Patient-doctor decision-making about treatment within the consultation--a critical analysis of models

Soc Sci Med. 2006 Jan;62(1):116-24. doi: 10.1016/j.socscimed.2005.05.017. Epub 2005 Jun 29.


This paper highlights some of the limitations of models of patient involvement in decision-making and explores the reasons for, and implications of, these limitations. Taking the three models of interpretative, shared and informed decision-making as examples, we focus on two limitations of the models: (1) neglect of which decisions the patient should be involved in (the framing problem) and (2) how the patient should be involved in decision-making (the nature of reasoning problem). Although there will inevitably be a gap between models and practice--this much is in the nature of the models--we suggest that these two issues are substantially neglected by the models and yet are fundamental to understanding patient-doctor decision-making. We also suggest that the fundamental problem that lies behind these limitations is insufficient attention to, and explicitness about, the dilemmas of professional ethics, which are played out in the professional-patient relationships that the models are supposed to represent, particularly with respect to the issue of expert and lay accountability.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel
  • Clinical Competence
  • Decision Making*
  • Humans
  • Interviews as Topic
  • Models, Theoretical*
  • Paternalism
  • Patient Education as Topic
  • Patient Participation*
  • Patient Satisfaction
  • Physician-Patient Relations*
  • Qualitative Research
  • Social Responsibility
  • United Kingdom