The end of paternalism in the NHS

September 17, 1999

(Paternalism or partnership? Patients have grown up and there's no going back)
BMJ Volume 319 18 September 1999 pp719-20

Angela Coulter of the King's Fund, guest editor of this week's issue, believes that it is time patients were treated like "grown-ups" and became more involved in their healthcare. In an editorial in this week's BMJ she writes:

"Paternalism is endemic in the NHS (National Health Service). Benign and well intentioned it may be, but it has the effect of creating and maintaining an unhealthy dependency which is out of step with other currents in society. Assumptions that doctor (or nurse) knows best...should have no place in modern health care. The key to successful doctor-patient partnerships is therefore to recognise that patients are experts too.

"The doctor is, or should be, well informed about diagnostic techniques, the causes of disease, prognosis, treatment options and preventive strategies, but only the patient knows about his or her experience of illness, social circumstances, habits and behaviour, attitudes to risks and preferences. Both types of knowledge are needed to manage illness successfully, so both parties should be prepared to share information and take decisions jointly."


Angela Coulter, Executive Director, Policy and Development, King's Fund, London


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