Power in the physician-patient relationship

[摘要] ENGLISH ABSTRACT:This paper examines aspects of power within the physicianpatientrelationship. The historical development of thephysician-patient relationship is briefly reviewed and some ofthe complexities of the relationship highlighted. It is shownthat, historically, there is no imperative for the physician toconsider only the interests of the patient and it has alwaysbeen acceptable to consider the interests of a third party,such as the State or an employer - essentially the interests ofwhoever is paying the physician.The classical sources of power are then considered. Thesesources include legitimate power, coercive power, informationpower, reward power, expert power, referent power,economic power, indirect power, associative power, grouppower, resource power and gender power. Other approachesto power are also considered such as principle-centred poweras described by Covey, power relationships as explained byFoucault, the power experience as described by McClellandand an analysis of power as expounded by Morriss.The various sources of power are then considered specificallywithin the physician-patient relationship to determine:if this particular type of power is operative in the physicianpatientrelationship, and if soif it operates primarily to the advantage of the physician or theadvantage of the patient.A simple method of quantifying power is proposed. Each formof power operative in the physician-patient relationship is thenconsidered and graphically depicted in the form of a bar chart.Each form of power is shown as a bar and bars are added tothe chart to 'build up' an argument which demonstrates theextent of the power disparity between physician and patient.It is clearly demonstrated that all forms of power operate tothe advantage of the physician and in those rarecircumstances where the patient is able to mobilize power tohis/her advantage, the physician quickly calls on other sourcesof power to re-establish the usual, comfortable, powerdistance. Forms of abuse of power are mentioned.Finally, the ethical consequences of the power disparity arebriefly considered. Concern is expressed that the powerdisparity exists at all but this is offset by the apparent need forsociety to empower physicians.Conversely, consideration is given to various societaldevelopments which are intended to disempower physicians,particularly at the level of the general practitioner.Various suggestions are made as to how the powerrelationships will develop in future with or without consciouseffort by the profession to change the relationship.

[发布机构] Stellenbosch University