The evolution of the physician-patient relationship: from information to counselling

The physician-patient relationship has changed over time: in the nineteenth century it was characterised by professional dominance; in the twentieth century a unilateral aleatory contract came into being between the professional and his client; it is expected that in the future medical practice will come to be based on individual genetic predisposition, where treatment will precede early symptoms and illnesses will be treated with personalised remedies and medicines. Until now, government policies have mainly aimed at safeguarding patients’ health; today evermore attention is being paid to patients’ right to self-determination. Society’s perception of the physician has also changed: the physician is no longer seen as the custodian of an absolute knowledge, but rather as a service provider and the patient has come to be seen as a consumer.Over the last decades patients’ protection has seen the rule of informed consent and efforts to favour patients under the law. Europe now fears that this favouritism will eventually trigger a crisis similar to the one which overwhelmed the U.S.A: in the U.S. the consequence was the halting of the lay standard in favour of the professional one; in Europe a defensive practice has come into being. This practice is based on complex risk management procedures and strict protocols consisting of many forms and very detailed information leaflets. Today, these two aspects - the preference of patients’ right to self-determination and defensive practices - are the main reasons behind the physicianpatient relationship transformation. Traditional one-way physician-patient communication is being replaced by dialogue. The move is one from information to counselling. The paternalistic approach of traditional medicine has already been replaced by the principle of physician-patient cooperation, which is a prelude to modern “talking medicine”. This paper focuses on describing this medical approach change and the juridical and practical implications that come with it