Stop playing God, BMJ tells arrogant doctors

DOCTORS WHO play God and assume they know what is best for their patients must change, the British Medical Journal says today.

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".

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