ABSTRACT
Social totalitarianism, expressed as the manipulation of our needs by vested interests, is obliterating the selves of both doctors and patients within contemporary healthcare. In learning how to resist this manipulation, which includes commercial pressures for profit maximisation and the siren calls of utopian social engineering, we can learn a great deal from writers, philosophers and poets who have escaped from totalitarian political systems. The first step we can take to recover the self in primary care is to recognise the centrality of suffering. Acknowledging the difference between scientific and medical knowledge, we need to operate within an ethical framework based on moral obligations to patients. We must learn to pay genuine attention to our patients, understand how dialogue is essential in generating meaning and develop greater aware of the ways in which biographical stress influences our sense of self. Finally, we have to recognise that the self-esteem of both doctors and patients is an essential precondition to intersubjective therapeutic dialogue.
