Abandoning the Golden Rule: The problem with "putting ourselves in the patient's place"

A large body of evidence documents the difficulties health care professionals have in predicting their patient's beliefs or wishes. These difficulties extend from the predictions of very specific patient wishes (such as for life-sustaining therapies) to more global assessments of patients' lives as a whole (for instance, their quality of life). Although many explanations have been offered for this phenomenon, we discuss one that has not received as much attention: the conscious or unconscious adoption of what we refer to as Golden Rule thinking. This refers to our attempts to understand another person's situation by imagining what we would believe or want under similar circumstances, in other words, "putting ourselves in the patient's place." Although Golden Rule thinking would seem to be a promising strategy, studies show that it actually results in inaccurate predictions of patients' wishes or beliefs. These mispredictions, in turn, have significant clinical and ethical implications. We review possible reasons why Golden Rule thinking may be of limited utility in understanding our patients' situations and suggest alternate strategies to maximize our understanding of our patient's lives.