Shrinking social space in the doctor-modern patient relationship: a review of forces for, and implications of, homologisation

Patient Educ Couns. 2009 Jan;74(1):97-103. doi: 10.1016/j.pec.2008.07.053. Epub 2008 Sep 11.


Objective: Forces for modernisation appear to have led to role convergence and reduced social distances between doctors and modern patients. This review aims to document and understand this process in theory and practice, and to consider the implications for modern patients in particular but also non-modern patients and doctors.

Method: Narrative review of published and grey literature identified from sources including electronic databases, the Internet and reference lists of retrieved works.

Results: Forces for role convergence between doctors and modern patients include consumerism and increased patient literacy; socio-technological changes; values convergence; increased licence for doctors to use their emotions in patient care; and structural changes in the social organisation of health care. As a result, modern patients appear to have gained more in health care than they have lost and more than have the non-modern (or less modern) patients. Doctors have lost authority and autonomy in patient care.

Conclusion: The net impulse toward role convergence is, on balance, a positive development. The differential uptake of modernisation by patients has increased health inequalities between modern and non-modern patients. The need of doctors to accommodate these changes has contributed to a form of reprofessonalisation.

Practice implications: A key challenge is to make available the benefits of modernisation, for example through patient education, to as many patients as possible while minimising the risk of harm. It is important therefore to elucidate and be responsive to patient preferences for modernisation, for example by enlisting the support of the modern patients in overcoming barriers to the modernisation of non-modern patients. There is also a need to support doctors as they redefine their own professional role identity.

Publication types

  • Review

MeSH terms

  • Attitude to Health
  • Authoritarianism
  • Cooperative Behavior
  • Decision Making
  • Humans
  • Narration
  • Patient Education as Topic
  • Patient Participation* / psychology
  • Patient Participation* / trends
  • Patient Rights / trends
  • Physician's Role / psychology*
  • Physician-Patient Relations*
  • Professional Autonomy
  • Psychological Distance*
  • Psychological Theory
  • Self Care / psychology
  • Self Care / trends
  • Social Change*
  • Social Values