PATIENT–DOCTOR RELATIONSHIPS

From the beginnings of Western medicine, medical culture has stressed a pater- nalistic value system in which only doctors, and not patients or their families, are presumed capable of making decisions about what is best for a patient. Often this paternalism is reinforced by patients who prefer to let their doctors make all deci- sions; indeed, at least part of doctors’ efficacy comes simply from patients’ faith in doctors’ ability to heal. Paternalism is also reinforced by the fact that doctors report spending 13–16 minutes per patient visit (and may actually spend less), which leaves doctors little time either to educate or listen to their patients.

Power and Paternalism

Doctors’ power over patients is greatest in two situations: (1) when patients are completely incapacitated by coma, stroke, or the like; and (2) when doctors’ cul- tural authority is much greater than that of their patients. For example, faced with a pregnant woman who refuses a cesarean section or a person diagnosed with schizophrenia who opposes hospitalization, courts and hospitals often sup- ports doctors’ decisions over their patients’ wishes. Finally, doctors’ power is higher when interacting with patients who don’t share the doctors’ language, culture, and social status.