Enlightenment Values, Iatroculture, and the Origins of Patient Mistrust

Jon Tilburt, MD, Johns Hopkins University

The doctor-patient relationship is in trouble. Some have described the moral problems of the doctor-patient relationship as a loss of trust. Fashionable explanations of this problem focus on variables extrinsic to doctors such as technology, the practice pace, economic constraints, and the sterility of the treatment environment. Initiatives aimed at reforming the doctor-patient relationship include behavioral, legislative, and conceptual efforts. The standard model of the doctor-patient relationship upon which such initiatives are built includes various patient characteristics and discrete health behaviors important to communication. Based on these behaviors, we offer external interventions: seminars, workshops, role-playing, and even architectural redesign to manipulate the therapeutic interaction. These initiatives aimed at medical practice assume that the loss of trust in medicine arises from a lack of appreciation for Enlightenment values. If only the principles of liberty and self-determination were restored, so these proponents argue, the doctorpatient relationship would be restored as well. Meanwhile, the discontent with physicians and the medical establishment escalates.