Doctors are being urged not to tell patients what is best for them but to lay out the options and tell them to get on with it. Hippocrates (5th century BC) would have had his doubts.
A key duty of the ancient doctor was, he said, ‘to help, or at least not to harm’. In this it was standard practice to involve the co-operation of the patient. As Hippocrates said, there were three components to the medical art: ‘the disease, the patient and the doctor. The doctor’s job is to serve the technical side; the patient’s is to co-operate with the doctor in combating the disease.’
Trust between doctor and patient was a key to that co-operation. Without it, patients ‘will not take medicine they dislike… and sometimes die as a result. They never admit what they have done, and the doctor gets the blame.’
New understanding of illnesses, said Hippocrates, ‘depends on how far the intelligence of the patients permits the drawing of conclusions’. Doctors took a joined-up approach to treatment: sick patients needed care, as did the well, to lead healthy lives, and the dying, to live out their last days contentedly. Words describing medical intervention — ‘treat’, ‘help’, ‘remedy’, ‘care’, ‘protect’ — far outnumbered those indicating restoration to full health. But as medicine developed, so doctors began to specialise: here an expert in health, here one in healing, here one in diseases, and so on. Doctors and patients gradually grew further apart. And that is the problem.
Once a doctor has developed a degree of expertise, the patient gets left behind and the sense of mutual co-operation is lost. In those circumstances it makes little sense to give the patient the final say, when the result may be the reverse of what the doctor was there for: ‘to help, or at least not to harm’. The doctor is certainly not helping by leaving the final decision to the patient. That is the ultimate trahison des docs.