Family Practice Vol. 9, No. 2, 210-218
© Oxford University Press 1992
research-article |
A Negotiation Model for the Doctor-Patient Relationship
Associate Professor of Family Medicine and Psychiatry, Director of Fellowship Training Program. Faculty Medicine Center, 885 South Avenue, Highland Hospital, Department of Family Medicine, University of Rochester Rochester, NY 14620, USA
A model has been developed to help physicians negotiate with patients in more explicit and effective ways. This model provides physician teachers and learners with a framework and a common language to describe the dynamic nature of the doctor-patient negotiation. This framework consists of three dimensions: content, relationship levels, and the problem-solving phases. The constructs of disease, illness, sickness and the patient's context are used to describe the content of negotiation: this is what the doctor and patient are talking about. Autonomy, power, control and responsibility are the constructs that define the relationship levels: autonomism, egalitarianism, parentalism, and autocracy. These levels describe how the doctor and patient relate to one another during their negotiation. The problem-solving phases are relationship building, agenda setting, assessment, problem clarification, management and closure. Teachers and learners can use this model to describe how the doctor and the patient affect the negotiation process, and how that process in turn affects the doctor-patient relationship and medical care. With practice using this model, physicians can increase their repertoire of negotiating strategies that will efficiently enhance doctor-patient collaboration, the problem-solving process and the health of the patient and family.