FOUR MODELS OF THE HEALTH PROFESSIONAL-

PATIENT/CLIENT RELATIONSHIP

• Paternalistic

• Informative

• Interpretive

• Deliberative

PATERNALISTIC MODEL

(Priestly, Parental)

• Selected information provided that will encourage patient/client to consent to intervention health professional considers best.

• At extreme, health professional tells patient/client when intervention will be initiated.

• Acts as patient/client guardian.

• Conception of patient/client’s autonomy is assent to health professional’s determination of what best.

• Health professional’s FACTS and VALUES.

INFORMATIVE MODEL

(Scientific, Engineering, Consumer)

• Objective of interaction is for health professional to provide patient/client with all relevant information; for patient/client to select interventions he or she wants and health professional to execute intervention.

• Assumes clear distinction between facts and values. Patient’s values are known but lack facts. Health professional provides facts, and patient/client’s values determine the treatments to be given. There is no role for health professional’s values.

• Health professional is purveyor of technical expertise.

• Conception of patient/client autonomy is patient control over decision making.

• Health professional’s FACTS and patient/client’s VALUES.

INTERPRETIVE MODEL

• Aim of health professional – patient/client interaction is to elucidate the patient/client’s values and to help the patient/client select the available interventions that realize these values.

• While providing information, the health professional also assists the patient/client in elucidating and articulating values. Model assumes patient/client’s values are not necessarily fixed or known.

• Health professional does not dictate; it is the patient/client who ultimately decides which values an course of action best fit.

• Health professional as counselor; engaging patient/client in joint process of understanding.

• Conception of patient/client autonomy is self-understanding.

• Health professional’s FACTS and patient/client’s VALUES as elucidated/interpreted/understood by the health professional.

DELIBERATIVE MODEL

• Aim is to help patient/client determine and chose best health-related values that can be realized in the clinical situation.

• Delineates relevant information on the patient/client’s situation and helps elucidate types of values embodied in available options. Health professional suggests why certain health related values are more worthy and should be aspired to.

• Health professionals actions are no more than persuasive -- coercion is avoided.

• Health professional as teacher (doctor) or friend.

• Conception of patient/client autonomy is moral self-development; patient empowered to consider, through dialogue, alternative health-related values, their worthiness, and their implications for treatment.

• Health professional’s FACTS and VALUES, and patient/client’s VALUES