Dueling in the clinic: When patients and providers disagree about healthcare recommendations

We begin by considering the evolving nature of the physician-patient relationship. Research shows that physicians have retained significant authority as health professionals but not to the extent that they had in the golden age of doctoring. Instead, as patient centered care movements gained momentum, patients became empowered through policies and parallel consumer social movements. Patient-centered care advocates envisioned an active patient who would ask questions and voice preferences and concerns but would remain rational and thus make choices that remained in line with standard of care practices. Instead, we discuss research on patient communication with clinicians that has documented an unexpected form of patient participation: patients sometimes advocate for treatments that are not necessarily good for them and sometimes resist recommendations that are the current standard of care. We review the varied ways in which these engaged patients influence diagnoses and treatment/care outcomes. Finally, we introduce the eight papers that comprise this special section of Social Science and Medicine on dueling in the clinic.