Summary

The transition from medical paternalism to patient-centered care has been catalyzed by technological advancements, fostering informed patient participation and challenging traditional doctor-patient dynamics.

Abstract

The historical perspective of medical practice, exemplified by the ancient quote of Henri de Mondeville and the philosophy of Benjamin Franklin, illustrates a long-standing tradition of medical paternalism. This approach, established since the time of Ancient Greece, positioned the physician as an authoritative figure whose expertise was to be followed unquestioningly, as per Hippocrates' teachings. However, the advent of technology around 1990 has drastically changed the landscape by empowering patients with access to medical information, thus promoting a more democratic approach to healthcare. This shift is characterized by the increasing involvement of patients in their own care, supported by the Pickers eight principles of patient-centred care. The principles emerged from extensive research and emphasize respecting patients' values, preferences, and expressed needs. The modern era sees physicians actively involving patients and their families in the treatment process, marking a significant departure from the historical withholding of medical information from patients. While there is still progress to be made in patient education, the current trajectory is seen as positive, moving towards a more collaborative and transparent healthcare environment.

Opinions

Henri de Mondeville's and Benjamin Franklin's views reflect a historical deference to the authority of medical professionals over patients' autonomy.
Hippocrates' concept of medical paternalism advocated for physicians' superior knowledge and the insignificance of patient knowledge, even proposing that patients should be kept unaware of their full medical conditions.
Technological advancements, especially the internet and smartphones, have significantly reduced the information gap between patients and healthcare providers, leading to a more informed patient populace.
The shift towards patient-centered care is a direct response to the unacceptability of ancient doctrines to modern patients and many physicians, emphasizing the importance of addressing patient needs and preferences first.
The era of paternalistic medicine is considered to have ended, as patients are no longer passive recipients of care but active participants in their health management, as articulated by Michael Specter.
Pickers eight principles of patient-centred care serve as a guideline for respecting patient autonomy and fostering a more inclusive and collaborative treatment approach.
There is recognition that despite progress, there remains considerable work to address patient education and ensuring that it is done on an equal footing.

Patient Education: From medical paternalism to patient-centred care

Patients should obey their surgeons implicitly in everything appertaining to their cure.

- Henri de Mondeville

This quote is part of the “morels and etiquettes of surgeons” which dates back to 1306 and reflects very well the attitude surgeons and doctors had towards the treatment of their patients at this time. But also hundreds of years later in the 18th century Benjamin Franklin who is considered to be one of the founding fathers of America as well as the founder of the American Psychiatry had a very superior opinion towards the doctros-patient relationship:

“Doctors should avoid sacrificing too much to the taste of (their) patients. Yield to them in matters if little consequence, but maintain an inflexible authority to them in matters essential to life.”

The guiding principle of western medicine has been known as “medical paternalism” since the time of Ancient Greece. This principle is based on the idea that doctors have intrinsically superior insights which should be followed and lived by patients undoubtedly. This approach was defined by Hippocrates, a Greek physician of the Age of Pericles, who insisted that physicians’ superior knowledge has to be self-reinforcing because the knowledge of a patient is simply worth nothing.

He even proposed that medical institutions should ensure that patients are being kept in the dark and unaware of their own full medical conditions.

Those who are already surprised by this attitude should know that this is the same person who penned the Hippocratic Oath. The oath obliges physicians to prescribe only beneficial treatments, according to his abilities and judgment; to refrain from causing harm or hurt; and to live an exemplary personal and professional life.

The rise of technologies enables patients to educate themselves and become part of the conversation

With the rise of disruptive developments around 1990 the pace of technological innovation has had a huge impact on the evolution in health care. The up until then massive information gap between patients and physicians has been bridged by technology and is democratising medicine again. With smartphones becoming a device in almost every persons pocket and access to all the information on the planet via Google, patients can educate themselves on their health status. Michael Specter, staff writer at The New Yorker in the area of digital health summarises it precisely:

“The era of paternalistic medicine, where the doctor knew best and the patient felt lucky to have him, has ended.”

This brings us to the point that we are right now in the middle of a transformation. We currently experience the shift from medical paternalism to patient-centred care.

With ancient doctrines becoming less and less acceptable for patients and also for many physicians we see a positive trend when it comes to putting patients and their needs first.

The times where it was common practice to withhold information about the health status of patients is over. A direct outcome of this development are Pickers eight principles of patient centred care. The principles are based on the scientific findings of a wide range of focus groups — recently discharged patients, family members, physicians and non-physician hospital staff — combined with a review of pertinent literature, researchers from Harvard Medical School, on behalf of Picker Institute and The Commonwealth Fund.

Physicians have come a long way from keeping patients in the dark and insisting on the medical supremacy. Today they are not only involving the patient but also the whole family and educating him about his health status and the respective procedures that will be undertaken to heal him. Of course there is still a lot work to be done when it comes to educating patients properly and on eye level, but considering our history we are on the right track.

If you want to know more about the challenges that patient education is facing today check out this article:

Why patient education is a pain.

And what you can do about it.

medium.com

Sources:

Anatomy and Atrophy of Medical Paternalism

Medical paternalism-the idea that patients should defer to the intrinsically superior knowledge of physicians in all…

www.mercatus.org

The Operator

One evening a few weeks ago, several members of a television film crew crammed themselves into a tiny examination room…

www.newyorker.com

Picker Institute’s Eight Principles of Patient-Centered Care

Picker Institute’s Eight Principles of Patient-Centered Care originated with the Seven Dimensions of Patient-Centered…

nexusipe.org

Eric Topol (2016): The Patient Will See You Now: The Future of Medicine Is in Your Hands