It is time we talk about the duties of a patient

Mohammad S Razai is a National Institute for Health and Care Research (NIHR) Clinical Lecturer in Primary Care at the University of Cambridge, UK.

Maide Barış is Assistant Professor of Medical Ethics at Marmara University, Türkiye.

The obligations placed on doctors — to provide care with competence and integrity — are firmly established in medical ethics, professional guidelines, and the law.^1,2 In the UK, the regulator explicitly sets out the duties of a doctor.¹ On the other hand, while patients’ rights have been well-defined, the corresponding duties of a patient are rarely articulated.

The evolving nature and increasing complexity of modern health care, the growing strain on health systems, medicalisation,³ medical overuse,⁴ and the impact of healthcare delivery on the environment⁵ all demand that patients engage as responsible agents, not solely as care beneficiaries. Just as doctors must adhere to professional standards, patients should be expected to fulfil certain duties — to themselves, healthcare professionals, the health system, society, and the planet.

Historically, the doctor–patient relationship was based on paternalism, where the doctor held knowledge and authority, and the patient’s role was largely passive. Over the last few decades, to prevent abuse and neglect, the focus rightly shifted towards protecting patient rights. The recognition of patients’ autonomy — particularly the principles of informed consent and the right to refuse treatment — represents a major advancement.

The rise of patient advocacy, the emphasis on patient-centred care and shared decision making, and the reframing of the doctor–patient relationship as ‘meetings between experts’ ⁶ — alongside broader socioeconomic and technological developments, and greater access to medical information — have collectively further elevated the status and agency of patients.

However, these developments have not been matched by a corresponding framework for patient responsibility. This imbalance has shifted the burden disproportionately onto the medical profession, contributing to widespread disillusionment, burnout, and the erosion of therapeutic relationships.

Healthcare professionals contend with rising workloads, burgeoning patient expectations and demands, and a highly litigious environment while operating under systemic constraints beyond their control. Moreover, the principle of autonomy, which has underpinned much of modern medical ethics,⁷ is often construed narrowly as freedom from constraint rather than a relational responsibility. This overlooks the communitarian aspect of healthcare practice.

Rights and responsibilities are two sides of the same coin. If patients have the right to receive competent, compassionate, and ethical care, they must also have a duty to engage with that care with full responsibility.

Patient duties are not meant to be punitive or restrictive; rather, they represent an ethical approach that might foster meaningful engagement with health care within the limits of individuals’ capabilities and opportunities. This responsibility should not be externally imposed but should arise from a relational ethic grounded in mutual respect, supported autonomy, and systemic fairness that acknowledges social determinants of health and structural inequalities.

Duties of a patient

The outline for patient duties could reflect the principles underlying the duties of a doctor² while adapting them to the changing realities of healthcare delivery and environmental sustainability.

Duties:

1. To oneself
• Take reasonable steps to maintain one’s own health through a balanced lifestyle, including proper nutrition, exercise, and mental health care.
• Engage with preventive care, including vaccinations and screening.
• Adhere to prescribed treatments and medical advice.
• Seek medical attention in a timely manner and avoid unnecessary delays that could worsen health outcomes.

2. To healthcare professionals
• Provide accurate, succinct, honest, and relevant information about one’s health — or, where acting on behalf of a child or dependent — and symptoms to the best of one’s ability.
• Treat healthcare professionals with respect and civility, recognising their challenges and pressures.
• Respect the professional expertise and clinical judgement of doctors and other healthcare providers.
• Engage in shared decision making with a willingness to listen, understand, and collaborate.
• Respect the time allocated for your appointment and avoid overrunning, as this may compromise the healthcare professional’s ability to provide timely care to other patients.
• Appreciate that medicine involves uncertainty and risk, and that outcomes are not always predictable despite the best efforts of healthcare professionals.

3. To the healthcare system
• Use healthcare resources responsibly, including appropriate emergency and urgent care services, and avoid medical overuse by not requesting unnecessary, futile, or inappropriate investigations and treatments.
• Attend appointments as scheduled or provide timely notice of cancellation to reduce the waste of clinical resources.
• Be mindful of the financial and operational limitations of the healthcare system, including waiting times and resource availability.
• Accept that not all treatments or interventions may be available or appropriate and that rationing may be necessary for the collective good.

4. To society
• Participate in public health measures, including vaccination programmes and infection control protocols.
• Refrain from actions that place others at risk, such as attending public spaces while knowingly ill with an infectious disease.
• Act in a way that contributes to the health and wellbeing of others, including vulnerable and marginalised groups.

5. To the planet
• Recognise the environmental cost of health care and support efforts to reduce waste and carbon emissions, environmental pollution, and loss of biodiversity by avoiding medicalisation, medical overuse, and unnecessary care.
• Engage in healthcare decisions with environmental impact in mind, as health care is a precious and finite resource — for example, managing minor illnesses through self-care.
• Support sustainable healthcare practices, including proper disposal of medications and reducing the overuse of medical resources.
• Accept trade-offs where sustainable healthcare delivery may involve limitations on certain treatments or interventions.

Concluding comments

Establishing a blueprint for patient duties could encourage a more balanced relationship between patients and healthcare systems. Patients are not merely recipients of care but active participants in their health and the wellbeing of the wider community. It could empower individuals to engage more thoughtfully with care, improve clinical outcomes, and consider the societal and environmental costs of healthcare use.

A social contract that recognises rights and responsibilities could strengthen the ethical foundation of health care,⁷ promote a more respectful and collaborative culture, mitigate professional burnout, and increase the efficiency and sustainability of service delivery. The future of health care may hinge less on what patients are entitled to and more on what they are willing to contribute — not financially, but through conduct, consideration, and collective responsibility.

Funding
Mohammad S Razai is an NIHR Clinical Lecturer in Primary Care. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

References
1. General Medical Council. The duties of medical professionals registered with the GMC. https://www.gmc-uk.org/professional-standards/the-professional-standards/good-medical-practice/the-duties-of-medical-professionals-registered-with-the-gmc (accessed 23 Apr 2025).
2. World Medical Association. Medical ethics: deontology, codes of practice, guidelines, professionalism. https://www.wma.net/what-we-do/medical-ethics (accessed 23 Apr 2025).
3. Thomas F. Medicalisation. In: Chamberlain K, Lyons A, eds. Routledge international handbook of critical issues in health and illness. Abingdon: Routledge, 2021; 23–33.
4. Razai MS, Oakeshott P. More healthcare consumption is not the answer to our ailments. BMJ 2022; 379: o2827.
5. Eckelman MJ, Sherman J. Environmental impacts of the US health care system and effects on public health. PLoS One 2016; 11(6): e0157014.
6. Tuckett D, Boulton M, Olson C, Williams A. Meetings between experts: an approach to sharing ideas in medical consultations. London: Routledge, 1985.
7. Beauchamp TL, Childress JF. Principles of biomedical ethics. Oxford: Oxford University Press, 2019.

Featured photo by Etactics Inc on Unsplash.