Tuesday, November 08, 2022

What impact can junior doctors have on paternalism in medicine?

“My blood pressure’s going to be high,” I told the med tech.

“Let me guess,” she said. “You have white coat syndrome.” 

The Grace of Bad Luck 🍀 

By Eleni Irene Azarias

 What impact can junior doctors have on paternalism in medicine?

In a dramatic and disturbing scene from Pat Barker’s “Regeneration”, a novel on fictional events from World War I, the main character (a psychiatrist) bears witness to a radical form of therapy for a patient who had been rendered mute, presumably from his difficult experiences as a soldier during the war. The treatment in question is the application by another psychiatrist of probes and, through the probes, of an electrical current, to the back of the patient’s throat – a painful and likely traumatic experience that the patient has no say in refusing, so fixated is the treating psychiatrist on his treatment succeeding.

Writhing, mute, powerless, the patient must simply bear the treatment in a locked room until it is successful, that is, until he speaks. “You must speak”, says the treating psychiatrist, “but I shall not listen to anything you have to say” (1). Such an instance of medicinal paternalism – of treating patients as if the doctor were their father, ideally benevolently, perhaps intrusively, but always in a superior and directive position – appears undoubtedly shocking in the setting of modern medicine. Traditional medicine may have relied as recently as a few decades ago on an established set of rules, whereby the doctor was king (and male, as doctors mostly were) and the patient was the subject, obeying doctor’s orders with little information or ability to dissent or refuse, but a cultural shift has patently occurred in many countries.

Patient-doctor collaboration

In theory, the power gap between doctor and patient has dramatically narrowed – the patient is an informed consumer, entitled to be educated about his or her illness and treatment options and, in most cases, to be the ultimate decision-maker in which medical path to choose. Doctors are no longer (presumably) benign dictators, but rather facilitators of information and of a patient’s decision-making process, a concept integral to the now-ubiquitous idea of patient-centred care, which largely focuses on partnering with rather than instructing patients during the delivery of healthcare. A doctor and his or her patient should no longer be viewed as parent and child, but rather as collaborators in shared decision-making regarding healthcare (2).

Yet is this noble principle of patient collaboration and partnership always applied in the practice of modern medicine? Even in my short time as a doctor in less than a year and a half, I have encountered a number of examples where this may not have been the case.