Stop playing God, BMJ tells arrogant doctors
Friday 17 September 1999
Old-style medical paternalism, immortalised by Dr Finlay of the television series, is out, and a new style of "partnership' between doctor and patient is now the gold standard. Patients who are involved in their care and have control over their treatment fare better, feel more satisfied and ultimately cost less. But paternalism is endemic in the NHS, says the journal.
The BMJ, which devotes its entire issue to the changing nature of the doctor-patient relationship, says some regard this as the most important area of development in medicine for the next decade.
Angela Coulter, of the King's Fund, guest editor of the issue, says paternalism, although well- intentioned, creates an unhealthy dependency out of step with other currents in society.
"Assumptions that doctor (or nurse) knows best ... should have no place in modern health care ... The key to successful doctor-patient partnerships is to recognise that patients are experts too."
The arrival of new genetics - enabling predictions about individual susceptibility to disease - and the Internet are changing the relationship. Increasingly GPs encounter patients who know more about their ailments than they do.
The changing relationship is putting strains on doctors and patients. Doctors find they have to spend more time explaining matters and sharing uncertainties. Often they have to reveal that no one really knows what the outcome is likely to be.
A study of 39 GP trainees by researchers from Wales and the Netherlands found anxiety about sharing uncertainties over the outcome of care made some doctors reluctant to involve patients in decisions. But another study of 26,000 GP consultations found those patients given the longest time - the average was eight minutes - were more satisfied and better able to cope.
Professor John Howie of the University of Edinburgh and colleagues suggest that doctors should be paid extra for longer consultations and providing continuity of care.
Patients differ in their desire for information and some prefer to be entirely passive. Younger people tend to be more critical of paternalism, while older patients and some with serious illnesses prefer to leave decisions to the doctor. However, complete passivity is not an option. Informed consent to treatment is now a legal and ethical requirement; a signature on a form is no longer enough.
Critics of the trend to "patient partnership" say it will cost more (because of longer consultations), remove inhibitions and increase litigation. David Carvel, a GP in Glasgow, says in a letter to the BMJ that to have a patient-partner is "political correctness gone too far".
- 1 I'm A Celebrity 2014: Jungle security stepped up after murder and 'suspicious death' near to camp
- 2 To help fuel their propaganda machine against the poor, our government has now decided to redefine the word 'welfare'
- 3 Jeremy Hunt: 'I took my children to A&E because I didn't want to wait for GP appointment'
- 4 Girl, 7, gets Tesco to remove 'stupid' sign suggesting superheroes are 'for boys'
- 5 This letter from a reader explains why women can’t play football
Sarah Vine criticises lesbian mother Jack Monroe: 'If she was unsure about her sexuality, she should have taken greater precautions'
'Kidnapped boy may have been abused and murdered by VIP paedophile ring,' say police
Black Friday 2014: Opening times for Asda, John Lewis, PC World, GAME and Argos
Jeremy Hunt: 'I took my children to A&E because I didn't want to wait for GP appointment'
Michael Brown shooting: Driver smashes into crowd as protests erupt across the US during a second night of unrest
Rochester by-election: Ukip gains second MP as Tory defector Mark Reckless holds seat
'Beast of Bolsover' Dennis Skinner takes Ukip MP Mark Reckless to task moments after he is sworn in
Ukip says babies born to immigrants in the UK should be classed as migrants – which would include Nigel Farage’s own children
Rochester by-election: Labour MP Emily Thornberry resigns after posting white van and England flags tweet
The young are the new poor: Sharp increase in number of under-25s living in poverty, while over-65s are better off than ever
Tamir Rice: 12-year-old boy playing with fake gun dies after being shot by Ohio police
Negotiable: Argyll Scott International: Senior Business Analyst - Insurance ...
£25000 - £29000 per annum: Recruitment Genius: This independent, growing Sales...
£16000 - £20000 per annum: Recruitment Genius: Multi-skilled graphic designer ...
£30000 - £50000 per annum + EXCELLENT: Austen Lloyd: Court of Protection Solic...