4.3.1 50-60

Until the late fifties of the last century the medico-centric perspective dominated the patient-physician relationship. The physician had authority and was solely responsible for decisions about diagnosis and treatment. Especially in medical specialist consultations, patient education only consisted of disease related information, often in incomprehensible medical language, and treatment related directions. Patients were not expected to participate actively in diagnosis and treatment decisions and their ideas, beliefs and values were not taken into account.

In his book "The doctor, his patient and the illness" Michael Balint was one of the first to stress the importance of good patient-physician communication [Balint 1957]. He stated that the physician himself was the most used medicine in general practice and also that despite our lack of knowledge about the effects of reassurance and advising, both are probably the most frequently used types of medical treatment. He asked for recognition of the emotional as well as the physical aspects of a patient's complaint and was probably the first to advocate the skills of attentive listening to patients. Balint's ideas inspired many general practitioners especially in their approach to patients with medically unexplained complaints. However, these ideas mainly focused on the diagnosis of physical complaints and patient education was still not much in view. Although the study of patient adherence dates back to the 1940s and the terms compliance and adherence were first used in 1966 [Dimatteo 2004], in specialist medicine consultations less than 5% of consultation time was used for patient education [Waitzkin 1976].