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Does giving a sugar pill lead to an undermining of trust between doctor and patient?Is deceiving a patient for his or her own good compatible with a respectful and consent-based doctor–patient relationship?for instance, with patients who do not want to know the truth about their condition.
At the opposite end of this spectrum is the Technocratic Approach to risk communication, in which the physician exerts authoritarian control over the patient's treatment and pushes the patient to accept the treatment plan with which they are presented in a paternalistic manner.
This communication model places the physician in a position of omniscience and omnipotence over the patient and leaves little room for patient contribution to a treatment plan.
A practice which is an alternative to this is for the doctor to make a person's health decisions without considering that person's treatment goals or having that person's input into the decision-making process is grossly unethical and against the idea of personal autonomy and freedom.
The spectrum of a physician's inclusion of a patient into treatment decisions is well represented in Ulrich Beck's World at Risk.
Shared decision making is the idea that as a patient gives informed consent to treatment, that patient also is given an opportunity to choose among the treatment options provided by the physician that is responsible for their healthcare.
This means the doctor does not recommend what the patient should do, rather the patient's autonomy is respected and they choose what medical treatment they want to have done.
In these circumstances and also in cases where there is genuine divergence of medical opinions, a second opinion from another physician may be sought or the patient may choose to go to another physician that they trust more.
Additionally, the benefits of any placebo effect are also based upon the patient's subjective assessment (conscious or unconscious) of the physician's credibility and skills.
Some medical specialties, such as psychiatry and family medicine, emphasize the physician–patient relationship more than others, such as pathology or radiology, which have very little contact with patients.
The quality of the patient–physician relationship is important to both parties.