The Doctor as Parent, Partner, Provider… or Comrade? Distribution of Power in Past and Present Models of the Doctor–Patient Relationship

Abstract

The commonly occurring metaphors and models of the doctor–patient relationship can be divided into three clusters, depending on what distribution of power they represent: in the paternalist cluster, power resides with the physician; in the consumer model, power resides with the patient; in the partnership model, power is distributed equally between doctor and patient. Often, this tripartite division is accepted as an exhaustive typology of doctor–patient relationships. The main objective of this paper is to challenge this idea by introducing a fourth possibility and distribution of power, namely, the distribution in which power resides with neither doctor nor patient. This equality in powerlessness—the hallmark of “the age of bureaucratic parsimony”—is the point of departure for a qualitatively new doctor–patient relationship, which is best described in terms of solidarity between comrades. This paper specifies the characteristics of this specific type of solidarity and illustrates it with a case study of how Swedish doctors and patients interrelate in the sickness certification practice.

“We're playing on the same team”: Communication (dis)connections between trauma patients and surgical residents

“…Both framed this struggle as one for survival and even reminiscent of war. These findings align with the solidarity model of the patient-physician relationship as described by Shutzberg, 24 in which power resides with larger structural forces as opposed to either physician or patient. The patient and physician, both disempowered by these same forces, are thus linked together in solidarity.…”

Is physical restraint unethical and illegal?: a qualitative analysis of Korean written judgments

“…Additionally, courts have ruled that the use of PR without consent (Ethical dilemma situation 1) is not illegal if it is for good purposes in emergency situations, which justifies paternalism. However, the justification for paternalism remains controversial and sometimes, care recipients may question practices based on paternalism [ 56 – 59 ]. Therefore, health workers must clarify that they have no choice but to use PR and obtain informed consent as soon as possible [ 36 ].…”

Enemy or friend: the personal and the factual patient-physician relationship

“…This assertion no longer applies in the formal patient-physician relationship, where both have equal rights jeopardizing the essential precondition of the patient’s primacy. In consequence, the currently spreading extreme of the formal model is commercialization ( 19 ).…”

“…The personal relationship also exposes the physician to deep irritations, even harboring potential risks to the physician’s self-confidence and self-esteem. The risk of interpersonal war’s absurdities ( 19 ) must be prevented by flexibly shifting from a personal to the strictly factual mode of interaction.…”