Every physician is aware of the Hippocratic Oath and their ethical duty to treat patients to the best of their ability, ideally without harming them in the process. Modernized versions of the 400 BCE oath, such as those adapted by the World Medical Association (WMA) for The Declaration of Geneva, go one step further and put additional emphasis on patient-centered care. The Physician’s Pledge – the ceremonial, spoken form of The Declaration of Geneva – includes the line, “I will respect the autonomy and dignity of my patient.”
Respecting the autonomy and dignity of an individual can be interpreted in various ways, depending on that individual. For example, with children this respect and granting of autonomy can manifest as encouraging them in their adventures and interests, offering feedback when needed, and nurturing them as they continue to grow into this autonomy. But this nurturing also tends to come with caveats. For instance, it’s not always such a good idea to unreservedly respect a child’s autonomy when you’re cooking together and they’re reaching for your eight-inch chef knife. Or when they’ve decided to run headfirst into oncoming traffic for no discernible reason whatsoever… No matter your views on parenting, it’s a fact that all children require a certain amount of guidance and limitation when it comes to respecting their autonomy and dignity – they’re still growing, after all.
So how should one best respect the autonomy and dignity of an adult patient? Should there be certain caveats here too?
A prerequisite for both dignity and autonomy is active listening, making a conscious effort to understand what someone is trying to communicate to you. It seems, however, that not all physicians incorporate active listening into their everyday patient care.
Oleksii Sologub is a patient communication strategist who has worked with post-op cataract and refractive lens exchange (RLE) patients for the last six years, diligently gathering their written and verbal feedback to gain a more holistic insight into what they really feel about their surgical experience. As a non-medical professional, he was granted insights that perhaps wouldn’t have been as forthcoming if the patients were speaking to the surgeon who’d just operated on them.
In his new article for The Ophthalmologist, Sologub notes a recurring theme of patients feeling like they had not had clear, trustworthy communication during their procedures. To illustrate his point, he gives the reader three real-life case studies: 1) A patient feeling unable to ask too many questions from their doctor for fear of angering them to the point where they performed a “less than optimal surgical procedure.” 2) A patient cancelling their cataract surgery because they felt pressured into the procedure, as well as being negatively influenced by online research. 3) A US-based patient even going so far as traveling to New Zealand where she perceived there to be “better premium options.”
Sologub writes that it is “the silence in the room” that unites these three negative experiences. “This silence can perhaps be best explained by understanding the patient’s behavior – facing any kind of surgical intervention will always, to a greater or lesser extent, generate fear.” And it is partly about recognizing and accepting this very reasonable fear on the side of the patient, not becoming inured to it through repetition, that can help surgeons to empathize with – and in doing so, better respect the dignity and autonomy of – the patient. After all, unlike the surgeon performing cataract procedures on a daily basis, patients may only go under the knife once or twice in their entire lifetime.
Solugub’s case studies are outliers, extreme examples of fear overcoming a patient and causing an overreaction. But they do serve as a reminder, at least, that respecting the dignity and autonomy of a patient and acknowledging their pre-operative fears is paramount to upholding the oath made when ophthalmologists enter the profession.
