The fundamental foundation of clinical medicine, the doctor-patient relationship, is going through a transformation. Through the ages, the degree of influence of the two participants of this axiom have seesawed back and forth depending upon the historic context.
According to the authors of the Oct. 15, 2018, article, “The New Age of Patient Autonomy,” in the Journal of the American Medical Association, there has been a meaningful shift in the doctor-patient relationship. Patients today seek a more personal involvement in their medical decisions than they did in the past. This has reshaped many practitioners’ traditional paternalistic approach of providing health care to the sick.
From the earliest ancient civilizations to the present day, the doctor-patient relationship has unfolded as a test of strength between the two sides resulting in a non-linear path of medical progress. Which party is the dominant force frequently depended upon the predominant theory of disease at the time.
Medical historians believe ancient Egyptian priest healers began the doctor-patient relationship. As people with various maladies sought care, early ecclesiastical physicians used mysticism while representing the sick individual before the primordial gods. The caregiver’s supplicant role gave rise to the “father like” symbol of these early practitioners who were controlling events on their patients’ behalf.
The ancient Greeks’ innovative empirical style of medicine changed the balance of power away from the one-sided paternalist strategy used by the Egyptians. The Hellenistic design codified the need for partnership and collaboration between doctors and patients. In the Hippocratic oath, specific ethical rules for physicians as well as rights for the sick under treatment were delineated. This fostered a cooperative spirit between the two groups.
But this synergy didn’t last.
In the Middle Ages, religious fervor and supernatural beliefs bestowed upon the healers increased power and control over their patients. This generated medical care that echoed back to the days when physicians dominated.
In the 18th and early 19th centuries, the doctor-patient relationship showed further evolution. Physicians believed symptoms and diseases were equivalent. This medical theory forced doctors to pay more attention to the physical complaints of the ill. The medical provider’s function became entirely dependent on patient cooperation.
Discoveries throughout the 1900s fostered another alteration between the medical professional and patient. Improved tests, new drugs, and better surgery necessitated patients to become totally dependent on physicians for care. The doctor became the gatekeeper to access the new age of medicine. The patient was a silent partner and had only minimal input into his or her own health solutions.
This pattern of care created calls for a more equitable doctor-patient interaction in the 1970s.
Patient rights advocates opened the door for greater availability of medical records, which provided an improved understanding about one’s own personal health profile. But more significantly, the eventual development of the internet and social media furnished patients with new capabilities previously held only by doctors.
These digital platforms allow the public to access the latest information on scientific research and clinical medicine. This has generated a seismic redefinition of the doctor-patient relationship.
Diagnostic and treatment plans have become a shared responsibility. The knowledgeable patient is now a vital component in all aspects of their health care including the economic consequences of the medical decisions in which they participate.
For the most part, this latest metamorphosis of the doctor-patient relationship has been a very positive one, but it does not work in all circumstances. Some people do not have the time, ability or desire to be their own healthcare advocate.
Conversely, overzealous individuals who accept everything on the internet as being true may be harmed if they utilize an unproven test or therapy without physician input.
Stolz is a retired physician and author of the book “Medicine from Cave Dwellers to Millennials.”