Sickness can return us to a frame of mind resembling childhood dependency. We need mummy or daddy to make us better. We are vulnerable and upset when we are in pain or danger and naturally cling to the one who might rescue us. The doctor-patient relationship has to navigate this surge of dependency, but in addition faces the expert-novice divide. The skilled scientist is there to intervene. A substantial imbalance in knowledge deepens the dependent character of the relationship. We might even complicate this picture further by examining how elites provide highly skilled services to those with more modest backgrounds and education.
Despite the best efforts of many clinicians who resist this sort of dependency, we still find the tides of human nature driving us towards the inevitable cliché: ‘Trust me, I’m a doctor’. Is it healthy for us to encourage this sort of paternalism as we regress to childhood dependency? Do we at the same time diminish our personal resources for health as we resort only to the latest medical interventions offered by specialists?
This trend has prompted new ideas about the role we play in health and sickness: ‘Patient activation’. ‘Person-centred medicine’. ‘Co-creating health’. ‘Patient empowerment’. Some of these tend towards the more technical challenges of how people manage complex chronic conditions independently. Others seek greater autonomy for patients in directing what treatment they might receive.
The creators of the concept, ‘Decent care’, suggest that, ‘Without actively participating in our own caring process and the caring processes of others, care is not decent’. We are to move from passive dependence on exalted professionals to active partnership with those who can assist us in overcoming disease. In confidently pursuing health, we can better determine the quality and nature of the care we require when sick.
This is a delicate issue in which I have sought useful insight from the following books: