1.4.2 The doctor–patient relationship
However, some care relationships are more tightly defined and more hierarchical, for example a doctor’s relationship with a patient. Within the biomedical model, the doctor’s role is to focus on the patient’s body and its functioning. The patient’s role is to report clearly and accurately on the body’s functions and the feelings it transmits. There is relatively little scope for the patient to influence the definition of this scene. The doctor generally makes the opening moves, while the patient waits to be asked questions.
Activity 5: Departing from the script
Think ahead to your next consultation with your GP. Are there opening moves you could make which would change the definition of the scene?
What would happen if you sat down with a pad and said, ‘Doctor, before starting on me, there are some details I’d like about your training and experience’? Or what if you breezed in and said, ‘I’m going to tell you exactly what’s wrong with me and what medicines I need you to prescribe’?
Doctors might vary in the manner of their response, but it is hard to imagine any doctor conceding much ground. If you cut across their projection of themselves as ‘in control’ of the consultation, most would refuse to proceed. One person who tried, simply found the consultation terminated and was invited to return in a different frame of mind.
Doctors cannot let patients take the lead in defining the scene. They are invested with responsibility. They are professionally and legally accountable. It is important that they stay close to accepted practice in conducting their consultations, or they could find themselves in trouble. When you enter your doctor’s surgery, the scene you enact is not played ad lib. The ‘script’ is fairly tightly prescribed
In many respects the ‘script’ for consultations does its job well. With its well-defined roles for doctor and patient, it gets people through the surgery at a steady rate. It enables doctors to diagnose and prescribe. It gives patients an impression of confidence and knowledge on the part of the doctor. And it gives doctors some protection against the doubts and ambiguities of their work.
However, it can also give rise to difficulties, if the doctor is projected as the person who has the expert knowledge, the matching role is a patient who knows nothing. Yet, for example, it is vital to sufferers from Parkinson’s disease that they know as much as they can about the implications of the disease, so that they can be ‘in control’ of the illness. Within the traditional doctor–patient relationship this transfer of information can be difficult, as reported by Mrs P:
I would like to discuss a lot of things with him [Dr X] … I’ve never had the opportunity to discuss the symptoms. And what to expect. I’d like to ask him. It’s hard isn’t it.
(Quoted in Pinder, in the Reader)
When a well-defined scene is already rolling, it is hard to find the right moment and the form of words to shift its direction. So the doctor patient ‘script’ both provides a very useful framework and also constrains the relationship in ways which may sometimes be detrimental.