08/06/2013 12:52 pm ET Updated Oct 06, 2013

The Physician-Patient Relationship

Once upon a time (when I started my career in medicine a mere 30 years ago), physicians thought they knew everything about medicine, and patients did what they were told. Omniscience followed by acquiescence summed up the dynamic. Of course, medical information wasn't nearly as accessible, and the options for diagnosis and treatment were far more limited. But the rules that guided the physician/patient relationship were deeply rooted in paternalism. It wouldn't have mattered how much information or how many choices physicians had at hand -- we kept it pretty close to the vest. We were, after all, physicians. And patients were... well, patients. Certainly not partners.

Everything in health care today -- and what's coming tomorrow -- is exploding that old paradigm. A huge amount of medical information is available anywhere, any time. Fast-moving technological innovations are offering many new health care choices. The rise of wellness, with its emphasis on personalized care, is driving patient empowerment. Meaningful health discussions are now happening everywhere: the hospital, the community center, school and home.

Strangely enough, these conversations are happening least often in physicians' offices. It's not because physicians can't engage with patients. But they have been slow to shed paternalism and adopt benevolence founded on equality and patient empowerment. There is a danger that physicians will be marginalized -- becoming technicians who offer specific skills and expertise, but are no longer the principal stewards of health. This represents a danger to patients, as well, as they become increasingly responsible for their own health absent the wisdom that comes from physicians' deep knowledge and long experience.

So what should physicians do to preserve the doctor/patient relationship? They must remain the medical practitioners who provide the safest, highest quality care. They must promote evidence-based medicine that provides analyses and guidance to support patient decision-making.

  • Medical specialists such as radiologists must learn to present images, convey information and provide interpretation to patients and families in ways that are understandable and empowering.
  • Medical educators must train physicians to be coaches, not dictators.
  • Healthcare organizations must change medical records into personal e-healthbooks that patients can relate to.
  • Global businesses like Philips Healthcare must develop innovative ways to help the ultimate consumers of their products, services and solutions manage multiple sources of complex medical information.

Most important, this brave new world demands that all of us in healthcare focus on creating the conditions for patients to participate fully in achieving their own health and well-being.

In sum, physicians need to lose the paternal attitude, embrace the new doctor/patient paradigm and gain some new partners who can help us prevent disease, manage big health global concerns (heart disease, cancer, hypertension) and shape a healthier world. These partners are right in front of us: They're our patients.

For more by Eric Silfen, M.D., click here.

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