





































 V38 N2 / 2023 

©2023 American Medical Writers Association. All rights reserved.  
ISSN 2163-5315

AMWAJournal.org     36

The Patient-Physician Relationship in the Context of Physician-Targeted 
Violence From the Perspective of a Medical Student
Kevin A. Wu  / Duke University School of Medicine, Durham, NC

EVERYDAY ETHICS

ABSTRACT 
The tragedy that transpired at a hospital in Tulsa, OK, in June 
of 2022 highlights the issue of physician-targeted violence 
in the United States.1,2 The shooting in Tulsa had occurred 
after a patient, dissatisfied with their back pain despite it only 
being 2 weeks after spinal surgery, attacked one of the few 
Black orthopedic surgeons in America, Dr Preston Phillips.1 
Dr Phillips’ murder is not an isolated incident. In 2015, Dr 
Michael Davidson, a cardiothoracic surgeon at Brigham and 
Women’s Hospital in Boston, MA, was shot and murdered 
by the son of a patient that the surgeon had operated on the 
previous year.3 Dr Davidson had spent a significant portion 
of time answering questions from the disgruntled son who 
would eventually murder him. The 2 tragedies, separated by 
over 7 years, center around physician-targeted violence. Both 
surgeons had operated on a patient and were murdered as 
a result. Both cases beg the question: what went wrong, and 
how could they have been avoided? 

These 2 cases represent examples of a greater trend of 
increasing violence toward physicians exacerbated by the 
COVID-19 pandemic.4,5 Figures from the US Bureau of Labor 
Statistics estimate that the rate injuries from attacks against 
medical professionals grew by 67% from 2011 to 2018.6 US 
hospitals reported an increase in assaults and threats mir-
roring the global trend during the COVID-19 pandemic.7 
Violence against physicians is symptomatic of a large issue: 
the deteriorating patient-physician relationship and the  
illusion of what the physician is. At the core of health care is 
the patient-physician relationship.8 
 Four models of the physician relationship have been 
described.8,9 The paternalistic relationship has the physician 
creating decisions on behalf of the patient. The interpretive 
relationship requires a physician to figure out a patient’s 
goals and values and subsequently offer options to achieve 
them. An informative relationship has the physician provid-
ing information and allowing patients to decide for them-
selves. Finally, in a deliberative relationship, the physician 

and patient collaborate as equals and work together to 
achieve a goal. 
 Historically, the paternalistic model predominated, 
in which the physician’s main duty was seen to protect 
patients even at the expense of their autonomy.10 This has 
contributed to the expectations that physicians are mira-
cle workers and if they fall short, they should be blamed. 
In line with a paternalistic model, physicians often avoid 
talking about poor prognoses to be protective or kind; how-
ever, research shows that patients end up feeling isolated 
with their concerns, and the inability to discuss poor out-
comes adds to the illusion of perfectionism.11,12 The pater-
nalistic model has contributed to the deterioration of the 
patient-physician relationship by disrupting communica-
tion for the sake of the patient.

 Part of the problem has been the portrayal of physicians 
by the media.13 Physicians are seen as wanting to maxi-
mize profits, seemingly pushing medications unnecessar-
ily.14 Historical events have contributed to that perception. 
In the past, the medical field acted against the best interest 
of already marginalized patients through experiments like 
the Tuskegee Syphilis Study conducted from 1932 to 1972, 
which withheld vital treatment from Black men diagnosed 
with syphilis.15 Actions to correct the matter only took place 
after it had come to light, resulting in regulations requiring 
researchers to obtain voluntary informed consent and the 
Institutional Review Board’s approval.16 Historical events 
have created a gap between specific marginalized popula-
tions and physicians. 
 Although institutional change is necessary to bridge 
the mistrust that exists within marginalized communities, 
individual physicians and medical students can take steps 
to help address the issue. Physicians can start at the bed-
side by showing that they want the best for patients, and 
breaking down mistrust begins at the medical education 
level.17 Understanding the historical origins and source of 
the mistrust would provide context to physicians in navi-
gating interactions with patients. Physicians use a historical 
lens to understand the decisions of patients and allow that 

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AMWAJournal.org     37Patient-Physician Relationship in the Context of Physician-Targeted Violence

knowledge to guide their responses. Decreasing the amount 
of discrimination experienced by patients would minimize 
the mistrust felt by patients and work to support the idea of 
physicians as true patient advocates. Physicians can begin 
to decrease the amount of discrimination through remov-
ing stigmatizing language in patients’ medical records that 
end up influencing future interactions.18 Similar to how 
one negative experience can paint a patient’s view of future 
interactions, a positive one can create a favorable view of 
the medical field. Over time, the accumulation of posi-
tive interactions would go a long way to mend the general 
patient-physician relationship.
 Trust remains low in the general population, partially 
a result of the affordability of health care and the lack of 
transparency in decisions made.19 This perception of the 
physician has contributed to an “us versus them” mental-
ity between the patient and physician. No longer are phy-
sicians seen as always doing the best for the patient.13,14 
Decisions are analyzed through the lens of potential ulte-
rior motives. Likewise, patients who end up distrusting their 
physicians are labeled as “noncompliant” even if they have 
legitimate reasons not to trust them. The relationship has 
been strained in both directions.20 The way the health care 
system is built up does not help the issue. Physicians have 
limited time with each patient.21 The lack of time has fed 
into the discontent felt by many patients. And so, when the 
health care system fails to meet the needs of the patient, it is 
the physician who is blamed. 
 Fixing the issue remains a complex and convoluted pro-
cess that requires moving away from a paternalistic model 
toward a more deliberative relationship that encourages part-
nership between physician and patients. First, change needs 
to occur at the level of medical education. Students should 
not be discouraged to broach conversations surrounding 
failure.22 A degree of perfectionism is required to make it to 
medical school, but it is important to allow medical students 
to fail. Fostering an environment where students can learn 
from their mistakes would go a long way toward removing 
the veil of perfectionism. Students and medical profession-
als should be encouraged to approach tough conversations 
about prognoses earlier rather than later. Physicians often 
feel inadequate in their training conducting these conversa-
tions, and starting from medical school would work to allevi-
ate that.23 Research shows these conversations do not harm 
patients and potentially strengthen the relationship between 
physicians and patients.12,24 Through discussions, patients will 
eventually realize that physicians, although trying their best, 
are not miracle workers. When failure arises, there should be 
steps to prevent it from occurring again; however, normaliz-
ing failure would allow patients to understand that it is  
a possibility. 

 Relationships go two ways. Patients need to realize the 
limitations that exist in medicine. The success of a proce-
dure or diagnosis depends on numerous factors. Fostering 
a deliberative relationship model and allowing discussions 
of failure would work to allow patients to recognize that. 
Ultimately, physicians have limitations. Medicine is a  
science, not a miracle, even though it may seem like it at 
times. The issue can only be resolved as patients realize 
that physicians are on their side, and that requires a mind-
set shift with the public. As America once again deals with 
another tragedy, the medical field needs to work to address 
the discontentment. Creating an environment that strength-
ens the patient-physician relationship is essential to ensure 
that these tragic events do not happen again. 

Author declaration and disclosures: The author notes no  
commercial associations that may pose a conflict of interest in 
relation to this article.

Author contact: kevin.a.wu@duke.edu

References

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