The Autocratic Doctor-patient Relationship

Junior (College 3rd year) ・Healthcare&Medicine ・MLA ・5 Sources

One of the major foundations of healthcare is the relationship between the doctor and patient. Medical practice and ethics is primarily dependent on the level or extent of rapport that the doctor establishes with his or her patient. It forms the basis for the collection of accurate information, diagnosis and implementation of appropriate interventions, and treatment measures to be applied (Morgan 53). The doctor-patient relationship is also crucial since this influences the extent of satisfaction and the decision of the patient to stay in a particular health institution (Goold 26).

This paper aims to compare the prevailing doctor-patient relationship as well as medical behavior present in Barbara Ehrenreich’s Welcome to Cancerland, with that of the proper ethics and approaches that medical professionals should exemplify. It is highly necessary to know the appropriate medical traits that a physician or other healthcare professional should possess in order to earn the trust and respect of patients like Barbara. In turn, the right approach will motivate the patients to pursue the necessary treatments geared toward their survival on diseases such as breast cancer.

Appropriate Medical Traits

In the chapter on Physicians and Patients which was authored by Jose Luis Pelaez, there are certain traits that a medical professional should possess in order to achieve a successful and productive doctor-patient relationship. These are the following: respect, fair treatment, effective communication and consent, as well as the patient’s participation in decision-making.

Respect involves the doctor’s regard on the patient’s needs, queries and expectations on the necessary procedures geared toward the patient’s recovery. This entails letting the patient know about the nature of his or her illness, the important medications and treatments that the patient needs to undergo, the possible side effects of such procedures and the consequences in case the patient decides not to pursue with the treatments. It also involves updating the patient and the family regarding the results of all medications and treatments done. Physicians are obliged to provide sufficient explanations for the purpose of answering the patient’s questions as well (37-39).

Patients are also entitled to fair or equal treatment may it be inside or outside the hospital premises. It is important for their needs to be properly addressed, regardless of the nature of the illness, their educational background or financial status. Physicians should intently follow the Hippocratic Oath, wherein they should not refuse to apply the necessary medical procedures to all patients who are in need of immediate treatment. This is most applicable for emergency cases wherein the patient’s life is at stake (37-39).

The ability to communicate effectively is one key towards a healthy doctor-patient relationship. Doctors are obliged to provide all necessary information with regard to the patient’s illness, not withholding even the minor details from them. Such information involves initial diagnoses, appropriate medicines to be taken, necessary treatments or medical procedures and possible treatment alternatives to undergo. Doctors have the responsibility to make their patients understand such pertinent information because it shall form the basis of the patient’s decision on every stage of his or her illness. They are to be informed of the benefits and risks of every procedure as well. Doctors should also be prepared to answer all questions from the patient and the family with regard to the nature of the ailment. Effective communication skills must be constantly developed in order to establish good rapport and trust on the part of the patients and their families (42-46).

The consent of the patients regarding necessary medical procedures must also be taken into consideration. Consent refers to a patient’s approval or refusal of treatments to be undergone. Competent patients have the sole right to disagree on any form of treatment, even if it may end up in complete paralysis or death. Consent may be explicit or implicit. Implicit consent refers to a patient specifying his or her approval to go through a medical procedure through his or her behavior. Explicit consent, on the other hand, is consent provided through oral or written form (43-44).

Patients who are able or are relatively knowledgeable have the right to participate in the decision-making process with regard to their illness. However, there are certain cases that require the family or the physician to decide in behalf of the patient. This is applicable in situations by which the patient is entirely incompetent due to age (too young to decide or is already aging), and completely disabled (cannot communicate verbally, in written form or through expressive gestures). In these particular situations, medical paternalism is most appropriate especially if the patient does not have an immediate family member who is capable of making decisions (47).

The 4 Approaches of the Doctor-Patient Relationship

The doctor-patient relationship has four known approaches. These models focus more on the rapport of the doctor and patient, the role of the doctor, the behavior of the patient and the establishment of the patient’s authority (Emanuel 1). Three elements are also involved in the doctor-patient relationship, namely, the doctor, the patient and the disease being handled.

The Autocratic Approach

This approach does not value the patient’s decisions or opinions regarding the condition being addressed. The doctor believes that whatever happens, he or she should be in full control over the patient. The physician also perceives that he or she is not obligated to answer questions regarding the nature and stages of the disease, the treatments or medications being given to the patient as well as the duration or frequency of the treatment. The doctor thinks that questions coming from the patient or patient’s family may pose a threat to his or her expertise and competence on the ailment being addressed. If the patient does not decide on pursuing a certain medication or treatment, it will be considered as a loss on his or her part. The doctor takes pride on being able to convey pertinent advice to the patient, therefore, he or she does not feel the need to inform or update the patient regarding all treatments or medications to be done. At this point, there is inadequate information on the patient’s part since the doctor refuses to be questioned frequently about the ailment itself (Mckinstry 340).

Analyzing it on a deeper level, it may seem that this is the general approach in Barbara’s case on breast cancer treatment. The radiologist does not fully inform Barbara why her breasts need to be constantly examined. Moreover, the radiologist refuses to answer Barbara’s queries regarding the results of her mammogram as well as the duration it will take to wait for such results to come out. In this case, there is disrespect on the part of the radiologist since Barbara has the right to know what is happening with regard to her condition. Barbara then feels frustrated as there is inadequacy of information and lack of encouragement with regard to the medical professionals involved on the diagnosis and treatment of her condition.

The Paternalistic Approach

This model entails the doctor being able to listen and acknowledge the needs of his or her patient. The ability to listen intently is one quality of an efficient doctor. Doctors generally desire the best for their patients nonetheless, there is a greater need for proper guidance especially when it comes to the patients’ decision-making process (Mckinstry 340). 
In this particular model, the doctor regards himself or herself as one who has greater authority over the patient’s decisions. This is most valid for cases wherein the patient is incapable of deciding alone because of being sick, aged or having inadequate knowledge of the condition (Emanuel 1). 

In the case of Barbara’s account on cancer, the doctor may be willing to alter or adjust the treatment methods according to her observed conditions. However, if she decides to stop the treatment, the doctor must assert the advantages of proceeding with it or highlight the possible consequences of stopping it. In the doctor’s opinion, Barbara may be in a better state if the treatment or medication will be pursued, regardless of its side effects. One treatment that has certain adverse effects on the body is chemotherapy, which is widely used nowadays to treat cancer. In Barbara’s case, she has already accepted the fact that the doctors will make the decisions on her behalf since in the end, she believes that she will not be able to survive the disease.

The Informative Approach

In this particular approach, the doctor acts as a medium through which pertinent information should be relayed to the patient. At this point, the doctor deems the patient as the one who will make decisions ultimately regarding his or her condition. The doctor’s main job is to discuss the possible treatment alternatives and the nature of each. Nevertheless, the doctor does not fully explain everything to the patient, leaving behind certain details of which the doctor considers to be of minor importance. Information may be explained at a greater or lesser extent depending on the stage of the treatment or disease itself (Mckinstry 341).

In the case of Barbara’s work, the radiologist or oncologist may give her certain medications or treatment alternatives for cancer yet the consequences of each may not be explained completely. Nonetheless, it does not entail deception on the part of the doctor since he or she knows that such treatments will benefit Barbara in the end. It may be assumed that Barbara will still be the one in complete authority of making decisions but with influence on the doctor’s suggestions on what should be the best treatment for her.

Possible influences that may help a patient decide with regard to his or her condition include the doctor’s communication skills and knowledge on the specific ailment, the patient’s prior knowledge and experiences, the patient’s attitude towards treatment methods, background information regarding the ailment and the doctor’s consultation availability (Mckinstry 341).

The informative approach puts greater significance on patient’s values rather than facts. There is lesser significance given to some information that the patient needs to know. The doctor may see it as minor details that do not need profound discussion, yet it may still affect the patient’s decisions to a certain extent. This approach values the patient as someone being in full control on the decision-making part, however, certain pieces of information are withheld. At this point, it is important that the doctor recognizes that he or she should have the responsibility to provide the necessary facts and that is part of his or her expertise on the ailment being addressed (Emanuel 2).

The Patient Autonomy Approach

This approach entails the patient having the complete right to make the ultimate decisions with regard to his or her condition. This is in a way similar to the informative approach, yet it differs in the fact that the doctor completely informs the patient regarding his or her present condition as well as the nature or factors affecting the condition. All necessary medications and treatments to be done and their side effects as well as the consequences if such treatments will not be pursued are fully discussed with the patient and his or her family. Eventually, the patient and family shall be left to make the necessary decisions with regard to the condition. If in case the patient decides not to pursue with the medications or treatments to be done, the doctor fully understands and respects the patient’s decision (Mckinstry 341).

Nowadays, the most common approaches in hospital scenarios would be the informative approach and the patient autonomy approach. There are some cases wherein medical paternalism is also followed. However, such cases are rare and usually happen in the event that a patient is entirely incapable of deciding by himself or herself. This is due to the absence of family members or inadequacy of information as a consequence of the effects of the illness or the patient’s age and educational background.


Doctors should embody the above-mentioned medical behavior in order to gain their patient’s trust and respect. Moreover, good rapport and a healthy hospital experience will be established in the long run through an effective doctor-patient relationship.

Patients like Barbara are entitled to efficient treatments and medications. Nonetheless, this will not happen without proper medical ethics as well as a successful doctor-patient relationship. Patients like Barbara do not deserve to be treated unfairly and disrespectfully as they have the right to know the necessary procedures to be done as well as the results of their treatments. Instead, they are to be encouraged in order for them to have a positive outlook toward their treatment and recovery. Diseases such as cancer are quite discouraging therefore, doctors and other medical professionals should be fully aware of the behavior that they exhibit in order to cultivate a healthy relationship with their patients.

Works Cited

Emanuel, Ezekiel J., and Emanuel, Linda L. Four Models of the Physician-Patient Relationship.  JAMA, Vol. 267, No. 16, pp. 5-13.1992

Goold, Susan Dorr. The Doctor-Patient Relationship: Challenges, Opportunities and Strategies, Vol. 14 (Supplement 1), pp. 26-33. 1999

Mckinstry, Brian. Paternalism and the Doctor-Patient Relationship in General Practice. British Journal of General Practice, Vol. 42, pp. 340-342. 1992

Morgan, Myfanwy. The Doctor-Patient Relationship. Chapter 4, Social Factors in Medical Practice, pp. 49-65

Pelaez, Jose Luis. Physicians and Patients. Chapter 2, Medical Ethics Manual. Jose Luis Pelaez Inc. Corbis

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