Reflections

In many clinical encounters, the doctor is expected to know, decide and direct. The patient is expected to listen, comply and be grateful. Questions can be interpreted as disrespect. A request for an explanation can feel like a challenge to professional authority. And when a family member tries to reach the doctor for clarity, the response can be even more disheartening: there is nothing to tell you.

This is the uncomfortable face of paternalistic medicine. It is also a conversation we need to have about medical autonomy, communication and the doctor–patient relationship in Ghana.

When the doctor becomes the decision-maker—and the patient becomes a spectator

Paternalistic medicine describes a model of care in which the physician makes decisions on behalf of a patient because the physician believes those decisions are in the patient’s best interests. In its softer form, this may be justified when someone is unconscious, confused or otherwise unable to make an informed decision, particularly in an emergency. But a more troubling form emerges when a patient who has capacity is excluded from decisions, denied explanations or made to feel that asking questions is inappropriate.

Modern medical ethics recognises that beneficence—doing good for a patient—does not erase autonomy: the patient’s right to receive information, express values and make informed choices. The physician brings clinical expertise. The patient brings their life, priorities, fears, beliefs and understanding of what matters to them. Good medicine needs both.

The God-complex: when expertise becomes unquestionable authority

There is a dangerous point at which confidence in medical knowledge becomes a belief that the doctor should not be questioned. I call this the God-complex: not because every physician consciously sees themselves as a god, but because the relationship begins to operate as though the clinician’s judgment is beyond scrutiny.

The doctor speaks; the patient listens. The doctor decides; the patient follows. The doctor is busy; the family must wait. A patient who asks, “What does this diagnosis mean?” or “Why are you recommending this treatment?” may be treated as difficult, distrustful or disrespectful.

But questions are not insults. They are not evidence that a patient thinks they know more than the doctor. They are often the clearest sign that a person is trying to understand what is happening to their own body. A physician should be able to welcome a question, explain uncertainty and discuss alternatives without feeling that their authority is under attack.

My father’s hospital experience: “I don’t have anything to tell you on the phone”

This issue became painfully personal when my father went to the hospital with terminal cancer. At a time when our family was trying to understand his condition and what lay ahead, we needed clear communication. We needed to know what the doctors understood, what the plan was and what we should prepare ourselves for.

I tried to speak with the doctor by phone. The response I received was that she did not have anything to tell me on the phone.

I have thought about that exchange many times. I understand that doctors work under pressure. I understand that patient confidentiality matters, that a telephone conversation may not be the right place to disclose sensitive information, and that a clinician may need to speak directly with the patient or an authorised family member. There are legitimate reasons to arrange a proper conversation rather than discuss a complex diagnosis over the phone.

But there is a difference between protecting confidentiality and shutting down communication. Even when details cannot be shared, a family can be told what the appropriate process is, when a conversation can happen, who is authorised to receive information, and how urgent concerns will be addressed. “I cannot discuss his medical details over the phone” can be followed by “Let us arrange a time to speak with him and the family, with his permission.” That is professionalism. A flat dismissal leaves a family feeling abandoned.

My father was facing a terminal illness. Our family was not asking for a miracle over the phone. We were asking for communication, clarity and the basic dignity of being guided through an extraordinarily difficult moment.

Why can asking a doctor questions feel so unfamiliar?

It would be unfair to suggest that every Ghanaian doctor behaves this way, or that every difficult interaction is caused by arrogance. Ghana’s health system is challenged by heavy workloads, staff shortages, long waiting times, limited resources and pressure on clinicians. These realities can make thoughtful communication difficult, even for well-intentioned professionals.

There are also social and institutional hierarchies that may shape the encounter. In settings where professional status is rarely challenged, a doctor may be regarded as an authority whose decisions should simply be accepted. Some patients may have been raised to avoid questioning elders or people in positions of authority. Others may fear that asking questions will offend the doctor, delay care or affect how they are treated. Language, health literacy, cost and the complexity of the system can make speaking up even harder.

These are possible contributors, not excuses or a description of every Ghanaian patient or clinician. The result, however, can be a culture in which the patient feels they must surrender their voice at the hospital door.

Medical autonomy is not an imported luxury

The idea that patients should participate in decisions about their care can sometimes seem foreign in a highly hierarchical clinical environment. But autonomy is not a rejection of medical expertise, nor is it a demand that patients make complex clinical decisions alone. It is the recognition that the person receiving care is a human being with rights, preferences and a life beyond the hospital chart.

Respecting autonomy means explaining a diagnosis in language the patient can understand; outlining reasonable treatment options, including no treatment where appropriate; discussing benefits, risks and uncertainty; checking understanding; and allowing the patient to express what matters most. It also means obtaining informed consent rather than treating a signature—or silence—as proof of understanding.

Family involvement can be essential in Ghanaian settings, where relatives often provide practical, emotional and financial support. But family involvement should not automatically replace the patient’s voice. The patient should guide who receives information and participates in decisions whenever they have the capacity to do so. When capacity is absent, clinicians should follow the appropriate legal and ethical process while respecting the patient’s known wishes and interests.

What needs to change?

First, we must normalise questions. Patients should be encouraged to ask what a diagnosis means, why a test is needed, what alternatives exist and what happens next. Doctors can make this easier by asking, “What questions do you have?” and “Would you like me to explain that differently?”

Second, hospitals should make communication predictable. Patients and families need to know who the treating clinician is, when updates are provided, how to request a family meeting and what the confidentiality rules are. A phone call may not always be appropriate for discussing sensitive information, but there should be a clear and respectful alternative.

Third, medical education should teach communication and shared decision-making as clinical skills, not optional courtesies. A technically excellent doctor who cannot explain a plan, listen to concerns or acknowledge uncertainty is not delivering the whole of good care.

Finally, professional authority must come with accountability. A patient asking for an explanation should not be labelled troublesome. A family seeking an update should not be treated as an inconvenience. Respect must move in both directions, and the power imbalance in the clinical encounter places a particular responsibility on healthcare professionals to make room for the patient’s voice.

We can do better than “the doctor knows best”

I am not arguing that doctors should stop leading clinical care. Patients seek us out because we have training and expertise that they may not have. In emergencies, decisive action can save lives. There will be moments when a clinician must make recommendations firmly and explain why delay is dangerous.

But leadership is not domination. Expertise is not infallibility. And a patient’s questions are not an attack on a doctor’s competence.

My father’s illness taught me that families do not only need investigations, prescriptions and procedures. They need someone who will explain, listen and help them navigate uncertainty. They need to be treated as people, not as interruptions to a busy clinic.

Perhaps the measure of a good physician is not simply how much they know, but how well they use that knowledge to empower the person sitting in front of them.

The patient is not a passive recipient of medical wisdom. The patient is a person whose life is being shaped by the decisions made in that consultation.

We must move beyond the idea that the doctor is always right and the patient should never question. In Ghana, as everywhere else, compassionate medicine should make space for informed patients, respectful families and clinicians who understand that listening is part of healing.

What has your experience been? Have you ever felt unable to ask your doctor a question or obtain a clear explanation about a loved one’s care? Share your thoughts in the comments. These conversations are necessary if we want a more respectful healthcare system.