The Changing Role of Uncertainty in Physician-Patient Relationships

Abstract

In ancient times, but persisting even today in some societies, the physician as a shaman possessed omnipotence through his divinely privileged connections in the eyes of his patient. In this exclusively authoritarian, paternalistic relationship, there was no place for uncertainty in the practitioner. The Hippocratic tradition brought egalitarianism to the physician-patient relationship but still supported the authoritarian role of the doctor as a hardline form of beneficence. The explosion of knowledge in medical science in the late nineteenth and early twentieth centuries, accompanied for the first time with the promise of rational treatment, created an even greater gap between physician and patient in understanding medical science, leading to the physician assuming an even more authoritarian position in their interactions. Beginning in the second half of the twentieth century, with the advent of “patient-centered medicine” and codes of patient rights, the doctor-patient relationship evolved into one of partnership, respecting the patient’s values, and more transparent sharing of the uncertainties of medical practice. Looking to the future, with its massively accumulating molecular information and its seemingly infinite amount of new data of as yet unknown significance, one can only speculate how physician (or robot)-patient relationships will shift again.