Transition from paternalism to shared decision making – a review of the educational environment in Bosnia and Herzegovina and Croatia

Marta Vučemilović, Mersiha Mahmić-Kaknjo, Ivančica Pavličević


In this article we will review the benefits of a system built on partnership of physicians and their patients, highlight some of the factors which impede this transition, and propose ways to address these factors. Also, we are going to analyze the educational environment in Bosnia and Herzegovina and Croatia concerning ethics and communication skills. Personal responsibility of patients for their health should be reflected in their joint involvement in health decisions with their physicians. Patients, insecure about their individual competence surrounding their health decisions, tend to shy away from responsibility, whereas physicians, pressured by the responsibilities of the profession, do not always show sensitivity to all of the patient’s concerns. They often treat illnesses instead of patients. A more open and collaborative relationship between the patient and the physician through shared decision making would be a better alternative. In the end, the patient ultimately decides whether a health intervention was satisfactory in fulfilling his or her specific needs. Transition from a paternalistic to a
mutual relationship between doctors and patients has already begun. In an era of intense information sharing, shared decision making is a sensitive, ethical, legal, and political concept which needs empathic doctors with well-developed communication skills to integrate their clinical knowledge with patient-centered care. Conclusion. Transition from paternalistic to partner relation between physicians and patients is moving slowly ahead in Croatia and Bosnia and Herzegovina. Educational environment is improving but needs intense efforts to develop further.


Shared decision making; Ethics; Communication skills; Medical schools

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