THE PHYSICIAN-PATIENT ENCOUNTER - THE PHYSICIAN AS A PERFECT AGENT FOR THE PATIENT VERSUS THE INFORMED TREATMENT DECISION-MAKING MODEL

Assuming a goal of arriving at a treatment decision which is based on the physician's knowledge and the patient's preferences, we discuss th e feasibility of implementing two treatment decisionmaking models: (1) the physician as a perfect agent for the patient, and (2) the informe d treatment decision-making models. Both models fall under the rubric of agency models, however, the requirements from the physician and the patient are different. An important distinction between the two model s is that in the former the patient delegates authority to her doctor to make medical decisions and thus the challenge is to encourage the p hysician to find out the patient's preferences. In the latter, the pat ient retains the authority to make medical decisions and the physician role is that of information transfer. The challenge here is to encour age the physician to transfer the knowledge in a clear and nonbiased w ay. We argue that the choice of model depends among other things on th e ease of implementation (e.g., is it simpler to transfer patient's pr eferences to doctors or to transfer technical knowledge to patients?). Also the choice of treatment decision-making model is likely to have an impact on the type of incentives or regulations (i.e., contracts) n eeded to promote the chosen model. We show that in theory both models result in the same outcome. We argue that the approach of transferring information to the patient is easier (but not easy) and, hence, more Feasible than transferring each patient's preferences to the physician in each medical encounter. We also argue that because better ''techno logy'' exists to transfer medical information to patients and time cos ts are involved in both tasks (i.e. transferring preferences or inform ation), it is more feasible to design contracts to motivate physicians to transfer information to patients than to design contracts to motiv ate physicians to find out their patients' utility functions. We illus trate our arguments using a clinical example of the choice of adjuvant chemotherapy versus no adjuvant chemotherapy for women with early sta ge breast cancer. We also discuss issues relating to the current reali ties of clinical practice and their potential implications for the way that economists model physician-patient clinical encounters. (C) 1998 Elsevier Science Ltd. All rights reserved.