Medical
Antonios P. Liolios, Medical School of Thessaloniki, Greece Although the stereotype of the powerful doctor that commands his patients has mostly been surpassed, the latter group’s complaints of violation of their autonomy remain. This article briefly examines the usual reasons for this behavior, while countering them with the proposal that modern medicine’s world view plays a greater role. This Weltanschaung has implications both to the medical education curricula and the public’s interaction and expectations from the doctors.
conflicts
world view and ensuing
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A scenario common to many will be the following one, quoted by Wilson, HJ, which concerns a woman which has been just diagnosed with breast cancer:“His management of my crisis consisted of a pat on the hand and the assurance that he was very sorry. […] My medical team were dealing with a diagnosis as a physical problem in terms of their personal and While technological resources, […] it seemed incredible that whatever attention had this may The been afforded to me generally was now withdrawn, and instead focused hold true, it case exclusively on my left breast. Doctors, studiously avoiding eye conacts only in a above tact, came, examined me and left. […] However my refusal to superficial way: if may be inaccept the preferred mastectomy so infuriated the docon the aforementioned terpreted as tor that he terminated our discussion by sweepexample we substituted the an extreme one, ing away the curtains that surrounded my doctor’s reaction with “and he but it definitely bed, firing as his parting shot over his stopped on his feet, sat with me, makes its point clear – shoulder: “The decision will oband we discussed on what troubled that this was not just lack viously have to be taken my mind at the moment”, this would be of bedside manners, which out of your hands””. more humane, but it would not nevertheless can be ameliorated by careful question the validity of the operation as the decoaching, but something more sired method of healing; the doctor would still try profound. Indeed, the most frequent to get the patient’s consent. reasons for such alienating behavior, Therefore, a range of patterns can be surmised when carewhich affects both patients and doctors, fall fully studying the case: first, the focusing on the affected body into three categories:financial structures: the part, with the simultaneous ignorance of the patient, and the act of conversation between patient and doctor power struggle between the patient and the doctor. As we is more time consuming, and therefore less profitwill see, these two patterns originate from a common stem, able, than a quick look-over, mumbling and the namely, the biomedical model and its clinical application. handing of a prescription to be filled, health structures: insurance institutions, whether public funds or private companies, require a definite diagnosis Contrary to popular belief that this model comes from that can be supported by concrete evidence; insothe biological sciences boom of the 19 century, the far the state of the patient himself is of little imporseeds of it were sown with Descartes, who proposed tance and educational attitudes: through exhaustive the dichotomy between mind and body. The res cogilearning, medical students acquire the skills to fill tans (the conscious subject of thinking) is impenetrain a diagnosis into a piece of paper, but not the ones ble, whereas the res extensa (the objects that belong to show empathy and compassion to the patient, reto the external, extended world) can be seen, and garding him as a byproduct of the whole process. therefore perceived, by all outside observers. ThereThe latter should be further stressed, for it is a often citfore, diseases affecting the body, which belongs to ed target of medical school reform; through a humanthis world, can be observed like all natural phenomistic education, it is supported, we can attain to underena; the signs can be perceived by sight, the various stand, interpret and mirror the emotions of an anxious changes in bodily structures can be realized by clinior furious patient, therefore reducing his stress levels. th
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its implications
A Model and