Negotiating Identity in the Patient Role: Tales from the Romanian Medical System (original) (raw)
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Between Patients and Doctors: It Takes a Person
Beyond Diagnosis: Relating the Person to the Patient - The Patient to the Person, 2014
Thank you, I feel so much more like a person now,' I told the Intensive Care Unit (ICU) nurse after the morning bath. The words came out spontaneously, and she was startled. What made me feel 'more like a person' at a time when my life was at risk, and I was tied to machines and entirely dependent on others' care? If becoming a patient entails the experience of vulnerability and ultimately the exposure to one's mortality, how does a patient remain a person in the midst of acute illness? Can a patient remain a person if she is regarded primarily as a malfunctioning body and/or mind? To what extent is the patient's self-perception shaped by others' perceptions of her? Can she contribute by reshaping those that prove harmful? By arguing for the need to listen to the patient's 'biological and biographical stories' in the interest of good clinical practices, John Launer pinpoints the limitations of a biomedical approach that splits the body from the person, and argues for the need to reconnect biology and biography within the therapeutic relation. 1 Indeed, one of the most striking conclusions of Klitzman's study on doctors who became patients is the stigmatisation of patienthood among the medical profession. Not only did doctor-patients feel diminished as patients and experienced the dissociation between body and person, but they also complained of the split between professional and personal responses from their colleagues. 2 The patient's split between body and person thus seems to find a correlate in the physician's split between professional and person, and both may be symptomatic of pervasive cultural practices. How to connect biology and biography, the professional and the personal in the clinical encounter is the question addressed in this chapter, which draws on personal testimony, illness memoirs, and literature on clinical practice.
The Micropolitics of Medicine: A Contextual Analysis
International Journal of Health Services, 1984
Certain features of the doctor-patient encounter "medicalize," and thereby depoliticize, the social structural roots of personal suffering. The critique of medicalization holds that medicine has become an institution of social control, that the health care system helps promulgate the dominant ideologies of a society, and that the doctor-patient relationship is a major site where these developments occur. This paper presents a contextual analysis of medical encounters, drawn from a sample of tape-recorded doctor-patient interaction in medical practice. The doctor-patient relationship manifests problems that arise despite the best conscious intents of wellmotivated participants. Conveying the symbolism of scientific medicine, messages of ideology and social control reinforce current relations of economic production and reproduction in work, the family, leisure, pleasure, sexuality, and other areas of social life. Ambiguities within the doctor-patient relationship both reflect and help reproduce broader social contradictions and structures of oppression. The medical encounter is one arena where the dominant ideologies of a society are reinforced and where individuals' acquiescence is sought. A vision of a progressive doctorpatient relationship must include a conception of how that relationship contributes to fundamental social change. This study was sponsored in part by grants from the National Center for Health Services Research (HS 02100) and the Fulbright Commission. The paper is adapted from a lengthier version (l), which extends work previously reported (2-7).
Chaos in Western Medicine: how issues of social-professional status are undermining our health
Global journal of health science, 2012
From the period immediately following the second world war, western (orthodox) medicine - both as a philosophy of medicine and as a professional guild of medical professionals actively practicing medicine - has made progress in leaps and bounds, especially considering the advances in technology and associated enterprises. Over the last thirty years, however, the practice of orthodox medicine has taken a turn for the worst despite progressive philosophies and tenets of basic practice as offered by the professional bodies that regulate how medicine is operated and implemented. Current healthcare environments are in a chaotic state of affairs, most notably due to issues involving affordability of medical professionals. It is argued that the social-professional status of medical doctors allow exorbitant and unreachable demands on governments for increased salaries. The title-based supremacy of doctors within the occupations domain is not supported by what they are offering society at la...
Medical Identity: A Socio-Cultural Analysis
Purpose: To examine philosophical stances underpinning medical identity and assess the conceptual relationship between physician, medical practice and culture. Argument: Medical identity is about the ideals and moral positions that physicians take when justifying themselves. Medical identity is the study of the sociocultural paragons that conceptually underlie the phenomenology of physicians' coming to take themselves as autonomous social agents. The paper relies on Hegel's Phenomenology of Spirit and investigates dilemmas pertaining to first objectivist versus subjectivist views and second hedonistic versus sentimentalist approaches to medical identity. The sociocultural philosophical analysis of medical identity can shed light on what it means conceptually for a physician to harbor beliefs associated with him/her being taken to be an autonomous professional. It is important because it touches on the meaning of being a compassionate, good and skilled physician, making its relevance to person-centered medicine self-evident. Conclusion: Medical identity should be analyzed with reference to literature, philosophy and medical practice in order for the physician to exercise a reflective position in the care of the individual patient which is both scientifically rational and subjectively meaningful.
Medicine, superstructure and micropolitics
Social Science & Medicine. Part A: Medical Psychology & Medical Sociology, 1979
How are macro-level structures of domination and oppression reproduced in the everyday micro-level interaction of individuals? This paper examines this theoretical problem through observations of doctor-patient encounters. A review of recent theoretical advances leads to the proposition that face-to-face interaction between health professionals and clients helps maintain broad patterns of ideology and social control. A theory is proposed that links professional-client interaction with ideology and consciousness, social institutions, social relationships of daily life, and the material conditions and class relationships of the workplace and economic system. Quantitative data from an empirical study of doctor-patient interaction are analyzed with reference to this theory. Qualitative analysis from the same study reveals themes of ideologic reproduction and social control concerning relations of production, class relations, the role of science under capitalism, and medical control of everyday life. Counterhegemonic strategy suggested by this work includes challenging the assumed objectivity of medical science, clarifying the partly political nature of messages that clients receive from professionals, and working against domination based on expert knowledge.
Perspectives on power, communication and the medical encounter
Over the past few decades there has been an increasing push towards 'enhancing' communication in the medical encounter, with a focus on moving towards a 'mutuality' of patient and health care professional that reduces a perceived 'power imbalance' between the two. Doctors in particular have been consmcted as dominating and coercive, either consciously or unconsciously repressing patients' capacity for autonomy. Nurses have typically been represented as less authoritarian in their dealings with patients in their idealized role as caring, kindly and empathetic health professionals. It is therefore often argued that the nurse-patient relationship is more 'equal' and less repressive than the doctor-patient relationship. This article explores critically these assertions in the context of the Foucauldian perspective on the role of power in the medical encounter, and draws out implications for nursing theory and practice. One of the most prevalent complaints in the literature on physiaan-patient communication concerns patients' failures to do as they are told ... To the extent that physicians issue their directives in the interests of patients' health, one can understand why patients' failures to follow than would be deeply disturbing.'
The clinical consultation encompasses a two-way gaze in which doctor and patient are essentially object and subject at the same time. Inevitably, however, doctor and patient are governed by a different set of rules and a different set of 'truths'. Indeed, contained within the two-way clinical gaze, there are distinct asymmetries in power/knowledge relations. Through hierarchical observation, normalising judgement, and the examination, it is the doctor who wields the overwhelming share of disciplinary power, and it is the doctor who is guided by the principles of biomedical ethics (problematic though they may be), not the patient. This calls for added responsibility on the part of the doctor to acquire and develop modes of decision-making understood as the logic of practical,