What is the difference between a paternalistic and collaborative relationship?
When we were children, our parents decided everything: what we ate, what time we went to bed, when we could play, what TV programs or movies we could watch, what clothes we wore. Everything. We weren’t offered many options. Debate over or questions about their decisions, made on our behalf, weren’t often welcomed. They knew better and they loved us, so the assumption was that they could make better decisions on behalf than we could. That’s paternalism.
Our traditional healthcare model made similar assumptions. Our physicians had knowledge and experience that we didn’t – and since we assumed they were the best and brightest in our society, there was an underlying assumption that some/most of this knowledge was beyond our understanding. And virtually all of our health care providers (nurses, physicians, and others) entered their professions so they could help people. So there was a further assumption that they would use their knowledge and experience to look out for our best interests. We weren’t offered many options. Debate over or questions about their decisions, made on our behalf, weren’t often welcomed. That’s paternalistic healthcare.
As we left childhood and grew older, we became more assertive about defining what we thought was best for us. Likewise, our parents continued to love us and recognized that we’d eventually leave home and would need to make decisions on our own, and they wanted to prepare us to make good ones. Most of us went through a tense period where we thought we knew better than our parents what was best for us, yet our parent’s love and concern for our best interests caused them to continue to want to participate in or drive our decision-making.
Eventually, as we gained maturity and knowledge over time, we gradually took over most of the decisions about what we ate, how we played, what we wore, and what friends we chose. Later, these decisions became more impactful: whether we pursued advanced education, what careers we chose, whom we chose as our spouse, and whether or not to buy a house or rent. Under the best of circumstances we were eventually secure enough to recognize that our parents still had a wealth of life experiences that we could benefit from. To the degree that they were willing to recognize that these were our decisions, to be made with our goals, values, beliefs, and self-interests in the forefront, we selectively stayed close and sought their advice. We might not have asked their advice about who to date, but we may have taken seriously their opinions on choosing a life partner. We may not have asked them what they thought about our first apartment, but we may have taken seriously their advice about where, when, and how to buy our first home. Our relationship evolved from paternalistic to collaborative.
“When I was a young man of 17, my Father was so ignorant I could barely stand having the old man around. Yet when I was 21, I was amazed at how much he’d learned in just four years”
– Mark Twain
It’s that evolution to a collaborative relationship that we should seek with our physicians. They will continue to have unique knowledge and experience that we lack but need to stay healthy or to understand our conditions and evaluate treatment options. Our responsibility is to seek and foster a relationship where they appreciate that these are our decisions to make in the context of our own self interest; our goals, values, beliefs, and circumstances. We want our physicians to understand us as complete beings, including our values and beliefs. Then, if we’re diagnosed with a condition, we want to understand what our treatment options are, which may be most effective relative to our goals, and what our physician’s advice is. Then it’s up to us to decide which treatment option to pursue and to comply with that treatment until we either achieve our goal, or, if we don’t, try other options until we do. That’s how we evolve from a paternalistic to a collaborative relationship with our health care providers.
Remember: We coach, support, educate, and empower. We illuminate options you may not have known you had. But we don't decide what's right for you in your unique circumstances; only you can do that. And we don't provide medical, financial, or legal advice; nor do we replace the valuable counsel of those who do.