The Mighty Doctor: Considering the Power Dynamic Between Patient and Doctor

“I always made a point of telling the doctors I was sane, and asking to be released. But the more I endeavored to assure them of my sanity, the more they doubted it.”

— Nellie Bly

I often ponder the power dynamic between patients and their health care providers. Clearly, doctors spend years gaining medical knowledge that people without this training do not possess. It is exactly this level of education that gives doctors the upper hand.

I have a neighbor, a retired nurse, who refuses to put on a gown or change out of her clothes in any way before she speaks with her doctor. She has a point. Who doesn’t feel vulnerable in those awful gowns? It automatically puts the doctor on higher ground – she’s fully dressed, you’re not.

A 2016 study* found that although current trends in health care seek to minimize this power dynamic through shared decision making, many doctors do not fully perceive, appropriately use or aim to curtail their authority when interacting with patients.

Historically doctors did have knowledge their patients did not. But now, well, now we have the internet, yes? (However, I do caution people to use well-respected sources and check more than one site when looking for answers).

Innately curious (yay, ADD) (and, yes, curiosity may kill the cat, but obviously knowledge is power), when I have a medical issue, I typically research my symptoms and discuss possible causes with my doctor. She listens. She has compassion. She answers my questions. She feels more like a partner than someone with superior knowledge. She respects my intelligence and my preferences.

Many years ago, I had an infection that needed medical attention. I had just moved to Portland, Maine, and hadn’t yet sought a regular doctor. The doctor I wanted to see upon recommendation from a friend was not taking new patients, but there was a new doctor in her practice who had an appointment available.

Dr. Peter Gordon became my primary care physician for nearly two decades. When I moved to northern Maine, I even traveled more than three hours to see him.

The reason?

That infection I had is usually treated with antibiotics. But I was adverse to taking them and told Dr. Gordon so. He wrote a prescription for the drug saying I didn’t have to fill it if I took other less-invasive measures and was able to rid myself of the infection within a day or two. If not, he encouraged me to take the antibiotic. He HEARD and RESPECTED me. In the end, I was able to avoid the drugs and I recovered. And that’s how it went with him and I’m sure still does for his current patients.

If your doctor isn’t treating you this way, you might want to consider finding a different health care provider.

Laura Nimmon and Terese Stenfors-Hayes, the authors of the aforementioned study wrote that although a caring, respectful, and empowering communicative physician-patient relationship is proven to improve patient outcomes, there are barriers to employing this level of care due to the inherent power imbalance by virtue of doctors’ qualifications and training. The authors recommended doctors are educated early on and have opportunities for ongoing professional development to raise awareness of their inherent power and teach them to exercise patient-centered communication “through reflective, effective and professional use of power…”

The following statements were taken from the study, during which doctors were interviewed about their perceptions of the doctor-patient relationship. Which of these practitioners would you be most likely to go to and why? Please leave your answer in the comments section.

A) “There is always a power relationship … Patients, they have to put their trust in you because you’re talking about and doing things that really they don’t understand or don’t have a background in. So they have to have a faith that you’re doing what’s best for them, and so you have to be cognizant of that to make sure that you never ever take advantage of that role.”

B) “There is a power imbalance … I mean, you are empowered by the knowledge that you have and the ability to treat patients. So there is an inherent power imbalance … that power imbalance is in knowledge.”

C) “I think you’re seeing that patients probably think they have more power. I think because there’s more consumerism within medicine, people have a U.S.-style consumerist way/approach where ‘I have all the information, you should do this treatment because I think this is what I need.’”

D) “A lot of patients really want to be an equal partner in the learning. And some of them are very intelligent and they will ask you difficult questions. And that’s fine, I kind of like that.”

 

* Laura Nimmon and Terese Stenfors-Hayes, The “Handling” of power in the physician-patient encounter: perceptions from experienced physicians (BMC Medical Education: 2016) [also posted on the National Institutes of Health’s PubMed Central