Discomfort of patient power

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7347.1214 (Published 18 May 2002) Cite this as: BMJ 2002;324:1214

Patients are not doctors' equals

  1. Daniel McQueen (daniel.mcqueen@virgin.net), general practitioner
  1. Brighton BN1 6EG
  2. Barts and The London, Queen Mary School of Medicine and Dentistry, London EC1A 7BE
  3. St James's University Hospital, Leeds LS9 7TF
  4. Royal Edinburgh Hospital, Edinburgh EH10 5HF

    EDITOR—Smith in his editorial on the discomfort of patient power says that there is no “truth” defined by experts.1 Coulter reports that doctors and patients are equals with different expertise.2 The government's working group on chronic fatigue syndrome and myalgic encephalomyelitis wove patients' assertions into the scientific research in its report.3

    It is absurd to say that there is no truth defined by experts, that patients are equals, or allow patients to define conditions and treatment. Although criticism of medical hubris is important, this is a denial of the nature of medicine. Clinical effectiveness depends on understanding the patient's beliefs and expectations. Patients are, however, not equals, and their beliefs do not have the ontological status of medical knowledge.

    Denial of the status of doctors and of medicine's tradition of research is false democracy. It is an attempt to avoid destructive envy. Destructive envy denigrates and spoils that which is needed, biting the hand that feeds us or cutting off one's nose to spite one's face. More than other professional groups, doctors are envied. Partly this derives from the inequality of the relationship between doctors and patients. It can be difficult to tolerate powerlessness, ignorance, dependence, needing help, and being helped. For doctors it is difficult having their attempts to help spoiled by the …

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