As far back in history as in the day of Hippocrates of Cos, often referred to as the father of Western medicine, 460 BC – 370 BC, a physician was viewed in a paternalistic manner, one in which a physician’s opinion(s) were simply just believed and their recommendation(s) were followed without question.  The prevailing culture was definitely one of passive, submissive acceptance.

Although there will more likely than not always be patients who want to have a paternalistic relationship with their physician, I believe that over the last several years, there has clearly been a physician image mutation under way.

Although one can argue as to whether this is occurring as the result of the natural selection process or not, I believe one can’t argue with the fact that the prevailing culture in this regard is swinging to one of active, aggressive questioning on the part of the patients.

I believe that a number of factors may have contributed to both the focus and the speed with which this image mutation has been occurring, only some of which include:

1. Rising cost(s) associated with all aspects of healthcare, from every involved entity’s perspective (patient, provider, other).
2. The initial managed care gatekeeper debacle, where by the health insurance companies’ calculated designation and explanation, a patient’s primary care giver was the one who made the decision as to what healthcare service(s) would or would not be paid for by the insurance company.
3. Many physicians’ misdirected frustrations often resulting in less than appropriate responses to governmental interventions or lack of interventions leading to physicians having to concentrate progressively more and more on documentation and book keeping functions than on actual time spent with patients.
4. The Internet and the incredible amount of uncensored, non-filtered, healthcare information on-line, giving many patients the idea that if only they could write their own prescriptions, and maybe learn to use robotic surgical equipment, they could be a physician;

Although our historic paternalistic role may very well have never been the most appropriate for our being able to accomplish our responsibilities to the best extent we possibly could, it certainly worked well for many years.  This paternalistic role was engrained in us over the years through our professional education and training, although obviously not to the same extent in all of us.

This image mutation is being met with varying degrees of resistance.  I believe that almost any degree of resistance appears to make the particular physician’s reaction to the situation worse.  The image that we as physicians should gladly cultivate is one of being knowledgeable in those matters in which we truly are, honest about those in which we are not, and painting a picture of being a good team player, there to add whatever extraordinary talents and knowledge we possess in helping each patient that seeks our ‘opinion’ in trying to make the very best decision they can make for themselves.  We are becoming healthcare decision facilitators and really never should have been or considered ourselves to be healthcare decision makers for others.

Richard A. Foullon is a family physician.

 

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