Intended for healthcare professionals


Paternalism or partnership?

BMJ 1999; 319 doi: (Published 18 September 1999) Cite this as: BMJ 1999;319:719

Patients have grown up—and there's no going back

  1. Angela Coulter, executive director, policy and development (
  1. King's Fund, London W1M 0AN

    Paternalism is endemic in the NHS. Benign and well intentioned it may be, but it has the effect of creating and maintaining an unhealthy dependency which is out of step with other currents in society. Assumptions that doctor (or nurse) knows best, making decisions on behalf of patients without involving them and feeling threatened when patients have access to alternative sources of medical information—these signs of paternalism should have no place in modern health care. The articles assembled in this issue of the BMJ consider the scope for creating meaningful partnerships between doctors and patients and between health policymakers and local communities.

    Partners work together to achieve common goals. Their relationship is based on mutual respect for each other's skills and competencies and recognition of the advantages of combining these resources to achieve beneficial outcomes. Successful partnerships are non-hierarchical and the partners share decision making and responsibility. The key to successful doctor-patient partnerships is therefore to recognise that patients are experts too.13 The doctor is, or should be, well informed about diagnostic techniques, the causes of disease, prognosis, …

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