Physician Recommendations and Patient Autonomy: Finding a Balance between Physician Power and Patient Choice

Timothy E. Quill, Howard Brody

Research output: Contribution to journalReview article

481 Scopus citations


Medical care in the United States has rapidly moved away from a paternalistic approach to patients and toward an emphasis on patient autonomy. At one extreme end of this spectrum is the "independent choice" model of decision making, in which physicians objectively present patients with options and odds but withhold their own experience and recommendations to avoid overly influencing patients. This model confuses the concepts of independence and autonomy and assumes that the physician's exercise of power and influence inevitably diminishes the patient's ability to choose freely. It sacrifices competence for control, and it discourages active persuasion when differences of opinion exist between physician and patient. This paper proposes an "enhanced autonomy" model, which encourages patients and physicians to actively exchange ideas, explicitly negotiate differences, and share power and influence to serve the patient's best interests. Recommendations are offered that promote an intense collaboration between patient and physician so that patients can autonomously make choices that are informed by both the medical facts and the physician's experience.

Original languageEnglish (US)
Pages (from-to)763-769
Number of pages7
JournalAnnals of internal medicine
Issue number9
StatePublished - Nov 1 1996


ASJC Scopus subject areas

  • Internal Medicine

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