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Sociomedical Perspectives on Patient Care
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Jeffrey Michael Clair and Richard M. Allman; eds.: Lexington, Kentucky: University Press of Kentucky; 1993. $36.00.
The physician-patient relationship has been an inherent problem throughout the history of medicine and has never been fully resolved. Currently, the relationship is made even more problematic by the proliferation of specialties, the various medical service organizations, and the rising costs driven by technology.
Single and collaborative authors have written 14 separate chapters on the physician-patient relationship, with topics ranging from reconciling the agendas of physicians and patients to fear of malpractice litigation. Chapters have been written exclusively for this book by eminent medical sociologists and are of uniformly high quality. The chapters are intended for practicing clinicians but should also serve a wider readership.
The authors encourage clinicians to incorporate principles of history-taking into their practices and to pay increased attention to factors in their patients' lives beyond specific biological and chemical variables. One chapter is aptly named "High Tech vs. High Touch" and deals with the effect of technology on patient care. The advice is: Do more talking and possibly less testing.
The two authors of the last chapter, who attempt to give an overview of the preceding chapters, are a professional administrator and executive and a practicing clinician in a big medical center. They are sympathetic to the medical sociologists who wish to add to an already overloaded 4-year medical curriculum and agree in principle with the advice given in "High Tech vs. High Touch." Their counter-advice is: "There is a great need for those who would undertake social medicine as a field of scholarly endeavor to develop an early and deep understanding of the structure and organization of the health care system. How do the parts fit? How did they get that way? What are the flows of authority and responsibility, power, and money? How do things look from the inside as well as the outside?" The authors note: "We must recognize that time for training is both limited and jammed full and that, once in practice, time is the physician's only item of exchange." The bibliography on the subject is exhaustive, comprising 32 pages, and the index is detailed.
The medical sociologists are in somewhat the same position as Henry Higgins, the linguist in My Fair Lady who was falling in love against his will with Eliza Doolittle. He wondered, "Why can't a woman be like a man?" Medical sociologists seem to be saying: "Why can't doctors be like medical sociologists?"
This book is worth reading. There is no compendium on the subject like it.
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