Governance mechanisms in the physician–patient relationship: a literature review and conceptual framework

Abstract Background The physician–patient relationship is a critical component of the integrated approach to excellence in health‐care delivery. Although commonly modelled within the boundaries of the agency theory and regarded as synonymous to an agent–principal interaction, there exists only a sparse understanding about the most effective ways of governing it. Objective This article undertakes a selective review of the growing body of research on the governance of the physician–patient relationship to discuss the current state of the knowledge in the field and suggest promising avenues for further exploration. Findings On the basis of an extensive analysis of the relevant literature, we identify two emerging streams of inquiry on the trust‐based (i.e. trust and ethical oversight) and distrust‐based (i.e. patient information‐empowerment and decision‐making authority) governance mechanisms of the physician–patient relationship and discuss the key findings within each stream. Discussion To conciliate the on‐going scholarly debate concerning the efficacy of trust‐ and distrust‐based mechanisms, we draw the foundations of a conceptual framework which might serve as a guide for more integrative research endeavours on the governance of the physician–patient relationship.