Models of the Physician-Patient Relationship-Reply

In Reply. —Defining the deliberative model as the paradigmatic physician-patient relationship serves heuristic and normative functions. For instance, the ideal guides physicians when they are uncertain; it also provides the shared assumptions and standards for physicians, patients, and society in general when evaluating medical practices. Nevertheless, just as physicians recognize that there is optimal clinical care for a particular disease and that deviation may be appropriate in particular clinical circumstances and for particular patients, so too there is an optimal physician-patient relationship and deviation from it may be appropriate in certain circumstances. As we stated, "Under different clinical circumstances [such as emergencies] different models may be appropriate.... [These deviations] would not be automatically condemned, but would require justification based on the circumstances of the clinical situation." These comments should make it clear that we agree with Drs Devereux and Silber, Mr Firlik, and Ms Schreiber. The best physician-patient relationship is