EDITOR - The editorial Paternalism or partnership? (BMJ 1999; 319:
719-20) is to be welcomed, as is the core suggestion that there be an
equal partnership between professionals and patients about health and
illness. As is common nowadays, there is however an implied criticism of
the "wickedness" of the ways of doctors and nurses who fall into states of
mind of being patronising to their patients. While undoubtedly unhelpful
as an attitude, it needs to be understood that it often takes two to have
a patronising/being patronised state of mind.
Patients who are in the grip of anxiety about their condition resort to
the well known mechanism of idealisation of their carers - after all, the
more omnipotent their carers the better the chance of personal survival.
This idealisation leads to the accretion of omnipotence in the staff, with
a resulting patronising attitude. Instead of being blamed for wickedness,
the staff should instead be seen as victims of these psychological
workplace dangers, and training and staff support should be geared to
helping them recognise and deal with these matters. Only then will a true
partnership be possible.
Rapid Response:
It takes two to patronise/be patronised
EDITOR - The editorial Paternalism or partnership? (BMJ 1999; 319:
719-20) is to be welcomed, as is the core suggestion that there be an
equal partnership between professionals and patients about health and
illness. As is common nowadays, there is however an implied criticism of
the "wickedness" of the ways of doctors and nurses who fall into states of
mind of being patronising to their patients. While undoubtedly unhelpful
as an attitude, it needs to be understood that it often takes two to have
a patronising/being patronised state of mind.
Patients who are in the grip of anxiety about their condition resort to
the well known mechanism of idealisation of their carers - after all, the
more omnipotent their carers the better the chance of personal survival.
This idealisation leads to the accretion of omnipotence in the staff, with
a resulting patronising attitude. Instead of being blamed for wickedness,
the staff should instead be seen as victims of these psychological
workplace dangers, and training and staff support should be geared to
helping them recognise and deal with these matters. Only then will a true
partnership be possible.
Anton Obholzer
Consultant Psychiatrist and Chief Executive
Tavistock & Portman NHS Trust
Competing interests: No competing interests