Silent World of Doctor & Patient

by Avner Katz

Historically, the doctor-patient relationship has been based on a one-way trust--despite recent judicial attempts to give patients a greater voice. Seeing a growing need for more honest and complete communication between physician and patient, Dr. Jay Katz advocates a new, informed dialogue that respects the rights and needs of both sides. A new Preface outlines changes since the book's publication in 1984. 263 pp.

Genres: Medicine, Medical, Health, Nonfiction, Science, History

263 pages, Paperback

First published January 1, 1984

Reviews

[Samuel Brown · Rating 3 out of 5]

An established classic in bioethics, this book is a kind of manifesto for Shared Decision Making. Its heart is in the right place, and its advocacy of honest, open communication between clinicians and patients is spot on. I found, though, that the book has multiple factual errors (including a strange nested error relating to the advent of the term "informed consent" in legal scholarship) and its reliance on freudianism as an actual account of human cognition and consciousness wears thin quickly. But the strong advocacy for something so clearly important as shared decision making makes it relatively easy to overlook the problems in the book. For historians of shared decision making and bioethics, this is a key text.

[Kelly · Rating 4 out of 5]

4.5 stars. This book is old, especially by medical progress standards (originally published 1984), so informed consent was just barely a thing and some of the author’s skepticism about it feels overdone in retrospect. But I think historical context on issues of doctor-patient communication is very important, and it’s very interesting to see which of Katz’s predictions (both about the legal status of informed consent and in general) have come true and which did not. He also is a big proponent of psychoanalysis and most of his psychological theorizing is based on it, so that rubbed me the wrong way a little bit. But otherwise he makes very valuable and thought-provoking points about the relationships between doctors and patients (the section about dying patients is particularly excellent), uses very effective examples, and writes excellently. Overall, I highly recommend this book to anyone looking for historical perspective on doctor-patient communication or relationship issues or the early history of informed consent laws.

[David · Rating 4 out of 5]

Jay Katz reasons and writes with clarity in this comprehensive work about the concept of informed consent. He traces the evolution of the right of patient self-determination from ancient times to modern court cases, thoughtfully evaluates the influence of thinkers like Mill (positive) and Kant (negative), and examines psychological dynamics in doctor-patient relations (relying a lot on psychoanalysis, the one aspect of the book I didn't welcome). Katz's illuminating vision is one of transcending old authoritarian norms and biases of doctor-patient relations, moving toward a more enlightened rational medical culture. 3.5 stars rounded up to 4.
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"Awareness of the irrationalities that physicians bring to decision making has been impeded by the idea that medical decision making involves largely technical-scientific issues that physicians can evaluate more rationally than patients can. Technical issues, however… are only one of the determinants that impinge on thinking about choices."

"...[F]aith, hope, and reassurance have to often served physicians' needs to maintain authoritarian control, to hide uncertainties, and to facilitate patients' regression to more infantile modes of functioning in order to encourage nonverbal interactions and compliance. If some physicians seek to justify such conduct on the grounds of medical necessity and their benign and altruistic intentions, they must also recognize the faithful consequences of their demands for compliance: the surrender of autonomy and independence, with all that such surrender implies about patients' inevitable disappointment over physicians' inability to deliver on the promise of total caretaking and, in turn, about the inevitable feelings of abandonment that such disappointment mobilizes."

[Keshav · Rating 3 out of 5]

The chapter on 'Acknowledging Uncertainty' is brilliant.

[Miriam · Rating 2 out of 5]

Eh. Very influential book in it's time, helped to steer medicine away from the traditional paternal "doctor knows best" to a more collaborative method of making decisions involving the patient and the patient's own ideas of what is most valuable to them. Other than that, this book just turns into a rant about how doctors really don't know anything. Also very dry and extremely repetitive, I didn't finish it. Basically, patients need to make their own decisions through informed consent. I would recommend reading just the intro to get the gist of it, and then moving on.

[TJ · Rating 2 out of 5]

Not quite what I thought it was. Interesting history of med but still dull