Power issues in the doctor-patient relationship

Power is an inescapable aspect of all social relationships, and inherently is neither good nor evil. Doctors need power to fulfil their professional obligations to multiple constituencies including patients, the community and themselves. Patients need power to formulate their values, articulate and achieve health needs, and fulfil their responsibilities. However, both parties can use or misuse power. The ethical effectiveness of a health system is maximised by empowering doctors and patients to develop 'adult-adult' rather than 'adult-child' relationships that respect and enable autonomy, accountability, fidelity and humanity. Even in adult-adult relationships, conflicts and complexities arise. Lack of concordance between doctors and patients can encourage paternalism but may be best resolved through negotiated care. A further area of conflict involves the 'double agency' of doctors for both patients and the community. Empowerment of all players is not always possible but is most likely where each party considers and acknowledges power issues.

Similar articles

Wilson-Barnett J. Wilson-Barnett J. J Med Ethics. 1989 Mar;15(1):12-6. doi: 10.1136/jme.15.1.12. J Med Ethics. 1989. PMID: 2926780 Free PMC article.

Christensen M, Hewitt-Taylor J. Christensen M, et al. Br J Nurs. 2006 Jul 13-27;15(13):695-9. doi: 10.12968/bjon.2006.15.13.21478. Br J Nurs. 2006. PMID: 16926716 Review.

Vinson AH. Vinson AH. Sociol Health Illn. 2016 Nov;38(8):1364-1378. doi: 10.1111/1467-9566.12480. Epub 2016 Aug 28. Sociol Health Illn. 2016. PMID: 27569852

Bottles K. Bottles K. Physician Exec. 2001 Sep-Oct;27(5):10-4. Physician Exec. 2001. PMID: 12881899

Ishiwata R, Sakai A. Ishiwata R, et al. Camb Q Healthc Ethics. 1994 Winter;3(1):60-6. Camb Q Healthc Ethics. 1994. PMID: 8032521 Review. No abstract available.

Cited by

Barnidge E, Terhaar A, LaBarge G, Arthur J. Barnidge E, et al. J Med Educ Curric Dev. 2024 Jul 25;11:23821205241264700. doi: 10.1177/23821205241264700. eCollection 2024 Jan-Dec. J Med Educ Curric Dev. 2024. PMID: 39070286 Free PMC article.

Ninković M, Ilić S, Damnjanović K. Ninković M, et al. Womens Health (Lond). 2024 Jan-Dec;20:17455057241249864. doi: 10.1177/17455057241249864. Womens Health (Lond). 2024. PMID: 38770772 Free PMC article.

Spithoff S, McPhail B, Vesely L, Rowe RK, Mogic L, Grundy Q. Spithoff S, et al. BMJ Open. 2024 Feb 8;14(2):e074019. doi: 10.1136/bmjopen-2023-074019. BMJ Open. 2024. PMID: 38331904 Free PMC article.

Otón T, Carmona L, Andreu JL. Otón T, et al. Rheumatol Int. 2023 Apr;43(4):735-741. doi: 10.1007/s00296-022-05249-3. Epub 2022 Nov 27. Rheumatol Int. 2023. PMID: 36436083

Barak LC, Kuijpers G, Hoeijmakers L, Scheele F. Barak LC, et al. BMC Med Educ. 2022 Nov 23;22(1):806. doi: 10.1186/s12909-022-03877-8. BMC Med Educ. 2022. PMID: 36419055 Free PMC article.

References

    1. Soc Sci Med. 1990;30(2):199-204 - PubMed
    1. Diabetes Care. 1995 Jul;18(7):943-9 - PubMed
    1. Theor Med. 1996 Dec;17(4):329-52 - PubMed
    1. Am J Law Med. 1993;19(1-2):37-74 - PubMed
    1. J Med Ethics. 1998 Aug;24(4):243-7 - PubMed