Patient autonomy: evolution of the doctor-patient relationship.

In recent years, much has been said about the shifting locus of control in clinical practice. This article discusses the influence on the physician-patient relationship of recent social and political history, patient culture and experience, and advances in medical practice. I suggest that effective partnerships between physicians and patients are possible in a supportive institutional environment in which the participants acknowledge and fulfil their roles and responsibilities in shared decision-making. While I recognize that there is considerable variability in practices across cultures and in individual behaviour, the scope of this article is based on literature and my knowledge, which is representative primarily of the North American experience.