chapter  5
12 Pages

The doctor-patient relationship

The doctor-patient relationship is framed at any given time by wider social and cultural constraints, and particularly the dominant mode of production of medical knowledge, and the association between the medical profession and the state . The currently entrenched high social status and authority of doctors is a relatively recent development . Medical practitioners in pre -scientific times were a disparate and relatively lowly group. Jewson ( 1 97 6 ) has characterised practice around the end of the eighteenth century as 'Bedside Medicine' . Physicians worked directly for affluent patrons of the upper and emerging middle classes . Diagnosis and treatment of the ills afflicting the patient, or ' sick man', were based on close observation of his external form, and attentive listening to accounts of his subjective experience . Within the holistic cosmology of the time illness was taken to be an expression of personal disorder and misalignment rather than the manifestation of discrete, arbitrary and regularly recurring disease entities . The patient played a central role in commissioning the service, constituting the illness and evaluating the efficacy of treatment.