© 1999 Robert A. Freitas Jr. All Rights Reserved.

Robert A. Freitas Jr., Nanomedicine, Volume I: Basic Capabilities, Landes Bioscience, Georgetown, TX, 1999

1.2.4.3 The Physician-Patient Relationship

Many other aspects of the physician-patient relationship, especially as this relationship may evolve in the coming era of nanomedicine, are important and worthy of extensive discussion. One such issue is the obligation of both parties in the partnership to tell the truth. The patient as a fellow human being has every right to know the truth about his or her biological condition, but other considerations may enter into the fulfillment of this obligation.²²³⁴ Patients have a quite natural anxiety about their own possible death, and it has been claimed that this anxiety implies that no one can be truly objective toward his or her own body.²²³⁶ Guttentag²²³⁴ observes that "telling an unwelcome truth to the unprepared is as ill-conceived as trying to hide the truth from the prepared."

In the nanomedical era, the sheer number of "truths" that may become available for disclosure will increase enormously even as the terminal prognosis becomes rare. For example, each human being is believed to possess at least 4-10 potentially serious genetic defects; up to 1% of human DNA is of exogenous viral origin, and as much as 10% of the genome consists of transposons, discrete sequences that are positionally mobile among the chromosomes (Chapter 20). Should something be done about this, or not? What should the average patient make of the news that his physician has discovered exactly 57 submicron-scale lamellar defects scattered throughout the compact bone of the caudal epiphysis of the patient's right humerus? In the nanomedical era, people will gain the ability to specify their own physical structure to minute detail, but many patients will not be ready, willing, or able to assume responsibility for this knowledge. Thus there is no ideal substitute for the doctor's interpretative abilities and judgements on the patient's behalf as to the personal significance of specific diagnostic information. As the great clinician Thomas Addis observed in another context:²²³⁷ "Honesty with patients requires thought and discipline and effort."

Perhaps the single most important aspect of the physician-patient relationship, in any century, is the humanistic quality of the good doctor. The patient seeks a physician who cares about him as a person and will diagnose and prescribe in a sensitive and compassionate manner, accepting some degree of obligation to the patient. Speaking to medical students, J.C. Bennett²²³⁸ describes the implicit social contract between doctor and patient that will still apply in the nanomedical era, as it does today:

"To receive medical care, patients must trust their bodies and their very lives to physicians, and so to be in an honest position to give medical care, physicians must earn such radical trust. Mere technical treatment of disease does not suffice. Patients must be able reasonably to believe that their physicians care about them in an extraordinarily personal way. This exchange of care for trust, while not identical to friendship or love, is equally binding. From it develops an interdependence that is far from unwholesome; rather, it potentiates care and promotes healing. Our late twentieth century sophistication and technologic orientation have too often cost us warmth, humor, and humanity, leaving us in social isolation. We do far better as professionals to err on the side of being human with our patients, than to try to play deus ex machina, the god from the machine."

Last updated on 5 February 2003