaction. Pediatrics. 1984 Dec;74(6):1047–1053. [PubMed] [Google Scholar]
  36. Weiss S. J. Consensual norms regarding patient involvement. Soc Sci Med. 1986;22(4):489–496. doi: 10.1016/0277-9536(86)90053-5. [DOI] [PubMed] [Google Scholar]
  37. Wennberg J. E., Mulley A. G., Jr, Hanley D., Timothy R. P., Fowler F. J., Jr, Roos N. P., Barry M. J., McPherson K., Greenberg E. R., Soule D. An assessment of prostatectomy for benign urinary tract obstruction. Geographic variations and the evaluation of medical care outcomes. JAMA. 1988 May 27;259(20):3027–3030. [PubMed] [Google Scholar]
  38. Wennberg J. E. Outcomes research, cost containment, and the fear of health care rationing. N Engl J Med. 1990 Oct 25;323(17):1202–1204. doi: 10.1056/NEJM199010253231710. [DOI] [PubMed] [Google Scholar]
  39. Woolley F. R., Kane R. L., Hughes C. C., Wright D. D. The effects of doctor--patient communication on satisfaction and outcome of care. Soc Sci Med. 1978 Mar;12(2A):123–128. [PubMed] [Google Scholar]
  40. Wright J., Duchesne C., Sabourin S., Bissonnette F., Benoit J., Girard Y. Psychosocial distress and infertility: men and women respond differently. Fertil Steril. 1991 Jan;55(1):100–108. [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES