MDOD

Paternalism in Medicine

When a patient describes a doctor as “paternalistic”, it’s the social equivalent of calling him a baby panda rapist. The implication is that the doctor is demeaning, condescending, and insensitive to your individual or cultural needs.

For you chuckleheads who never took Latin, the root of the word is “pater”, which means “father”. A nice definition of paternalism from dictionary.com is: “the system, principle, or practice of managing or governing individuals … in the manner of a father dealing benevolently and often intrusively with his children”.

To be clear, I am NOT condoning paternalism with the historically negative connotations related to racism, sexism or anti-libertarian governmental policy. What I am arguing for is a retreat from medical relativism: some courses of action are scientifically sound and others are clearly not. “Respecting” those that are not, in the name of cultural or individual sensitivity, is not in the patient’s interest.

I’m sorry to burst the PC bubble, but the doctor-patient relationship is NOT one of co-equals. The patient comes to the doctor for help and not vice-versa. The patient is typically not a medical expert; the doctor is. A good doctor bases a diagnosis and course of treatment based on the best available, scientifically validated evidence; and will strongly push the patient to follow this course even if cultural beliefs and individual sensitivity are somehow ‘violated’.

The classic example and the one I have heard several people complain about is the doctor telling the patient: “You are obese and need to lose weight. Here is why and here is how to do it…”

“I mean, what a paternalistic jerk! Telling me I’m fat! The nerve!”

Listen, chunky, eating deep-fried Snickers bars and a 2 liter Coke as a pre-dinner ‘app’ is bad for you. If you consider ‘exercise’ the crunches you do sitting up off the couch to pick up the X-Box 360 control, you are wrong.

Yes, I get that you are an adult and these things are ultimately your choice, but guess what, I’m not your friend and I’m not here to support you in your decision to treat your diabetes with chiropractic manipulation and aromatherapy even though “it worked” for your yoga instructor.

So, grow up and listen to your father.

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