AND EIGHT MODELS OF PHYSICIAN-PATIENT RELATIONSHIPS

The Concept of Care

The Lady With the Lamp

A nurseConsidered “curing”, the

use of therapeutics, less important to patient outcome

Assigned the task of “caring” to the nurse

“Doctors cure and nurses care”

Does this paradigm still exist?

Ingrained into society Patients influence professional

self-perceptionWhat are the implications?

Lack of clarity on the concept of care

Dissociates physicians from caring, and encourages a one-dimensional idea of nursing care

Producing the Dichotomy

Expectation of nurses to: Follow procedures Report incidents to supervisors Organize wards/departments

Whereas physicians: Order procedures Make decisions Lead wards/departments

Why Men in Medicine Tend to be MDs

Project danger into intimacyMore comfortable with

personal achievement

Why Most Nurses are Women

Project danger into situations related to personal achievement

More comfortable in activities that involve closeness

Medicine an objective science that denies subjectivity

Another suggestion

Early 19th-century thinking shifted the female image from seductive to pure

This prudery confined the social roles they were qualified to fill

Seen as unfit for medicine based on the need to restrain natural sympathies

On the Contrary

Male nursing graduates 1,694 in 1972 3,492 in 1981

More likely to advance to higher positions

Although...

Historical Case

Pre-1870 “Nurses” were

housewives/daughters “Domestic Medicine”

advised to rarely consult with physicians

In physician’s presence, nurses act as assistants

Professionalizing the Physician

Involved a separation from laypersons

Requires emphasis on special skills

At odds with empathy and caring

Concept of Care

Distinction between “care” and “cure”?

“Cure” from “curare” – to care for

Therefore cure a part of caring Possible to cure without caring?

Caring For versus Caring About

Two definitions for care: “A burdened state of mind arising from... Concern

about anything... Mental perturberation Caring about

“Oversight with the view to protection, preservation, or guidance: hence to have the care of” Caring for

Care-based Interaction

Caring For and About a Patient

Caring For, but Not About a Patient

Caring About, but Not For a Patient

Caring Neither For nor About a Patient

Caring For and About A Patient

Caring For, but Not About a Patient

Caring About, but Not For a Patient

Neither Caring For nor About a Patient

Four Models of the Physician-Patient Relationship

GoalsPhysician

obligationsRole of patient

valuesConception of

patient autonomy

Paternalistic Model

Aka Parental or PriestlyGoal to promote patient’s

well-being despite preference

Assumes shared objective values

Little/no autonomy“You’ll thank me later”Guardian

Informative Model

Aka Scientific or Engineer

Goal to provide extensive information and let patient decide intervention

Assumes patient values are known and fixed

Full autonomyTechnical expert

Interpretive Model

Goal to elucidate patient values and help find a suitable intervention

Patient values are unclear

Autonomy in self-understanding

Counselor or Advisor

Deliberative Model

Goal to support admirable values and providing relevant information

Open to development through moral discussion

Self-developmentFriend or Teacher

Connecting the Models

For/About For/About For/About For/About

Paternalistic Informative Interpretive Deliberative

Sources

E. Emanuel & L. Emanuel, Four Models of the Physician-Patient Relationship. In E. Boetzkes & W. Waluchow (Eds.), Readings in Health Care Ethics (pp.39-49). Toronto: Broadview Press.

N. Jecker & D. Self, Separating Care and Cure: An Anaylysis of Historical and Contemporary Images of Nursing and Medicine. In E. Boetzkes & W. Waluchow (Eds.), Readings in Health Care Ethics (pp.57-68). Toronto: Broadview Press.