Are Patients Knights, Knaves, or Pawns?

• Published in: JAMA : the journal of the American Medical Association Vol. 305; no. 20; pp. 2112 - 2113
• Main Authors: Jain, Sachin H, Rother, John
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 25-05-2011
• Subjects: Community Participation; Delivery of Health Care - economics; Delivery of Health Care - trends; Fraud - prevention & control; Health Behavior; Health care; Health Policy; Health Services - utilization; Humans; Le Grand, Julian; Motivation; Patient-Centered Care; Patients; Patients - classification; Personal Autonomy; Physicians; Public policy; Social Conditions; United Kingdom; United States; United Kingdom > UK; United States > US
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2011.694

British sociologist Julian Le Grand has noted that public policy is grounded in a conception of humans as "knights," "knaves," or "pawns." Human beings are motivated by virtue (knights) or self-interest (knaves) or are passive respondents to their circumstances (pawns). A society's view influences whether it builds public policies that are permissive, punitive, or prescriptive. Le Grand's original analysis applied to British citizens affected by the postwar social welfare state in Britain, and it has previously been applied to the role of physicians in the US health care system. Here, Jain and Rother describe ways in which patients might be considered knights, knaves, and pawns in public discourse and the importance of policies that match actual motivations.