Okay, so I started to write the book, and much to my surprise, it turns out to be about conflict in a setting of unequal power. Here are some of the distinctive features of the physician role vis a vis the patient role:
- Physicians want to invade our privacy, and they have cultural authority and license to do so in ways that just about nobody else does.
- Physicians have license to invade our bodies, to see us naked, to touch and enter our most intimate orifices, and even to cut us open and dismember us. No-one else in the world has such license.
- Physicians judge our behavior.
- Physicians try to control our behavior.
- Physicians control the prescription pad; they alone decide whether we have access to most medications.
- Physicians may have power over our very sustenance, as by certifying for disability or worker's compensation.
- Physicians may control whether our insurance plans will pay for us to see specialists.
- Physicians can ask a judge to have us imprisoned in a mental hospital, and will almost always get their way.
Under the circumstances, it is a considerable credit to the profession that most people say they like their doctors, and that we generally willingly submit to the indignities and infantilization inherent in medical care. We place immense responsibility on physicians not to abuse these privileges, and most of them do their best to earn our trust. Nevertheless, it is very difficult, when handed such direct power over people, always to wield it harmlessly, let alone for the maximum good. However benign and cooperative the relationship appears on the surface, there is always a power struggle going on underneath. Medical ethicists talk about the physician's obligation to be beneficent, to grant patients autonomy, and to respect persons. Yet those principles are often in conflict with each other, and with the physicians' own experience of being locked in combat with disease -- a combat in which the person who has the disease, or the risk for disease, is an uncertain ally or even an enemy.
So Collaboration, Conflict and Power, with a suitable subtitle. How's that?