ethicists, Ezekiel and Linda Emanuel,on the different
kindsofrelationshipsthatwe,asbuddingnewclinicians,
mighthavewithourpatients.Theoldest,mosttraditional
kind is a paternalistic relationship—we are medical
authoritiesaimingtoensurethatpatientsreceivewhatwe
believe best for them. We have the knowledge and
experience.Wemakethecriticalchoices.Iftherewerea
redpillandabluepill,wewouldtellyou,“Takethered
pill.Itwillbegoodforyou.”Wemighttellyouaboutthe
bluepill;butthenagain,wemightnot.Wetellyouonly
what we believe youneed to know. It is thepriestly,
doctor-knows-bestmodel,andalthoughoftendenounced
itremainsa commonmode,especially withvulnerable
patients—thefrail,thepoor,theelderly,andanyoneelse
who tends to do what they’re told.
The second type of relationship the authors termed
“informative.” It’s the opposite of the paternalistic
relationship.Wetellyouthefactsandfigures.Therestis
uptoyou.“Here’swhattheredpilldoes,andhere’swhat
thebluepilldoes,” wewouldsay.“Whichonedoyou
want?” It’s a retail relationship. The doctor is the
technicalexpert.Thepatientistheconsumer.Thejobof
doctorsistosupplyup-to-dateknowledgeandskills.The
job of patients is to supply the decisions. This is the
increasinglycommonwayfordoctorstobe,andittends
todriveustobecomeevermorespecialized.Weknow
lessandlessaboutourpatientsbutmoreandmoreabout
ourscience.Overall,thiskindofrelationshipcanwork
beautifully, especially when the choices are clear, the
trade-offs are straightforward, and people have clear
preferences. You get only the tests, the pills, the