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Doody's Review ServiceReviewer: 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.