Developing Sanity in Human Affairs

By Susan Presby Kodish; Robert P. Holston | Go to book overview

15
Healing Medicine with Language 1

Joseph F. Fennelly

Healing in medicine today is gravely impaired by both a lack of communication between doctor and patient and the poor quality of that communication when it occurs. This problem is out in the open. And much work is being done on it. That work includes efforts at shared decision making on treatment, encouragement of patient autonomy, and explorations in the legal doctrine of informed consent.

But little work is being done directly on the underlying malaise--the very language that doctor and patients use to communicate with one another. In this human linkage there is great silence. The reasons for this silence are old and new. There is the old attitude of "doctor knows best" which persists even when the doctor doesn't know where, or even why, it hurts.

Medical paternalism has grown much more complex with the ongoing explosive growth of medical technology and pharmacology. Today the phrase "doctor knows best" is simply ludicrous. No single doctor and probably no single team of specialists and practitioners can know best. Doctors, faced with highly complex and diverse treatment options, now tend to tell themselves, "I may not know best, but I sure as hell know more than this poor patient about her treatment options and the possible medical outcomes."

This newer form of medical paternalism is sharpened by new economic and social pressures on medicine. Medical economics are finally such that there is real debate in society about whether we can actually afford to use all of the medications and machines we've developed. For the individual doctor, this can translate into very hard choices about test and drug choice--choices that are rarely simple to explain to the individual patient. With added time constraints from managed care, there is a new sort of pressure to say, "Doctor knows best!"

Meanwhile back in the waiting room, what about the patients? Many new things have impacted on them. Some are as abstract as the breakdown of common religious beliefs. For some patients the doctor has become the new

-217-

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