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Encounters Between Patients and Doctors: An Anthology.

Encounters Between Patients and Doctors: An Anthology.

In medicine, balance is needed among science, technology, and patient care. Francis W. Peabody in his compassionate account, "The Care of the Patient," most aptly describes the interworkings of science and patient care--the art of medicine:

The practice of medicine in its broadest sense includes the whole relationship of the physician with his patient. It is an art, based to an increasing extent on the medical sciences, but comprising much that still remains outside the realm of any science. The art of medicine and the science of medicine are not antagonistic but supplementary to each other.

As a consequence of technological advances, however, the current practice of medicine is, in fact, out-of-balance. Nevertheless, on many fronts attemps are

being made to salvage what is known about the art of medicine and to recover its value for medical education and practice.

Encounters between Patients and Doctors provides one such opportunity to focus our attention on the art of medicine. The anthology is unusual as it presents an analytic review of the components of the patient-physician relation with interdisciplinary reflection on what is needed to make that relationship a productive and successful one. Stoeckle's premise is that "medicine's task is patient care" and "in that work, nothing is more important than the doctor-patient relation." This premise is reflected in the purposes of the anthology, which are to address "new goals and old values" of patient care in an attempt to "renew practice, education and the everyday contracts of doctors and patients," and "to stimulate and sustain interest in the plain, difficult, and satisfying tasks of care while reviving memories of those unique encounters that begin at the very first visit with a patient--or a doctor."

Stoeckle's introductory essay is a well-documented, detailed discussion of the patient-physician relationship that provides useful, descriptive information not available in any other single source. It begins with a cross-cultural analysis of the numbers and types of doctors in various countries and a description of the persons who seek the professional care that is offered. In "Places to Meet," floor plans of a doctor's office in 1932 are compared with those of an office in 1982, and Stoeckle describes changes in the size, seating arrangement, and decor that minimize overhead and improve efficiency, encourage communication between the patient and the doctor, and further a professional atmosphere. "Home Encounters" relates the tendency away from home visits and toward more office encounters as patients gain transportation to the doctor's office: Now only 1-3 percent of all encounters take place in the patient's home. "The Interview" and "The Physical Exam" provide evaluative descriptions of what usually happens during these encounters now and during previous years. The section, "The Literature, Its Themes, and Who Writes It," considers patients' accounts of medical encounters, popular accounts about doctors, and doctors' accounts of their relationships with patients.

Following Stoeckle's essay is a compilation of seventeen papers by clinicians, anthropologists, sociologists, and philosophers published in scientific journals between 1927 and 1978. Stoeckle has organized the readings according to six general features of the doctor-patient relation: its structure, its dynamics, the nature of communication, the barriers to communication, the study of the relation, and the good relation. Authors such as L.J. Henderson, Talcott Parsons, Thomas Szasz, Marc Hollander Eliot Friedson, Barbara Korsch, Arthur Kleinman, Milton Davis, Irving K. Zola, Francis W. Peabody, and Harry A. Wilmer will be familiar to many readers.

The opening section examines the "ground rules of the doctor-patient relation." Henderson in "Physician and Patient as a Social System" (1935), was the first in America to argue that the patient influenced the doctor through "sentiments," values, and emotions. Parson's "Illness and the Role of the Physician" (1951), describes the roles of the doctor and patient in the care of the patient.

In the concluding section on "The Good Relation," Peabody's classic "The Care of the Patient" (1927) is reprinted. This article, emphasizing that physicians should maintain the proper perspective of the patient as a person, is often used to introduce third-year medical students to the hospital service, and residents who practice medicine primarily in the hospital should be encouraged to read and re-read this paper. Another provocative article is Wilmer's "The Doctor-Patient Relationship and the Issues of Pity, Sympathy, and Empathy," (1968) in which he uses diagrams to communicate his definition of sympathy and empathy.

Encounters between Patients and Doctors offers a thoughtful and descriptive account of the relationship as presented step-by-step in the introductory essay and through the selected articles. The anthology provides an opportunity to read at leisure a selection of some of the most important writings on the doctor-patient relationship during this century. The impact of this text is a powerful one.
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Author:Connelly, Julia E.
Publication:The Hastings Center Report
Article Type:Book Review
Date:Jan 1, 1989
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