Patients and Doctors

Perspective

200th Anniversary Article

Patients and Doctors — The Evolution of a Relationship

Robert D. Truog, M.D.

N Engl J Med 2012; 366:581-585February 16, 2012

 Comments open through December 31, 2012

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Audio Interview

Interview with Robert Truog on issues in medical ethics and the physician-patient relationship. (21:39)

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The relationship between patients and doctors is at the core of medical ethics, serving as an anchor for many of the most important debates in the field. Over the past several decades, this relationship has evolved along three interrelated axes — as it is defined in clinical care, research, and society. Many of the pivotal discussions of these issues have appeared in the pages of the Journal (see Key NEJM Articles on Medical Ethics).

CLINICAL CARE

The relationship between patients and doctors in the clinical realm has historically been framed in terms of benevolent paternalism. Until about 1960, most codes of medical ethics relied heavily on the Hippocratic tradition, framing the obligations of physicians solely in terms of promoting the welfare of the patient, while remaining silent about patients' rights. The past several decades have seen tectonic societal shifts that have resulted in increasing empowerment of individuals against the authority of government and institutions, creating a surge of rights-based movements, with patients' rights emerging as a societal demand alongside women's rights, minority groups' rights, consumers' rights, and others./.../