Just because a physician is paternalistic, it does not mean he doesn't care about the patient. Think of paternalism as a pair of glasses that only let the physician see the physical body of the patient. The physician does not see the soul, spirit, or mind of the patient. He ignores the patient's wishes, especially for modesty.
He is running on the autopilot that was instilled in him over the many years of his training. This autopilot is good because he can react immediately to any situation. The downside is not seeing the patient's soul or wishes. He is the source of knowledge, of healing, and the treatment has to be his way.
Remember the Twilight Zone episode "The Private World Of Darkness" (originally titled and more commonly referred to as "Eye of the Beholder")? It originally aired on November 11, 1960 on CBS.
Fact: Many TZ fans mistakenly believe that the tile of this episode is "The Eye Of The Beholder," which would have been quite appropriate as the relative nature of beauty was discussed. Apparently, that was the original plan as creator Rod Serling referred to this episode with that title in a preview announcing it as the next week's episode, but somewhere along the line it was changed...
Janet Tyler has undergone her eleventh treatment (the maximum number legally allowed) in an attempt to look like everybody else. Tyler is first shown with her head completely bandaged so that her face cannot be seen. She is described as being "not normal" and her face a "pitiful twisted lump of flesh" by the nurses and doctor, whose own faces are always in shadows.
The twist in the tale is unveiled when the bandages are removed, and the reaction of the doctor and nurses is horror and disappointment. The procedure has failed, and her face has undergone "no change—no change at all". The camera pulls back to reveal a gorgeous blonde surrounded by grotesque doctors, nurses and hospital staffers.
Distraught by the failure of the procedure, Tyler runs through the hospital. Flat-screen television screens throughout the hospital project an image of the State's despotic leader giving a speech calling for greater conformity.
As she runs through the hospital until she encounters another "disfigured" human with the same "condition" as her. He arrives to take the crying, despondent Tyler into exile to a village of her "own kind", where her "ugliness" will not trouble the State. Before the two leave, the man comforts Tyler, saying that "beauty is in the eye of the beholder."
This made me think that the patient's dignity is mistreated by the healthcare system, and providers can't see it because of how the healthcare system enforces conformity...
Don't believe me? Read: "Death by a thousand cuts: how the machinery of academia enforces conformity." Academia is also involved in the teaching of the healing arts.