“Paternalism” isn’t always bad, “Partnerism” isn’t always desirable. Many patients, especially the elderly, those from other cultures, and very sick people often want a more take-charge type of physician. Some patients become more assertive, less passive and dependent, as their illnesses resolve. As an MD, I’ve been amiss when I’ve erred on the side of partnerism with patients who, for the reasons I gave, were uncomfortable with that balance. You allude to this when you say “Doctors who subscribe to [the partnerism] philosophy tend to push a lot onto their patients, which they may or may not be in a position to handle.”

I teach a course in doctor-patient communication at Stanford University. Stanford Medicine and Horsemanship employes horses to teach bedside manner and other interpersonal skills. Just like some horses need a strong hand and some horses like to be asked and guided, patients gravitate to the type of doctor–more directive or more peer-oriented–that serves them best. The important thing that we teach is awareness of the spectrum of manner, from more active to more passive, and respect for where on the spectrum one is comfortable–and yet is still respectful to the patient.

Beverley Kane, MD
Palo Alto, CA