Paternalism, participation and partnership - the evolution of patient centeredness in the consultation

Patient Educ Couns. 2009 Feb;74(2):150-5. doi: 10.1016/j.pec.2008.08.017. Epub 2008 Oct 18.


Objective: There is much discussion at present on the need for a more patient-centered health service. However, it is not always clear what exactly this means for patients or healthcare providers. Furthermore many current trends in healthcare and society may in fact move the consultation further from the patient-centered model. In this article I shall critically review the current state of the consultation.

Methods: This article is based on a critical review of the literature. I shall firstly outline what is meant by the terms 'patient centeredness' and 'participation'. I shall then examine what wider factors may facilitate or impede effective communication within the consultation.

Results: Patient centeredness and participation is challenged by several factors including the 'co-modification' of healthcare, the information revolution, the tension between choice and continuity, the process of medicalisation, population health strategies and the availability of resources.

Conclusion: I will argue that precisely because of these wider trends in society the consultation is now more important than ever as a point of access, communication, understanding and delivery of healthcare.

Practice implications: The structure and aims of the consultation must be re-visited in the light of the rapid pace of change in service delivery. As such, healthcare professionals may need to advocate for the continuing role of the patient-centered consultation.

Publication types

  • Review

MeSH terms

  • Communication
  • Cooperative Behavior
  • Evidence-Based Medicine
  • Family Practice
  • Humans
  • Negotiating
  • Paternalism* / ethics
  • Patient Advocacy
  • Patient Education as Topic
  • Patient Participation / methods
  • Patient Participation / psychology
  • Patient Participation / trends*
  • Patient-Centered Care / ethics
  • Patient-Centered Care / trends*
  • Philosophy, Medical
  • Physician's Role / psychology
  • Physician-Patient Relations* / ethics
  • Power, Psychological
  • Primary Health Care
  • Referral and Consultation / ethics
  • Referral and Consultation / trends*
  • Social Change