Patients and medical power

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7310.414 (Published 25 August 2001) Cite this as: BMJ 2001;323:414

Shifting power in favour of the patient may not be so straightforward

  1. Richard Canter, consultant surgeon
  1. Royal United Hospital, Bath BA1 3AG

    After the announcement of the Alder Hey report into retained organs after postmortem examinations the health secretary, Alan Milburn, said he wanted the balance of power to move away from doctors and “shift decisively in favour of the patient.” He suggested that patients should be offered free choices to make up their own minds about treatment options. Many assumptions underpin such an idea, including the belief that medical “power” is a currency that can be transferred from doctor to patient, so that the patient becomes “free” to choose. It is not as simple as this.

    Power is the means by which A gets B to do something, and many models exist to explain how A might do this. The medical profession sees itself, and is seen, as expert in understanding and managing disease. However, expert power is only part of the picture. The concept of power also includes reward, coercive, legitimate, and charismatic power.1 Individual clinicians may exercise elements of each of these types of power in different proportions so that each has his or her own distinctive consultation style.

    Perhaps Mr Milburn really means that the medical profession should …

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