In sum, a variety of factors continue to reinforce paternalistic patient–doctor re- lationships. Other factors, however, are changing the nature of these relationships. Most importantly, as Boyer and Lutfey note, “Today’s patient role is more often chronic rather than acute; is based on risk of disease rather than ex- isting illness; and requires more active engagement by the patient in monitoring, self-educating, and self-treating over time rather than just seeking treatment from a provider on a one-time basis.”
When a patient with a high fever arrives at a hospital and is diagnosed with encephalitis, the doctor in charge will likely begin treatment immediately. In such cases, the patient may be incoherent and unable to give consent to treatment. In contrast, when patients who have lived with diabetes for a decade arrive at a doctor’s office, the patients usually have a well-honed sense of their own bodies and of which treatments work best with the fewest side effects. They also may regularly check news reports, websites, and Internet discussion boards to find out what treatments others are using. In these circumstances, communication between doctors and patients often becomes less paternalistic and more a process of negotiation.