Humanity and Illness: Reflections on the Patient-Doctor Relationship

The French system of sickness insurance regularly makes the headlines on account of the financial problems besetting it, and there is a danger its difficulties will increase as the population ages and the state experiences budgetary restraints. Various scenarios and options for reforming the system are frequently proposed, some of which verge on the idea of rationing care. Though it is clear that savings are going to have to be made and efforts will have to be undertaken to rationalize health expenditure, it shouldn’t be forgotten that behind the figures lie flesh-and-blood patients and doctors. These patients and their doctors are engaged in individual relations around a pathological situation, relations which become increasingly complex with the advances of science and the spreading of information. It is of this that André Khayat –himself a medical practitioner– reminds us here, in order that this human relationship to illness and to those attempting to treat it should be correctly perceived and incorporated into current thinking with regard to health system reform. After a brief review of the history of medical solidarity between human beings, this article shows how the doctor-patient relationship, which was at first exclusively individual, has gradually come to be a collective issue. Khayat then describes the mechanisms of doctor-patient communication (language elements, the relation to the body, keys for understanding etc.) and shows how we have moved from a paternalistic model to a relationship based on autonomous decision-making by the patient –and also the limitations of this latter. Lastly, he offers some lines of thinking with regard to future issues surrounding this relationship to sickness and medicine.