Paternalism And The Demise Of Health Care

Clinicians like to think they know what is best for the patient. And oftentimes, that is true. I mean, isn't that why patients come to see us?

But there is a fine, yet distinct, line between patient-centered care and paternalism. You know, the "father knows best" mentality that pervades our health care system right now. It might have been fine in the 1950's, but patients of the 2000's are becoming consumers when it comes to their health care. And rightfully so.

If we don't start paying attention, paternalism will be the demise of health care as we know it. And maybe that's a good thing.

Paternalism, by definition, is

"Behavior, by a person, organization or state, which limits some person or group's liberty or autonomy for their own good. Paternalism can also imply that the behavior is against or regardless of the will of a person, or also that the behavior expresses an attitude of superiority."

Back in the 1950's, physicians were the hub of patient care. They were the only show in town. They made house calls. Add to that the behaviors of many groups, organizations, and states that drove the health care environment. We were told these behaviors were for the best interests of patients.

So it is to this day.

Many groups continue to promote a paternalistic agenda disguised as "patient safety". Most states continue to have paternalistic health care laws which limit personal autonomy. All of this assumes that someone other than the patient knows what is best for the individual.

But we are now in a new era. It is an era in which patients are demanding to truly be a part of the decision-making process. They want to be able to make choices regarding their provider and how they access those providers. They are coming in to clinical visits armed with the latest data from the Internet, and oftentimes it is the same data that clinicians should be (or have been) reading.

Google and PubMed have become wonderful places for patients to explore options. When 35% of Internet users are online not just for health information but to self-diagnose, then we have to officially consider the health care world a different place. They have the capacity to make informed decisions, and they choose to do so for their own best interest.

The roles have changed. Or as Dylan once said,

"For the loser now / Will be later to win / For the times they are a-changin'"

These changes, however, won't come without a fight. All of this forces the powers-that-be to relinquish power and control. Be warned, because paternalism, which has a stranglehold on health care, simply doesn't fit well with a patient-centered model of care.

Paternalism is ultimately a limiter to personal autonomy. The battle lines are drawn - and something has to give.

Photo credits: Newtown grafitti

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