When consumerism meets continuity: the tension between patient autonomy and soft paternalism

Patients increasingly approach general practitioners (GPs) with a consumer mindset, presenting “shopping lists” rather than symptoms to explore. This shift reflects a broader evolution in health care driven by rising patient autonomy, telehealth and the influence of the wellness industry. While health literacy remains important, many patients are unknowingly influenced by markets that prioritise product sales, while hidden costs are absorbed by the health care system.

Overwhelmed by conflicting information, patients may feel dismissed when their expectations are challenged. Many turn to no-gap telehealth services, often without notifying their usual GP, which further fragments care.

General practice traditionally embodies soft paternalism, where clinical expertise gently guides patients through complex decisions within the context of their unique bio-psycho-social determinants of health. Yet, this vital role has lost its perceived value, contributing to fragmented care. This fragmentation forces GPs to integrate disjointed advice and conflicting recommendations, without adequate time or funding. With GPs spread thin across rising demands, the profession risks losing the continuity and trust it was once known for. This pressure extends beyond patient care and begins with how we train doctors to navigate competing values and an evolving landscape.

Medical training and the challenge of communicating clinical judgement

During foundational training, doctors learn to support informed decision making by balancing competing ethical principles, such as respecting patient autonomy, with clinical knowledge of disease progression and treatment guidelines. This delicate balance is evident in heart health checks, where some patients seek to avoid medications despite conditions like hypertension and dyslipidemia already having manifested. We discuss the risks of cardiac disease and negotiate a trial of lifestyle strategies before follow-up; yet patients may leave not fully aware of the tension we navigate between beneficence and non-maleficence in an increasingly diluted system that favours quick answers over nuanced dialogue.

The impact of marketing and misinformation

In today’s “Information Age”, patients encounter targeted adverts tailored to their browsing habits and demographics. The rise of health influencers adds another layer of challenge placing algorithmic advice alongside trained medical expertise. Claims like “My doctor said my iron levels were normal, but this supplement made me feel better,” or promotions for “over 50 tests your GP won’t do,” exploit fear and mistrust, ultimately portraying doctors as gatekeepers withholding care. While consumer-driven care can empower patients to actively manage their health, such tactics erode community trust and contribute to conflicting information that may lack a basis in evidence-based medicine. These narratives lead patients to virtual clinics, often unaware of the provider’s qualifications.

Digital health services and its risks

The coronavirus disease 2019 pandemic accelerated telehealth expansion, introducing virtual clinics that often operate outside patients’ usual GP network, which can lead to inefficient duplication of care. For example, a minor with post-surgical pain was prescribed opioids after a telehealth consult, with minimal documentation sent to me as their GP. What was scheduled as a 15-minute consultation extended to 45 minutes, as it is my duty of care to explore the opioid prescription for a minor, including the possibility of emerging post-op complications. We rebooked to address the original concern that had prompted her appointment, but by then I was already running late for my next two patients.

While integrated digital services, like the Victorian Stroke Telemedicine program, improve specialist access, Medicare-subsidised virtual clinics are structured to only capture straightforward cases, further diluting accountability and leaving complex, layered care to already stretched GPs. Ultimately, addressing this fragmentation is essential to preserve continuity of care.

The broader impact on vulnerable populations and the future of general practice

Continuity becomes even more crucial for vulnerable groups who depend most on consistent, coordinated care. For instance, elders are less equipped to navigate emerging technologies, often experience rapid health deteriorations, and lack capacity for informed decisions without consistent GP follow-up.

Looking ahead, GP registrars are already facing the dual challenge of learning within fragmented systems while delivering coordinated care amid incomplete records, conflicting advice, and inadequate time for complex consultations.

Central to addressing this issue is the requirement for mandatory closed-loop communication between virtual clinics and GP practices, alongside clearly defined roles that reaffirm GPs as the medical lead in community health. Funding models must also reflect the time taken to integrate fragmented information, manage chronic disease, and identify preventive health opportunities, rather than prioritising access and volume at the expense of quality and continuity.

Recommendations

With bulk-billing no longer viable, many Australian GP practices have shifted towards mixed billing, unintentionally encouraging patients to seek alternative providers who may not offer the same continuity and depth of care. GPs, who stand at the frontline of both individual and population health, are now witnessing a rise in mental health presentations driven by disconnection, decision fatigue, and a weakening of community support, reflecting the very fragmentation they’re trying to navigate.

The soft paternalism that once enabled GPs to accompany patients from early life to a dignified death is eroding. Without concerted action to restore continuity and context, future generations may never know what has been lost. The Royal Australian College of General Practitioners cannot offer a single clear solution to uphold holistic evidence-based care while adapting in this complex landscape; however, this uncertainty calls for policy makers to collaborate with the RACGP, which represents frontline GPs. The future of primary care depends not on one fix, but on ongoing dialogue that places general practice at the centre of coordinated, patient-focused care.

So, who will set the table?

Dr Shipra Sankpal is an Australian general practice registrar, working across clinical, aged care and medical education in north-west Tasmania. As a member of the Indian diaspora, her work is informed by her commitment to culturally responsive, context-driven care that places continuity and whole-person understanding at its core.