Physician-family partnerships: The adaptive practice model

In the traditional medical model, the physician, acting in the best interes ts of the patient, assumes full responsibility for delivering information, making decisions about treatment, and providing care. This model is not sui table for chronic care or preventive health maintenance. Recent alternative s to this model include participatory decision-making and family-centered c are, clinical approaches in which the patient and family share the responsi bility for decision-making with the physician, Research has demonstrated th at patients and families vary in their willingness to make decisions about care, The Adaptive Practice model describes how compassionate and effective medical practice ranges from traditional hierarchical relationships to ful l patient or family control, depending on the situation. Four different cli nical approaches-directing, teaching, collaborating, and supporting-result from variations in the direction of leadership and in the degree of interac tion in the situation. Each approach is suitable for specific situations. F or example, directing is appropriate in emergencies or crises. Supporting i s appropriate when families are both knowledgeable and motivated to make de cisions that affect their quality of life, Sensitive physicians assess the situation, negotiate an approach suitable to the family's and patient's nee ds at the time, and adjust their approach as the partnership evolves. The A daptive Practice model provides a structure for analyzing clinical situatio ns, choosing clinical approaches, and understanding problems in physician-f amily relationships when they arise.