Lázaro J, Gracia D
Universidad Autónoma de Madrid.
An Sist Sanit Navar. 2006;29 Suppl 3:7-17.
In the final decades of the XX century the way doctors and patients related to each other changed more than in the twenty-five preceding centuries. The change from a paternalistic to an autonomous model represented a transformation with few historical precedents. The evolution of this phenomenon over time affected the three elements involved: 1. The patient, who had traditionally been considered as a passive receiver of the decisions that the doctor took in his name and for his benefit, was transformed at the end of the XX century into an agent with well-defined rights and a broad capacity for autonomous decision-making on the diagnostic and therapeutic procedures, which were offered to him and no longer imposed on him. 2. The doctor, from being a priestly father-figure (as corresponded to the traditional role of his profession) was transformed into a technical adviser to his patients, to whom he offered his knowledge and advice, but whose decisions were no longer taken for granted. 3. The clinical relationship, from being bipolar, vertical and infantilising, became more collective (with the involvement of numerous health professionals), more horizontal and better adapted to the type of relationship appropriate to adult subjects in democratic societies.
在20世纪的最后几十年里,医生与患者之间的关系变化比此前的25个世纪还要大。从家长式模式向自主模式的转变是一种几乎没有历史先例的变革。随着时间的推移,这一现象的演变影响了三个相关要素:1. 患者,传统上被视为医生以其名义并为其利益做出决策的被动接受者,在20世纪末转变为一个拥有明确权利、在诊断和治疗程序方面具有广泛自主决策权的主体,这些程序是提供给他的,而非强加于他。2. 医生,从一个神职人员般的家长式人物(符合其职业的传统角色)转变为患者的技术顾问,向患者提供知识和建议,但不再理所当然地替患者做决定。3. 临床关系,从两极化、垂直化且使人幼稚化,变得更加集体化(有众多医疗专业人员参与)、更加横向化,并且更适应民主社会中适合成年人的关系类型。