The Silent World of Doctor and Patient

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In this eye-opening look at the doctor-patient decision-making process, physician and law professor Jay Katz examines the time-honored belief in the virtue of silent care and patient compliance. Historically, the doctor-patient relationship has been based on a one-way trust—despite recent judicial attempts to give patients a greater voice through the doctrine of informed consent. Katz criticizes doctors for encouraging patients to relinquish their autonomy, and demonstrates the detrimental effect their silence has on good patient care. Seeing a growing need in this age of medical science and sophisticated technology for more honest and complete communication between physician and patients, he advocates a new, informed dialogue that respects the rights and needs of both sides.

In a new foreword to this edition of The Silent World of Doctor and Patient, Alexander Morgan Capron outlines the changes in medical ethics practice that have occurred since the book was first published in 1984, paying particular attention to the hotly debated issues of physician-assisted suicide and informed consent in managed care.

Johns Hopkins University Press

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Editorial Reviews

Doody's Review Service
Reviewer: Cynthiane J. Morgenweck, MD, MA (Medical College of Wisconsin Health Policy Institute)
Description: This book, originally published in 1984, described the problem of physicians who assumed knowledge of their patients without much conversation. The author analyzes the forces that seemed to dictate the classic paternalistic relationship where the physician told the patient what to do and "good" patients readily agreed. He then proposes a model of shared decision-making that would actually enhance the physician/patient relationship.
Purpose: This book was written to examine the relationship between doctor and patient. The author aimed to spark a discussion about the kind of relationship that would be most suitable to the medical knowledge found within contemporary society, as well as its members. He makes the radical suggestion that the paternalistic model that has been used since the beginning of medicine is no longer an adequate model. Recognizing that there would be many barriers to his suggested new model of shared decision-making, he provides many examples of the benefits of such a model. When this book appeared in 1984, it certainly ignited a conversation that has continued to this day.
Audience: This book was written for both physicians and patients. It would be beneficial at any stage of medical training, and will certainly give patients a better understanding of the anxieties a physician has about the correct model of physician/patient relationships. This book is the classic in the increasing literature on the nature of the physician/patient relationship and should be read by every physician at least once.
Features: The author presents the classic paternalistic physician/patient relationship and the reasons for its development. He describes the relatively recent legal concept of informed consent and its implications for that relationship. He advocates for a model of shared decision-making, realizing that there will be barriers that will have to be addressed before such a model becomes the standard. His analysis of the first heart transplants is particularly insightful and still relevant as we continue to learn about the toll of innovative surgical therapies such as the total artificial heart.
Assessment: This book has maintained its impact, nearly 20 years after it was first published. The new introduction discusses the manner in which the book can be applied to current dilemmas in physician/patient interactions. This book was out of print for several years and many clinicians will be excited to find it is available again. For those who have not read it, the time expended is worthwhile, as the book presents the reasons for a relationship based on thoughtful conversation. As stated in the introduction, much work still has to be done. It is wonderful that this book is back in print to provide some much needed wisdom as physicians contemplate how best to serve their patients.
Business Week
A remarkable book... Goes a long way towards ending the silence that ultimately dehumanizes both doctor and patient.
Wall Street Journal
What gives this book unusual power is Dr. Katz's understanding of the historical origins of doctors' silence and his perceptive analysis of the relationship between doctor and patient that has led to this silent state.
New England Journal of Medicine
Jay Katz's poetic manifesto... will no doubt long be noted as a milestone on the rehumanization effort.
New Physician
A thoughtful analysis of the doctor-patient relationship and informed consent: clearly a labor of love based on years in medicine, law, psychiatry, and psychoanalysis.
Journal of the American Medical Association
As compelling and vital as it was when it appeared two decades ago. Tragically its critique of contemporary medicine still is right... A classic. It merits attention and discussion.

— Stanley J. Reiser, MD, MPA, PhD

A much-needed addition to the bioethical canon.

— Syd M. Johnson

Journal of the American Medical Association - Stanley J. Reiser
As compelling and vital as it was when it appeared two decades ago. Tragically its critique of contemporary medicine still is right... A classic. It merits attention and discussion.
Metapsychology - Syd M. Johnson
A much-needed addition to the bioethical canon.

4 Stars! from Doody
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Product Details

  • ISBN-13: 9780801857805
  • Publisher: Johns Hopkins University Press
  • Publication date: 9/10/2002
  • Edition description: New Edition
  • Pages: 320
  • Sales rank: 1,158,618
  • Product dimensions: 6.00 (w) x 9.00 (h) x 0.70 (d)

Meet the Author

Jay Katz, M.D., is Elizabeth Dollard Professor Emeritus of Law, Medicine, and Psychiatry and Harvey L. Karp Professional Lecturer in Law and Psychoanalysis at Yale University. Alexander Morgan Capron, is University Professor, Henry W. Bruce Professor of Equity, Professor of Medicine, and the Co-Director of the Pacific Center for Health Policy and Ethics at the University of Southern California.

Johns Hopkins University Press

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Table of Contents

Contents: Foreword to the Johns Hopkins Edition: The Once and Future Silent World, by Alexander Morgan Capron Preface and Acknowledgements Introduction Chapter I. Physicians and Patients: A History of Silence Chapter II. Physicians and Citizens: The Struggle for Freedom from Lay Control Chapter III. Judges, Physicians, and Patients: The Legal Doctrine of Informed Consent Chapter IV. Sharing Authority: The Willingness to Trust Chapter V. Respecting Autonomy: The Struggle over Rights and Capacities Chapter VI. Respecting Autonomy: The Obligation for Conversation Chapter VII. Acknowledging Uncertainty: The Confrontation of Knowledge and Ignorance Chapter VIII. The Abandonment of Patients: A Final Argument against Silence Appendix A. Code of Ethics of the American Medical Association (1847) Appendix B. American Medical Association Principles of Medical Ethics (1980)NotesIndex

Johns Hopkins University Press

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