The doctor/patient relationship: revolution or evolution

A few weeks ago, the theme of the British Medical Journal concerned the ‘patient revolution’, complete with a rather Stakhanovite image of empowerment on the front page. The so-called patient revolution was the main feature in the editor’s column, the first editorial1 and an article by Ray Moynihan2. Let me say at once that I am entirely signed up to doctrines of patient autonomy, patient-centred care and involving service users and citizens in the decision-making apparatus of healthcare. And yet, and yet – there was something rather censorious about these articles. The articles implied that doctors are a bunch of remote, self-serving, pompous, Lancelot Spratt-type characters. There was an insinuation that doctors habitually ride rough shod over patients’ sensitivities, that patients are not involved in decision-making, that doctors override patient autonomy and that the idea of involving the public in decision-making is totally novel. What nonsense! I was a member of the Maternity Services Liaison Committee in my days as a gynaecologist back in Leeds – some 25 years ago. And let me tell you, the members of the committee were no shrinking violets.

In my current role as a National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care director, service users and members of the public interact with researchers and care providers at every stage of the process – from deciding on priorities, to advising on the design of new services. I am certainly not holding myself up as a paragon of virtue; heavy user consultation is a feature of the entire research landscape. Indeed, it is not just a feature but a requirement for access to National Institute for Health Research funding. Medical students have extensive education on communication with patients, and on medical ethics. Here in Birmingham we have a ‘mini medical school’ which is an educational resource for the general public, and in which I lead a discussion group on medical ethics. I believe I created the first medical ethics course at the University of Leeds, in collaboration with Jennifer Jackson, from the Department of Philosophy, and that was now 25 years ago.

Fiona Godlee tried to defend her war metaphors in the context of patient engagement/empowerment but I wasn’t convinced by the argument. A friend of mine recently started the process of converting to Judaism. I met her a few years later and asked her if she was now Jewish. She turned to me and said: “Richard, it is a journey, not an arrival.” In my opinion, that is a far more apt metaphor for the ongoing relationship between our caring profession and those for whom we care.

1. Godlee F. BMJ 2013;346:f3153
2. Moynihan R, BMJ 2013;346:f2789


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