Map of life expectancy at birth from Global Education Project.

Monday, December 13, 2004

Doctors and Patients: Second Installment

Until the mid 20th Century, the generally accepted relationship between physicians and patients in the West was of a nature now characterized as "benevolent paternalism." The expertise and wisdom to choose the appropriate treatment of disease resided entirely with the physician. The patient's role was to trust the physician and to follow "doctor's orders" --a condition analogous to childish dependency.

Patients ordinarily could be said to have consented to treatment, if only because, as a practical matter, they had to physically submit to the surgeon's knife or swallow the doctor's potions. However, there was no expectation that the patient would be specifically informed about the physician's theory of the patient's disease state, the theoretical basis of the proposed remedy, possible adverse effects, or alternative treatments.

This paradigm came into serious question after 1950, in connection with broad changes in social attitudes about hierarchy and personal autonomy, and the growing technical complexity of medicine, which, along with more effective treatments, brought increasing uncertainty and tradeoffs among risks and benefits.

Some important critical examinations of the physician-patient relationship include work by Jonathan Katz (The Silent World of Doctors and Patients), Howard Waitzkin (The Second Sickness; The Politics of Medical Encounters), who viewed medical practice as, in part, an agent of social control, as did Alexandra Dundas Todd (Intimate Adversaries) who saw male ob/gyns as imposing patriarchal
morality on their female patients. A particularly fruitful and well-known analysis was by Elliott Mishler, in The Discourse of Medicine. Elliott saw patients speaking in "The Voice of the Lifeworld," trying to explain their conditions of health and illness and experience of symptoms in the context of their lives, and being thwarted by physicians, who controlled the discourse and channelled it into "The Voice of Medicine," focusing exclusively on the biomedical paradigm in which they were trained. Put another way: They just don't listen.

1 comment:

Buy Generic Valium said...

Valium, the two most traditionally prescribed subordinate tranquilizers are thought to be of high-minded help as one begins falling pursue to panic attacks and depressive fight. They have turned out to be the jolly first two medicines that may terminate to your health pains provider mind if you originate speaking more killing thoughts, buy cheap valium no prescription of being singular and when anxiousness bothers you unnecessarily. There isn't a inquiry on the extraordinary success that and Valium procure achieved in a short time span. You may do to an end your anxiousness and dent from attaining a life-threatening progressive stage in anyway a lest you are appointed whichever of these benzodiazepines at preferred moment in time.