Map of life expectancy at birth from Global Education Project.

Tuesday, February 03, 2009

Power Play

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?


kathy a. said...

the title is a start, a good one.

the thing is, i bet we all could have good long cheerful [or not] arguments about some of the distinctive features on your list. although without question, those are real concerns, to greater or lesser extents. and always true that there are power struggles, or potential ones.

C. Corax said...

What sort of audience is the book aimed at? If it's for the general public, you might want something a little more eye-catching, such as Dr. I Am That I Am Okay, kidding.

And I do like my current doctor. I just needed to make an effort to find a PCP rather than settle for "catch as catch can" at the on-campus clinic.

I also wanted to note that doctors are sometimes very much on our side against the insurance companies. That said, your summary of the doctor/patient is excellent.

kathy a. said...

good question from corax.

world health medicine said...

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hope you keep posting, i will arrive here always