good doctors listen (3/5)

Is it self-evident that doctors listen to their patients?

Last week, in my previous blog, I spoke about the change of medicine in the West. From doctors who were used to visiting patients at their homes, to the time of modern hospitals where patients were brought to a bed. In the time of modern hospitals, doctors had a chance to investigate the interiors of the body. 

In this blog I trace a transformation in the expectations with regards to what it is, that doctors do. 

Well, what makes a good doctor? What does the expertise of medical doctors entail? One study, a historical analysis, looks at autobiographies of doctors in the period from 1850 to 2010, in Germany and the UK. In those autobiographies doctors speak about their work. What they write is part of a process of expectation management. It reflects the expectations of outsiders who may read their autobiography. 

The way that doctors speak about their profession has changed between 1850 and 2010. The change can be found in the way they speak about their patients

SILENT PATIENTS – Good doctors fix

In the early autobiographies, patients are silent. In an experimental surgery the patient may die. But what is important for the doctor to report, is that they have accumulated more knowledge about doing surgery. The project of science develops. However personally affected the doctor might have been by the patient’s death, this does not shine through in the narration of the event in his autobiography. When he writes, he only cares to mention what he thought of as the most significant goal of his work: the furthering of medicine as a rational, scientific enterprise. This is the event narrated purely through the Medical Gaze. Good doctors fix bodies. At least, at that time, people seemed to agree on that point.

VOCAL PATIENTS –  good doctors listen

Now, the big change in how doctors narrate their professional work, came in the 1960s. Yes, during "the Sixties". Along with maybe the flowers or a man on the moon that may come to mind, public expectations with regard to medical doctors changed in this time. Patients resisted to being the passive recipient of treatment. They increasingly gained a voice in the medical decision making process. This is reflected in autobiographies since this time. Doctors now generally put more emphasis on the interaction with their patients. They narrate how they value and integrate their patients’ individual preferences and choices. Because now, good doctors are expected to listen, as well.

LEADING PATIENTS – good doctors co-create

In premodern Europe, a patient and a doctor would co-create a story about illness [see previous blog]. With the rise of modern hospitals, patients were brought to hospital beds and became silent. In the sixties, patients became vocal. Currently, there is a rise of patient organizations. Patients' voices become louder and louder. What is the next step? Dr. Zach Bush M.D. (also quite vocal) is a physician with a vision. He aims to create a new paradigm, where doctors say: 

“You have all the health and resilience already in you, let me show you how to get there. Let me show you. Let me, as a physician, be a guide into your own intrinsic health.”

References

Atzeni, G., & von Groddeck, V. (2015). Normality, Crisis and Recovery of narrating medical Professionalism. Tamara Journal of Critical Organisation Inquiry, 13(1/2), 25.