Re-sacralisation of doctor-patient relationship



There comes a time when the doctor realizes that his life is not so good, lacking meaning and satisfaction that the profession was trying to offer before. Part of the new medical economy, adjusted to the market economy, the doctor is faced with a growing professional competition, strengthened by the fact that European countries have visible difficulties in financing health. The patient, in turn, is in the situation of having consumer behaviour not only wants to be happy, but also pleased with the quality of medical care services it receives.

Although the doctor has the monopoly of decision on investigations, treatment and medical care by virtue of his diploma of study (brand attraction), the patient cannot have total confidence in him, unless he is willing to listen to his life and health problems, if is helped to overcome bureaucratic obstacles of the hospital or, in other words, if the doctor will pay personalized attention. Depending on the satisfaction of those needs, the patient will express the degree of appreciation and fidelity with the doctor and the medical structure in which the doctor operates.

The respect for the ontological dimension of the patient, taking a perfected medical behaviour in determining the diagnostic and prescribing therapy, and provision of quality health care services advocates for the need of re-sacralisation of doctor-patient relationship, desired aspect by both stakeholders and the society at large.


Tablet of Contents:

1. The paradigms of Kierkegaardian irony in contemporary medicine

2. The Power to be Patient

3. Rediscovering the dialogue between the physician and the patient


1. The paradigms of Kierkegaardian irony in contemporary medicine

The discussion proceeds from the article of Farr A. Curlin (2016), referring to J. Lear’s work, published in 2011, which states that the dissatisfaction of physicians reflects, in addition to a deep anxiety, a corollary meaning of misunderstanding [1].

The first paradigmatic moment of irony occurs when the doctor realizes the gap that opens between his social representation and the aspirations he pursues through his medical career. In other words, it is about the way a person is acting as a physician and what one should do to match the desired image even when, fulfilling or surpassing all imposed social standards, finds that they do not respond to the idea of medicine in the classical sense of the notion. It is the moment when the doctor, aware of the dramatic loss of ideals, begins to experience irony.

The second ironic, otherwise unpleasant, occurs when the doctor begins to ask oneself radical questions: What is the disease? What does it mean to cure? Who are my patients?

What can I do for them as a doctor? What are the odds regarding my efforts? and so on. It is the moment that sends us to the contemplation of Kierkegaard's ironic observation that becoming a human is not at all simple and has little to do with the conscientious and devoted way in which we practice our profession [2].

In his notes, J. Lear reminds us that in acting as a physician we may miss out due to duplicity, hypocrisy or even imposture, in the worst sense of the word and states: “Someone is  said to be a good doctor, when in fact he is just a good façade[3]. Of course, there are cases where we do not have to deal with individual hypocrisies, but with situations where the physician, as a conscientious representative of social practice, finds that, in fact, the latter is the one who missed.

However, we must admit that it is not easy to be one of those exemplary physicians because of the practical nature of the profession, which includes implicit and explicit rules and requires a hard to sustain dedication. Sometimes its hard to listen to the patient, its hard to follow him if youre tired, if youre busy, its hard to deal with the patients if you have other obligations at the same time. That is why most of us are failing to give patients what the good medical practice teaches us: placing the suffering person in the center of attention; the patience to listen to him, the effort to understand his suffering, the respect of the body and the soul, his approach as a person, providing care with love, etc.

On the other hand, many doctors fail to keep pace with medical science the way they believe and know they should, although masters have shown them and taught them how hard it is to do this. When we are aware of these misses, it is no longer about irony, but simply recognizing that we do not represent ourselves how we should against the rules established by the society for the medicine. Irony occurs when the doctor does not realize that he is out of the standards that society imposes on his medical career. Perhaps the problem would not be so difficult, and the irony so important if reflection and self-criticism were not already part of social practice [4].

Medical students and young doctors are always reminded that, in order to reach and remain good doctors, their work always requires critical and correct reflection. Irony occurs when the doctor interrupts this reflection by creating his own, but wrong, creed, when he thinks he knows best what it means to be a good doctor.

Nowadays, science together with its pompous daughter, the technique, undoubtedly represents the most important masterpieces of the beginning of the millennium, placing medicine, as a social representation, on a historical peak. Ultimately, it gives us a long life and the release of suffering, things we all desperately want. These successes have enabled medicine to become a powerful cultural force. In this state, critical reflection on medical practice becomes an expression of social representation, and the Kierkegaardian irony correctly understood not only leads to detachment, but also to the way social practices can be adequately met. Since irony depends and evokes a persons desire to be a doctor, the experience of irony should, in the case of this paradigm, stimulate him, so that the old activities are re-committed in a new form, leading to a better outcome of medical practice.


2. The Power to be Patient

There is the opinion that nothing has changed so much in the health care system of recent decades as humanitys perception of its own health [5]. Today’s patient is no longer the former, knowing too well his rights, which he claims vehemently. Medical paternalism gradually diminished, in favour of the consuming model that gives patients control and full responsibility [6].

Looking superficially, the meeting between the doctor and the patient is undoubtedly motivated by the patient's need to have access to the doctors professional knowledge, and the medical act itself appears to have a definite purpose, that of improving or even curing the disease based on applying medical knowledge.

However, things are not simple, and the dialogue between the physician and the patient is much more than just a discussion in which medical knowledge is applied. In medical language, the communication between the two is called a clinical consultation, that is, an intimate encounter between the doctor and the patient when, from the multitude of subjective and objective signs, the doctor strives to decipher the disease, formulating a diagnosis, prescribing a treatment, and in the end establishing the prognosis.

A relationship is established between the two interlocutors, which, if we reduce it only to the biological aspect, would mean that we are getting it depleted from its human content. The patient is not only a living organism suffering from a dysfunction, but a being to be seen in its bio-psycho-social and spiritual integrality, which during the time spent with the doctor acquires the consciousness of a unique personal connection with a lot of meanings.

Nowadays, in the doctor-patient relationship the contract model has accredited, which is seen as an interaction between two equal agents, in which the doctor commits not to abandon the patient and inform him to allow him to express his/her options, taking into account four of his/her rights: access to relevant information, autonomy, fidelity, humanity. However, trapped by the alternatives offered by the doctor (the choice between the different types of treatments and the accompanying risks), the patient, who is not a medical practitioner, can accept or refuse the proposed medical act without realizing if one does good or bad. Being unable to give informed consent, one is limited only to the ticking of administrative responses, whose purpose is only vague. The development of bureaucracy, which Max Weber describes as the social mark of the worlds disenchantment,” in which the doctor-patient relationship prisoner to the technicism system, descends into the dark and cold clutches of a meeting exhausted by the mystery of human life. Finally, this model does not deny the imbalance in power and recognizes the danger of moving to unwanted paternalism [7].

Most of the time, doctors strive to understand patients’ opinions and to inform them of alternatives to diagnosis and therapy, giving the medical examination a personalized aspect.

As some patients dramatize and amplify their suffering, you need to pay extra attention to them; to others, who do not want to live their lives under a minimum level of dignity, you ought to respect their desire; you are compelled to satisfy the claimants; in front of the indifferent or undisciplined people, you must impose yourself with energy, especially if, through their illness, they are a danger to others; anxious people need repeated assuasive reassurance. Every step of the doctor must therefore be well thought out, because ultimately there is a relationship between him and the patient, as the storytelling thread of a story that takes root in the miraculous and mysterious universe of ontology to which we must give the necessary dose of hope and well-being (good mood, trust, charm, optimism) [8].

As a personality, the doctor may also be an optimist or pessimist, anxious or balanced, restless or calm. He is greatly influenced by his own health, fatigue, and his familys problems. How will one turn and what alternative will one choose? The degree of competence and concentration power decrease, of course, at the end of a night shift, when errors can occur more often. At such a time, to a young doctor a new case, just brought to emergency service, may appear to him as a torture machine[9].

Even if it is often silenced, the social value of the patient is an element that the medical device cannot ignore. Here are the many anxiety and interrogations of the doctor: How should I care Einstein if he were a patient? But how much attention do you pay to the beggar taken from the street? The Russian atomist Landau, a member of the Academy, received the Nobel Prize after being taken out of a deep 44-day posttraumatic coma. However, Artificial Life Maintenance would have been discontinued, under normal conditions, two to three days after the disappearance of electroencephalographic activity (brain death”). Fourteen specialists were mobilized at General Francos bed at the terminal stage. There is, as a reality, an “elitist” medicine for those who can afford it. At the antipode – the “etatist” (budget-dependent) and the social insurance’s, which also has here, like everywhere in the world, several steps, after the paid price. We come again to the decisive factor as a last resort: the money. The value of the patient also depends on the size of the bank accounts! There are private hospitals and hospitals for the poor. Healthcare has become more and more expensive, reaching an absolutely real critical point [10].


3. Rediscovering the dialogue between the physician and the patient

The secularisation placed the desire for bodily health instead of the desire to save the soul, and trust in medicine replaced the hope promised by religion. Up to a point, the desire to have a perfect health and a long life, to correct physical deficiencies and to improve the functional limits of one’s body is undoubtedly a legitimate hope.

Contrary to the optimism that the science insufflates us, we must not forget that for man, physical health cannot be a definitely acquired good. Moreover, in this world, it never exists absolutely and forever, representing nothing but a partial and provisional equilibrium, and it may even be said to be a state of less disease (St. Simeon the New Theologian) [11]. In addition, the human body signifies more than just a network determined by biological rules. It represents the presence of a conscience that starts from the biosphere through the Word and the responsibility to make this Word the instrument of its development and its peers [12]. We see how the Word is embodied, and people realize that the time when, pretending that medicine is a science, actually has to do with an autistic medicine, which at the same time claims to be gifted with rationality and that its purpose is to do good” has passed [13].

But when science is used without the consciousness of inherent presumptions and limits of a limited reason by itself”, when man can no longer reasonably inquire about the essential things of his life, his withering, his imperatives and his permissions to life and death, having to leave these decisive problems to a sense separated from reason, then he does not live the reason, but dishonours it. The disintegration of man that occurs at that time can equally generate pathology of religion as well as pathology of science [14]. That is why it is necessary to re-establish the connection between scientific reasons” with the broad horizons, presumed by the life worthy of man, which Christianity embraces with such generosity.

In this situation, contemporary medicine must rediscover the delightful force of words, to re-sacralise the relationship between the physician and the suffering man. The ethic of this dialogue does not mean, interposing a friendship or empathy, but the emergence of a therapeutic alliance through which words can contribute to healing.

Although there is an epistemological difficulty, resulting from the inductive method of the procedure that does not allow the quantification of the meaning of words in any of the possible situations, the result of this process can be seen in the growing desire of patients to tell their disease history as a soul discharge in which they actually seek, physical healing [15].

Neither prayer is considered today a chimera of the soul, but rather a support on the path of healing. Moreover, the terms medical paternalism” or medical information transmissionare no longer relevant, because medical rationality does not belong exclusively to the doctor.

In order to improve the quality of his performance, he will have to learn from now on the re-sacralisation of the physician-patient relationship by returning to the Word and thus to the imaginary. Here is a new mission for Christians to promote our concept of God in controversies around people. God Himself is the Logos, the original theme (Urgrund) rational, of everything that is real, the creative reason from which the world results and mirrors in the world. God is Logos – meaning, reason, word, and therefore man corresponds to Him by opening and promoting reason, who cannot be blind regarding the moral dimension of being.

In fact, healing and the use of reason lead to the recovery of moral, in a society that tends to dissolve it in utilitarian considerations or exercise of power [16].


The Authors:

BUTA Mircea Gelu [1]

VIDICAN Emanuel [2]

[1] Faculty of Orthodox Theology, UBB Cluj-Napoca (ROMANIA)

[2] Faculty of Orthodox Theology, UBB Cluj-Napoca (ROMANIA)


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Contribution selected by Filodiritto among those published in the Proceedings “13th National Conference on Bioethics with International Participation - 2018”

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1. Lear, J. (2011). A Case for Irony. Cambridge. MA: Harvard University Press.

2. Kierkegaard, S. (2013). Works I, About the concept of irony with constant reference to Socrates. Humanitas. Bucharest.

3. Lear, J. quoted work, p. 12.

4. Curlin, F. A. quoted article, p. 67.

5. Thomas, L. (2009) 1977, quoted by Dumitrașcu D., Medicine between miracle and disappointment. Iuliu Hațieganu”, Cluj-Napoca, p. 33.

6. Turcu, I. (2010). The right of health. Ed. Wolters Kluwer, Romania, pp. 154-155.

7. Weber, M. (2003). Protestant ethics and capitalist spirit. Ed. Antet. Bucharest.

8. Bauzon, S. (2006). La personne biojuridique. Ed. Presses Universitaires de France. Paris.

9. Dumitrașcu, D. quoted work, pp. 61-62.

10. Ibidem.

11. Cv. St. Simeon the New Theologian. Catechesis. XXV, pp. 124-125.

12. Buta, M. G. (2007). The dialogue between science and faith in defining the notion of disease in Doctors and Church. vol. V – Theology and Ecology. Ed. Renașterea. Cluj-Napoca, pp. 234-238.

13. Lecourt, D. (2009). Le mort de la clinique. Paris. PUF, p. 27.

14. Ratzinger, J. (2004). Glaube – Wahrheit – Tolernaz. Das Christentum und die weltreligionen, Herder, Freiburg. Basel. Wien, p. 127.

15. Bauzon, S. quoted work, p. 4.

16. Marga, A. (2010). Absolute today. The Theology and Philosophy of Joseph Ratzinger. Ed. Eikon. Cluj- Napoca, p. 304.