The Doctor-Patient Dynamic In Healthcare

The Hippocratic Oath is in many ways an oath about the doctor-patient dynamic. For millennia, doctors and patients have worried about and discussed the relationship between doctors and patients. That conversation is a conversation we are still having today.

Informed Consent

Informed consent has been with us since at least the sixth century A.D. when the emperor Justinian’s doctors made him swear upon a scalpel that he gave their consent for them to perform surgery on him. The emperor was known for killing his enemies.

Informed consent is often treated as a burden among many regulatory requirements, but it serves a real purpose. It serves to protect the doctor, but also to ensure that patients understand just what they are getting themselves into. Treated badly, informed consent is a boilerplate agreement that patients hurriedly sign at the behest of their doctors. Treated right, it’s the basis of a discussion about what patient expectations are and what the doctor is seeking to do and achieve. This view enriches informed consent, raising it from a dull document to limit a doctor’s liability, to something that can elevate the doctor-patient relationship. Rather than leaving the consent form to an intern to oversee, doctors should treat it as a vitally important document in helping their patients achieve the outcomes they desire.

The Doctor-Patient Dynamic in the 20th Century

In the 20th century, patients interacted with doctors over simple procedures. There was simply not enough medical knowledge to have more done. As the field evolved, and knowledge accumulated, medicine reached a point in the ‘70s where doctors knew far more than it was possible for any patient to know. Consequently, patients were expected to listen to doctors. The dynamic became much more deferential. That attitude remains to this day. Drs. Brian C. Drolet and Candace L. White argued for what they called, “selective paternalism”. Selective paternalism is an attitude in which decisions are generally left to the experts, that is, doctors, because they know so much more than patients.

Democratization of Knowledge

In the late 20th century, the internet changed the relationship that doctors have with their patients. Patients had access to an unprecedented amount of information, allowing them to do their own research about their medical problems.

Today’s family medicine doctor has to balance their superior learning with the information that patients are able to gather about their condition. Patients are better informed and able to weigh the pros and cons of different treatments and engage in intelligent conversation with their doctors.

The result is that doctors and patients have a more collaborative relationship. Patients no longer instinctively defer to their doctor. Doctors must engage patients and help them understand their condition and the available options.
Doctors are the experts and patients are capable of misunderstanding the scientific literature, but doctors lack the specific knowledge that comes with being the patient. The two should collaborate to make better medical decisions. This is why consent forms could play a unique role in providing a platform for a conversation that too few doctors have with their patients.