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Am Fam Physician. 2005;71(7):1261

to the editor: Family medicine is a discipline that has always supported a patient’s right to medical care. Family physicians are advocates for their patients and consider them as equal partners in their health care. Our primary focus as family physicians is on the development and maintenance of a trusting relationship with our patients.1,2

It is interesting that in the developed world an autonomy-based model of medical practice exists that has evolved from a more paternalistic model.3 In parts of the developing world, there is still a paternalistic model of medical practice that is now reported to be in transition toward a model based more on patient autonomy.4

The traditional paternalistic model of medical practice assumes that the physician knows what is best for the patient.4 The patient in such a model is a passive recipient of the medical care, which violates fundamental patient rights and therefore cannot be supported. However, the good aspect of such a model is the trust that a patient has in his or her physician,5 which unfortunately can be violated.

The patient autonomy model of medical practice protects patient rights, gives them partnership status in their health care, and involves them in the decision making process. However, this can sometimes have detrimental consequences for the trusting relationship that existed between the physician and the patient. The focus is on providing care to the patient while safeguarding against a possible lawsuit. This can seriously erode the trust between physician and patient.

We, in the developing world, are perhaps witnessing the gradual demise of the strong paternalistic model of medical practice; this is a welcome happening, but at the same time we are wary of the possible advent of a strong patient-autonomy–based model, whereby the trusting relationship is likely to be eroded.

There are good aspects in both of these models of medical practice. Physicians should ensure to keep them in order to guarantee patient rights and maintain the trust in the physician-patient relationship.

We, as primary care physicians, are in an ideal situation to ensure medical practice that is ethical and based on dignity and respect for physicians and patients.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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