Models of the Physician-Patient Relationship

To the Editor. —Regarding the four models of the physician-patient relationship by Emanuel and Emanuel,¹ I suggest that they need to be expanded and/or adapted to the special case of the physician-adolescent patient relationship.^2-4 This is an important stage in life when abstract thought develops, the capacity for reflection grows, and the need to establish an identity (to which the development of a value system is essential) becomes first and foremost.³ What happens at the time of this "second period of individuation" will have a dramatic impact throughout adult life.⁴ Hence the importance of the interaction with parents, teachers, and physicians. For many teenagers, the physician-adolescent encounter may be the first time they experience being taken seriously "as persons."⁵ The deliberative model is a natural for adolescents.

Moreover, the deliberative model especially needs to be used with teenagers at any physician encounter because they are