The patient and doctor should try to develop a relationship that broadens beyond just the professional level. Doctors must take the extra step by building a relationship with patients to make them more comfortable in the presence of a doctor. A deeper relationship could facilitate the healing process and allow for more self determination for the patients. Being medical professionals, doctors should strive to create an ideal atmosphere for patients, and in an atmosphere of pure professionalism a client may not feel much comfort in regards to either their health or treatment. Patients should feel at level with their doctors and at the same time doctors should try to make patients feel as though they are in a mutually empathetic relationship. It is the doctors’ duty to go beyond only an engineering method relationship to build a bond with the patient while preventing himself from forming a priestly relationship in which the patient is treated in an absolute domineering manner and left with very little self determination. In the early stages of Dr. McKee’s transition he began to realize more and more deficiencies in the medical world he started forming relationships that seemed to have more depth. Dr. McKee shied away from the engineering/contractual relationships he was used to having with patients in which everything was done for each parties self interest rather than with compassion that a doctor should possess. The fiduciary model in which “both parties are responsible and their judgments given consideration” (Callahan 119) is the most ideal because trust is important and both the doctor and patient are placed on same level rather than one party being an imperious figure, the transition was a huge step from where his authoritative and condescending relationships were.
Due to the complexity of society and the issues around us today, doctors have grown in their professional significance. It seems as though without doctors, society would not be able to function properly. As Plato said, “The public is not capable of performing every professional duty on their own.” (The Republic pg. 40) Not just anyone could be a doctor and our society needs doctors to help heal our health troubles. The specialized knowledge of doctors is of the utmost importance in keeping society from falling sick to plague or pestilence. Although doctors are required in a properly functioning society, they should not be given the inherent right to power based solely on their professional position. Power could deteriorate the relationship between doctors and patients as was shown in the film. When Dr. Abbot realized that she was in the position of power regarding Dr. McKee’s health; Dr. McKee grew very uncomfortable and soon fired her due to the power that corrupted Dr. Abbot’s power to treat. Giving too much power to doctors take away from the patients self-determination and could likely turn patient/doctor relationships into a more paternal one rather than a fiduciary.
The role of a professional medical doctor is that of a healer. Doctors should dedicate not only their time, but also develop a personal caring relationship with the patients to hasten the healing process. The debate over self determination often comes into play when patients must face the choice between methods of therapy as Dr. McKee faced when he had to choose between radiation therapy and surgical removal of his tumor. Models such as the contractual and especially the fiduciary and that encourage leaving the final choice with the patient after receiving medical advisement are models that should be applied in the medical field. The paternalistic model fails in this aspect because it allows the doctor to perform without patient consent. Although the professional may have far superior knowledge of the medical field, the doctor/patient relationship is not a parental/child relationship. Some may argue that under the stress of health problems, patients may choose the inappropriate course of action for treatment and that doctors should choose for the sick patient. Although doctors do know better, the paternal model places far too much liability in the doctors hand which places the doctor in a position to practice defensive medicine.
People go to doctors to receive medical treatment and options for therapy. If doctors chose all our treatments and handled all of our medical affairs without personal consent, the doctor/patient relationship could be deteriorated to nothing more than a condescending tie between two individuals, as stated in Callahan “Patients need a more active role in their health than given with the parental model.” (Callahan pg. 188). After studying the readings in the Callahan book, the fiduciary relationship seemed a more appropriate model for the patient/doctor relationship. The fiduciary model strongly encourages empathy and trust on both sides, which helps create a deeper relationship than other models serve to create. As long as the fiduciary relationship is not deteriorated unto the point of paternalism, a fiduciary relationship is far more advantageous for both the patient and doctor. The doctor must maintain a fiduciary relationship without making decisions that the patient is not informed about, except when “1) the matter is chiefly technical one or 2) the value effect is not significant.” (Callahan pg. 119). The fiduciary relationship creates a balance of empathy on both sides and a stronger sense of self determination for the client that other relationship models lack.
The movie The Doctor does a superb job by making the depth of relationships between the patient and doctor explicitly clear throughout the film. The transition of Dr. McKee’s position on emotional proximity with patients shows that doctors can create an emotional bond with patients and not be viewed as weak or inefficient. As a viewer I immediately began to ponder what an ideal model relationship should be and thought about how much self determination patients should have. Although all the relationships have their pros and cons, the fiduciary relationship is as close to ideal that the relationship between patients and doctors can get. Being that the fiduciary model allows for a great amount of self determination on the patients half, it seems most logical that the fiduciary model be encouraged in the medical world. A fiduciary relationship strikes a exceptional balance between the professional status of doctors and its affect on their relationship with patients, all while strengthening the patients right to self determination.
