title: Refusal of treatment by mentally competent patient: the choice of doctor-patient relationship models.
abstract: BACKGROUND
  In modern medicine professional relationship between the clinician and the patient is patient-centered. Patients become actively involved in the treatment decision making process and are encouraged to express their health-related preferences. Some patients may, however, refuse a favorable risk/benefit ratio treatment. This manuscript presents three cases of refusal of treatment by mentally competent surgical patients and discusses differences in their management.
  
  
  CONCLUSIONS
  To achieve the best medical outcome for patients who possess the Actual Understanding test of mental competence clinicians use the deliberate model of medical professional relationship. For patients demonstrating the Understanding test of mental competence and wishing to utilize their health-related preferences physicians are obliged to deploy the interpretive model of doctor-patient relationship. In mentally competent patients with an illness-induced acute psychological regression the interpretive model of doctor-patient relationship as an initial strategy and cognitive behavior therapy can be useful in modifying treatment rejecting behavior and improving medical outcome.
authors.affiliation: General Surgery Deparment, Middlemore Hospital, Auckland, New Zealand. Andrei.Belyaev@middlemore.co.nz
authors.forename: Andrei M
authors.initials: AM
authors.lastname: Beliaev
mesh_terms: D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D010817:Physician-Patient Relations; D013315:Stress, Psychological; D016312:Treatment Refusal / Q000523:psychology*