Conflict models, in contrast to consensual models focus not on the state but on the aims of the DPR. Friedson emphasized the fact that often, the patient guides the doctor, a not uncommon aspect in care for chronic conditions, or where the doctor becomes passive and the patient active in the care process.

These models recognise the conflict that often exists between the aims of the doctor (to control a symptom) and those of the patient (e.g. to regain a normal life).