The Doctor Still Knows Best

How Medical Culture Is Still Marked by Paternalism

by Janet Farrell Leontiou (Author) Michael Staffieri, Jr. (Drawings by)
©2020 Prompt X, 84 Pages
Series: Health Communication, Volume 15


The Doctor Still Knows Best explores an answer to the question: how can medical culture still be marked by paternalism despite the focused attempts by the medical community to put doctor and patient on more equal footing? The recent push within medicine has been on shared decision-making, truth-telling by the doctor, and creating a medical culture that is patient-centered. The author has discovered that, in practice, medicine tells a very different story.
Since entering the medical world twenty years ago seeking treatment for infertility through IVF, subsequently seeking treatments for her disabled son through the present day, Janet Farrell Leontiou has continually encountered a medical culture where she is not treated as an equal. As a professor of communication, the author has developed an ear for language and is able to deconstruct the ways in which communication choices create a patriarchal medical culture. Dr. Farrell Leontiou also understands how no communication can create a culture without her participation. She, therefore, invites the reader to recognize how we can endorse and recreate a culture that does not serve our interests. Through an examination of her own experience, the book offers insight on how medical paternalism has survived for as long as it has and argues that it never serves the best interest of the patient.
The book provides the reader, medical student and/or health communication student with a fresh way of thinking about how communicative choices create culture.

Table Of Contents

  • Cover
  • Title
  • Copyright
  • About the author
  • About the book
  • This eBook can be cited
  • Contents
  • Acknowledgments
  • Introduction
  • Part 1 the medical chart
  • 1 past medical history—ivf
  • 2 history of present condition
  • The NICU
  • From the NICU to the Pediatricians
  • The Specialists
  • 1. A referral to Gastroenterology
  • 2. A referral to Neurology
  • 3. A referral to Genetics
  • 4. Another referral to a different Neurologist
  • 5. Endocrinology
  • 6. The GI doctor that all the mothers favor
  • 7. The guru of neurologists for seizures
  • 3 the chief complaint
  • Hospitalization
  • Another Hospitalization
  • Post Hospitalization
  • conclusion
  • Part II the cultural indicators
  • 1. Withholding information
  • 2. Causing an adverse reaction without taking responsibility
  • 3. Not using the patient’s name
  • 4. Taking credit
  • 5. Acting like the professional knows the child better than the parents
  • 6. Seemingly uninformed about news reports and warnings issued by governmental agencies
  • 7. Calling the mother’s logic emotional
  • 8. Telling the family that their practices are old school
  • 9. Lack of responsibility
  • 10. Offering a tautology
  • 11. Ridiculing the mother
  • 12. Offering an option which is not really an option
  • 13. Lack of eye contact
  • 14. Treating questions as outside of the norm
  • 15. No recognition of unexamined bias
  • 16. Negatively interpreting lack of compliance
  • 17. Refusing to acknowledge that which falls outside the doctor’s area of expertise
  • 18. Lacking awareness that the documentation only tells a partial story
  • 19. Speaking in generalities
  • 20. Not recognizing that patients have competing needs
  • 21. Speaking about the patient as an object
  • 22. Lack of empathy
  • 23. Challenging what someone else has witnessed
  • 24. Announcing confidential information
  • 25. Blaming the mother
  • About the Illustrator


Thank you to Chris and Alma for all that you do every day.

Thank you to Nassau Community College for providing the sabbatical leave from teaching to work on this project and thank you for placing Michael Staffieri in my class those many years ago.

I wish to thank Gary Kreps for believing in this work and to Erika Hendrix at Peter Lang for being most supportive.

Thank you to Dr. Amy Eisenberg who has been with us through it all.


As I set out to write this book, I feel a connection with those I am writing about. Doctors regularly need to deliver bad news to patients. How do they do it? How does one deliver news of a bleak situation but still remain hopeful and optimistic about recovery? Given that none of us are 100% sure of outcomes, remaining hopeful seems like the only wise thing to do.

I feel an affinity with doctors because I also have some bad news to deliver. From my perspective, the current state of our health care system is in poor shape. This, I know, does not come as a surprise but I am not talking about a sickness produced by rising medical costs, interference by insurance companies, and the bureaucratic paperwork. Although all of these elements are draining an already ailing system, I am instead talking about a system that seemingly has forgotten how to treat the patient with decency and respect.


X, 84
ISBN (Hardcover)
Publication date
2020 (March)
New York, Bern, Berlin, Bruxelles, Oxford, Wien, 2020. X, 84 pp., 25 b/w ill.

Biographical notes

Janet Farrell Leontiou (Author) Michael Staffieri, Jr. (Drawings by)

Janet Farrell Leontiou received her Ph.D. in speech communication from Penn State University and she is Associate Professor of Communication at Nassau Community College. This book is her second book on the topic of medical communication. Her first book, What Do the Doctors Say?: How Doctors Create a World Through Their Words was published in 2010.


Title: The Doctor Still Knows Best