Models of the physician-patient relationship.

g the last two decades or so, there has been a ggle over the patient's role in medical decision aking that is often characterized as a conflict tween autonomy and health, between the values bf, the patient and the values of the physician. Seeking to curtail physician dominance, many have advocated an ideal of greater patient con( rol.',2 Others question this ideal because it fails to acknowledge the potentially unbalanced nature of this interaction when one party is sick and searching for security, and when judgments entail the interpretation of technical information." Still others are trying to delineate a more mutual relationship.'-' This struggle shapes the expectations of physicians and patients as well as the ethical and legal standards for the phVsician's duties, informed consent, and medical malpractice. This struggle forces its to ask, What should be the ideal physician-patient relationship? We shall outline four models of the physicianpatient interaction, emphasizing the different understandings of (1) the goals of the phvsicianpatient interaction, (2) the physician's obligations, (3) the role of patient values, and (4) the conception of patient autonomy. To elaborate the abstract description of these four models, we shall indicate the types of response the models might suggest in a clinical situation. Third, we shall also indicate how these models inform the current debate about the ideal physician-patient relationship. Finally, we shall evaluate these models and recommend one as the preferred model. As outlined, the models are Weberian ideal types. They may not describe any particular physician-patient interactions but they highlight, free from complicating details, different visions of the essential characteristics of the physician-patient