Paternalism in practice: How we create obstacles for sexual, reproductive, and menopausal healthcare despite our best intentions

Abstract

How we create obstacles for sexual, reproductive, and menopausal healthcare despite our best intentions P a•ter•nal•ism: the policy or practice on the part of people in positions of authority of restricting the freedom and responsibilities of those subordinate to them in the subordinates' supposed best interest. 1 Hopefully, you haven't judged this article by the title, because the aim is not to single out any gender, as we have all likely made paternalistic recommendations to patients based on our personal beliefs or fears, as opposed to evidence-based principles. As I refl ect on close to 30 years of patient care, I have seen many examples of this within my fi eld of women's health.In theory, we all understand the concept of shared decision-making, but in practice, clinical recommendations are often still dictated, as opposed to being discussed. Patients are now better informed than ever before and may wish to discuss a variety of options. A perceived lack of choice has led patients to seek alternative sources for care, some of which may be harmful owing to less evidence or regulation. If a treatment is not within the doctor's comfort zone, of course there should be no obligation to prescribe. But in many circumstances, there are lost opportunities to align plans more closely with patient's priorities. Using specifi c women's health topics as representative examples, this article aims to show how clinical care may be improved using 3 principles: humility, advocacy, and fl exibility.