The informed and expert patient
Introd uction The highly educated populations of modern industrial societies have unprece dented and virtually unlimited access to specialist information on just about any subj ect that takes their interest. Health and illness have become topics of particular social and personal concern and the focus of a vast industry producing materials giving advice and instruction about how to preserve health, in the first instance, and deal with illness in the second. Education is viewed as an important lever in the general reduction of social and economic inequality. The steady erosion of the professional monopoly of expert medical knowledge is seen as a means of overriding the entrenched paternalism of clinical practice and reducing the structured asymmetry of medical consultations . Democratisation of relation ships between doctors and patients is regarded as intrinsically desirable in an aspirationally meritocratic and egalitarian society . Within the research and policy spheres it is also favoured as a means of increasing professional accountability and improving the quality and efficiency of healthcare. The provision of comprehen sive and good quality information to patients is viewed as essential to their involvement in shared decision making about treatment and the development of patient-centred medicine as a central goal of current health policy ( Coulter 2 002a; Makoul, Arntson & Schofield 1 99 5 ) . Nevertheless, the acquisition and practical application of lay specialist knowledge in medical consultations remains a source of tension and difficulty in the relationships between patients and professionals . More generally, the issue of how expert knowledge is processed by individuals and distributed within society requires further exploration and analysis .