Many metaphors and models have been applied to relationships between patients and physicians. One example is an interpretation of physician-patient relationships as paternalistic. In this case, the physician is regarded as a parent and the patient is regarded as a child. Opponents of such a paternalistic view of medicine rarely reject the use of metaphors to interpret medical relationships; rather, they simply offer alternative metaphors, for example, the physician as partner or the patient as rational contractor. Metaphors may operate even when patients and physicians are unaware of them. Physician-patient conflicts may arise if each party brings to their encounter a different image of medicine, as, for example, when the physician regards a paternalistic model of medicine as appropriate, but the patient prefers a contractual model.As these examples suggest, metaphors involve seeing something as something else, for example, seeing a lover as a red rose, human beings as wolves, or medical therapy as warfare. Metaphors highlight some features and hide other features of their principal subject. 1 Thus, thinking about a physician as a parent highlights the physician's care for dependent others and his or her control over them, but it conceals the patient's payment of fees to the physician. Metaphors and models may be used to describe relationships as they exist, or to indicate what those relationships ought to be. In either the descriptive or the prescriptive use of metaphors, this highlighting and hiding occurs, and it must be considered in determining the adequacy of various metaphors. When metaphors are used to describe roles, they can be criticized if they distort more features than they illuminate. And when they are used to direct roles, they can be criticized if they highlight one moral consideration, such as care, while neglecting others, such as autonomy.Since there is no single physician-patient relationship, it is probable that no single metaphor can adequately describe or direct the whole range of relationships in health care, such as open heart surgery, clinical research, and psychoanalysis. Some of the most important metaphors that have shaped health care in recent years include: parent-child, partners, rational contractors, friends, and technician-client. We want to determine the adequacy of these metaphors to describe and to direct doctor-patient relationships in the real world. In particular, we will assess them in relation to patient and physician autonomy.