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A History of the Patient-Physician Relationship
The physician-patient relationship has deeply evolved over the past millennium, reflecting and keeping pace with the social changes that would alter the dynamic between caretaker and infirm. As a starting point much can be inferred about the patient-provider relationship that existed in ancient Egypt.
Although the civilization was progressive in many respects, Egyptians took an unsophisticated but well-meaning approach to medicine, believing other forces of a religious or magical persuasion were at play in ailments of the populations. This created a deferential tone, which may well have colored the relationship between patient and provider. The role of doctor coincided in identity and function with that of a healer/magician, and this helped to create an atmosphere in which the patient was not only deferential to the forces that be but also to their physician. With distinct ‘active’ and ‘passive’ roles, the groundwork was laid for handing the doctor almost complete authority over one’s body, entrusting them with the responsibility to make the correct calls for one’s well-being. A landmark moment in the history patient care was the Greek contribution of the Hippocratic oath.
The Greeks adopted a far more empirical approach to governance, medicine and a number of other social area. Abandoning the over-reliance on unseen forces, 5th century Greece began relying on rationale, observation and trial and error, which in turn transformed the country’s medical practice. Although the country and era were not ripe to make strides in scientific advancement, they were apt to advance one area of medicine that had to see any articulated code: ethics. In laying down the Hippocratic oath, the Greeks institutionalized the humanism of medicine and unwittingly set about defining standards of medical care.
The Hippocratic oath reads:
“The regimen I adopt shall be for the benefit of my patients according to my ability and judgment, and not for their hurt or for wrong…Whatsoever house I enter, there will I go for the benefit of the sick, refraining from all wrongdoing or corruption, and especially from any seduction, of male or female, of bond free. Whatsoever things I see or hear concerning the life of men, in my attendance on the sick or even apart there from, which ought not be noised abroad, I will keep silence thereon, counting such things to be as sacred secrets.”
The French Revolution saw another momentous shift, although it was more so a side effect of the sociopolitical turmoil erupting at the time. With citizens asserting themselves and their rights before a belligerent and out of touch ruler, assertion of good conditions was a trope of the era and this applied to medical/mental health treatment as well. Although patients themselves may not have been the most emboldened lot, the French Revolution brought close to an era in which the mentally ill were locked in dungeons. A model of guidance and cooperation began to take root, supplanting the fully paternalistic, active-passive dynamic of centuries past.
Modern Models of the Patient-Physician Relationship
The way in which illness is understood and evaluated has a great deal to do with the nature of the physician-patient relationship. In their Contribution to the Philosophy of Medicine, M.D.s Szasz and Hollender posted three models of the physician-patient relationship.
A) The Activity-Passivity Model:
While aspects of the paternalistic dynamic remain in place today (particularly so in emergency medical situations), there was a time in which paternalism was the defining characteristic of the patient-physician relationship. Comparable to the relationship between a parent and infant, an activity-passivity model operates in the notion that the patient asserts little to no agency and needs the aid and expertise of the physician. The physician is given total control and treatment is commenced.
B) The Guidance Cooperation Model:
This model is founded in part in the patient’s conscious desire for treatment, but also in their ability to not seek it/opt against it. (For example, the treatment of depression.) Still giving the physician a position of power, the patient now has more agency in that they are cooperating with the physician and the patient’s actions are of equal importance under this model.
The physician, rather than acting paternalistically with no input from the patient, administers guidance. Such guidance would be ineffective without the patient’s conscious decision to cooperate and implement that which the physician suggests. In descriptions of this model, the comparative relationship prototype is that which exists between parent and adolescent.
C) The Mutual Participation Model
Rooted in the belief that human equality is mutually advantageous, this model advocates for a far different approach than the two prior. Under this model, the doctor admits to not know with absolute authority what is best for the patient. For a model of mutual participation to exist between patient and provider, there must be equal power and mutual independence – befitting of an egalitarian societal model. The patient and doctor are partners under this model. The patient’s need and ability to take care of themselves is every bit as critical as the physician’s role of providing treatment.
Thrusting a greater degree of responsibility on the patient forces them to acknowledge their role in their own health, and their ability to maintain a high standard of it. Essentially, a patient’s health becomes a subject of concern and regular maintenance long before they would ever require admission to a hospital setting. This way, the patient already has accepted a role in the maintenance and betterment of their health, rather than entrusting these things exclusively to a physician. The physician still imparts relevant medical advice, and the two are mutually responsible for the management of the patient’s condition. A good example where such a model works well is the management of chronic disease. The aid and counsel of the physician are critical, as is the patient’s active role in implementing their advice and taking an affirmative role in not exacerbating their condition with poor choices or living habits.
Physician-Patient Relationship and Medical Malpractice
The nature of the relationship between patient and provider has evolved over the past centuries. Modern models place more emphasis on a collaborative approach, rather than permitting a physician to have unquestioning power over the direction of care.
However, even when the physician works along with a patient to ensure complementary life habits, a mistake during medical treatment can result in serious detriment to a patient’s health. Establishing that a physician-patient relationship existed is one of the core elements of a successful medical malpractice claim.