**Abstract**

Patient-doctor relationship has traditionally been paternalistic, in which the doctor decided on behalf of the patient. It focused mainly between the patient who called for help and the doctor whose decisions had to be silently observed and followed by the patient. In this paternalistic model, the physician used his skills to choose the necessary interventions and treatments that were likely to restore the health of the patient. All the information given to the patient was selected to encourage them to consent to the doctor's decisions. This definition of the asymmetric or unbalanced interaction between physicians and patients has begun to be questioned over the last 20 years. There has been a shift from this direction to one where the patient is more informed, empowered, and independent - a move from a "paternalistic" to a more "complementary" relationship. Critics suggested a more active, autonomous patient-centered role which supports greater patient control, reduced doctors' dominance, and a more mutual participation. This approach has been described as one where the doctor attempts to enter the patient's world to see the disease with the eyes of the patient and is becoming the predominant model in clinical practice today.

**Keywords:** Shared Decision-Making, Doctor-Patient Relationship, Informed Decision, Patient involvement, Measuring shared decision-making

## **1. Introduction**

The relationship between the patients and the doctors has been dependent through the centuries on the medical situation and the social scene. This relationship was predominantly between a patient seeking help for an illness or symptom and a doctor whose decisions were silently complied with by the patient. The patient-doctor relationship has traditionally been paternalistic, in which the doctor took all decisions on behalf of the patient. Nevertheless, there has been a shift from this direction to one where the patient is more informed, empowered and independent - a move from a "paternalistic" to a more "complementary" relationship. In this 'mutualistic' relationship, the patient is more empowered, informed, and autonomous [1].

This paternalistic doctor-patient relationship focused mainly on the patient, who called for help, and the doctor, whose decisions had to be silently observed and followed by the patient. In this paternalistic model, the physician used his skills to choose the necessary interventions and treatments that were likely to restore the health of the patient. All the information given to the patient was selected to encourage them to consent to the doctor's decisions. This definition of an asymmetric or unbalanced interaction between physician and patient has begun to be questioned over the last 20 years. The critics suggested a more active, autonomous and, therefore, a more patient-centered role which supports greater patient control, reduced doctors' dominance, and a more mutual participation. This patientcentered approach has been described as one where the doctor attempts to enter the patient's world to see the disease with the eyes of the patient and has become the predominant model in clinical practice today [2].

## **2. Historic pathway**

In Ancient Egypt, the doctor-patient relationship was that of a priest-supplicant relationship, retaining the ideology of a parent-figure to manipulate events on behalf of the patient [3]. Such healers used rationality, theology, magic, and mysticism in their care of external and visible disorders. This type of relationship may be defined as activity-passivity type of relationship. This relationship was not changed for years, as there were no technical advances or the appropriate social circumstances to require such a change. During the Greek enlightenment in the 5th century BC, medicine shifted to a naturalistic observation with the elements of trial and error. Based on the Hippocratic Oath, the doctor provided regimen which had to be to the benefit of the patient, irrespective of gender and age. The needs, the well-being and the best interest of the patient were above the doctor's self-interest, respecting confidentiality. This doctor-patient relationship under the Hippocratic approach was based on a guidance-cooperation and mutual participation. During the Medieval times, the doctor, was in a glorious, high ranking position in society, filled with magical powers. The patient was regarded as helpless infants. The relationship between doctor and patient weakened and deteriorated and resembled the activity-passivity model of the ancient times, with the era of witch hunting and incarcerating the mentally ill [2].

The social and cultural changes brought in the transition period of the Renaissance movement and the period towards the French Revolution encompassed innovative flowering of an increased demand for equality, liberalism, and dignity. This, inevitably, led to changes in the doctor-patient relationship from the activitypassivity model to a more guidance-co-operation model [2, 4].

In the 18th century, Medicine was based on symptoms and thus the model of illness was developed. Hospitals emerged to treat ill patients following the foundation of professional nursing by Florence Nightingale. With the development of microbiology and surgery, Medicine focused, not on the symptom but the biomedical model of diagnosis. The expert clinical and anatomical knowledge, the knowledge of the patient's body and the necessity of physically examining the patient, evolved the doctor as an active participant, with the patient becoming more dependent as a result. The relationship resulted in a dominant doctor and a passive patient, i.e. an activity-passivity (paternalistic) model [2].

#### **3. Doctor-patient relationship: the models**

There are three models of the doctor-patient relationship as proposed by [4]: **The model of activity-passivity:** A paternalistic model with limited interaction, as the patient is unable to actively contribute, as they are regarded as helpless

#### *Shared Decision-Making towards a Higher Quality of Care: Is This the Norm? DOI: http://dx.doi.org/10.5772/intechopen.98752*

requiring the doctor's expert knowledge. Treatment is commenced "irrespective of the patient's contribution and regardless of the outcome". This doctor-patient relationship focused mainly between the patient who called for help and the doctor whose decisions had to be silently observed and followed by the patient. In this paternalistic model of doctor-patient relationship, the physician uses his skills to choose the necessary interventions and treatments that are likely to restore the health of the patient. All the information given to the patient is selected to encourage them to consent to the doctor's decisions.

**The model of guidance-co-operation:** This takes into account that, despite the fact that the patient is ill, they are conscious and thus have feelings and aspirations of their own. The patient is, therefore, ready, and willing to "cooperate" and obey to their guidance without question.

**The model of mutual participation:** This model, also advocated by [5], considers that the doctor does not know exactly what is best for the patient. It is argued that there is an equal interaction between the doctor and the patient, having equal power, mutual independence, and equal satisfaction with mutual participation between this relationship. This model has elements of mutual and equal partnership, without power or control of any member of this relationship upon the other. This gives a greater emphasis on patient-centered medicine.
