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Intimate adversaries: cultural conflict between doctors and women patients PDF

348 Pages·1989·0.89 MB·English
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Intimate Adversaries : Cultural Conflict title: between Doctors and Women Patients author: Todd, Alexandra Dundas. publisher: University of Pennsylvania Press isbn10 | asin: 0812212770 print isbn13: 9780812212778 ebook isbn13: 9780585342085 language: English Physician and patient, Women patients-- subject Psychology, Interpersonal conflict. publication date: 1989 lcc: R727.3.T63 1989eb ddc: 610.69/6 Physician and patient, Women patients-- subject: Psychology, Interpersonal conflict. Page iii Intimate Adversaries Cultural Conflict Between Doctors and Women Patients Alexandra Dundas Todd Page iv Copyright © 1989 by Alexandra Dundas Todd All rights reserved Printed in the United States of America Library of Congress Cataloging-in-Publication Data Todd, Alexandra Dundas. Intimate adversaries. Bibliography: p. Includes index. 1. Physician and patient. 2. Women patientsPsychol- ogy. 3. Interpersonal conflict. I. Title. R727.3.T63 1989 610.69'6 88-27957 ISBN 0-8122-8152-7 ISBN 0-8122-1277-0 (pbk.) Designed by Adrianne Onderdonk Dudden 2nd printing, 1990 Page v For Drew Page vii Contents Acknowledgments viii Introduction 1 1 9 The Heart of Medicine 2 25 The Diseasing of Reproduction: When the Patient Is a Woman 3 47 "The Patient Doesn't Have Anything to Say About It" 4 77 Delusions in Discourse 5 101 Good Doctors in a Bad Model 6 131 Across a Crowded Room: Some Problems, Some Solutions Bibliography 153 Index 163 Page viii Acknowledgments "The loneliness of the long-distance runner" is simultaneously the most appropriate and inappropriate metaphor for the writing of this book. On one hand, it brings to mind long hours spent alone, some glorious, some excruciating, moving toward a goal at times elusive, at times imminent. On the other hand, this book, like most books, is a social product, the result of a multitude of contributions from friends and colleagues. I am enormously grateful to the following people for the interest they brought to this project. Will Wright and Sue Fisher offered their help and suggestions from the beginning to the end of the study. Rosemary Taylor and Nicole Rafter encouraged me to turn the research into a book, and I have benefited from their critical interest. Joined more recently but with equal intensity by Stephen Fox, these friends read drafts and provided a model for how exciting intellectual exchange can be. Others contributed by reading individual chapters, offering editorial suggestions, or stimulating conversation. I would like to thank Rae Lesser Blumberg, Kate Ermenc, Joseph Gusfield, Robert Hahn, Evelyn Fox Keller, Jane Leserman, Bud Mehan, Joseph Rouse, Catherine Ryan, Wendy Sanford, Marlie Wasserman, and Irving Zola. I also want to thank all of the peoplemedical staff and women patientswho agreed to participate in this study; Suffolk University reference librarians Kathy Maio and Joe Middleton; secretarial staff Cindy Morley, Annalisa Kebadjian, and Frank Pellegrino; and Patricia Smith, editor at the University of Pennsylvania Press, who has made the publishing process smooth and steady. My son, Drew Todd, in his usual wonderful way, offered his enthusiasm for and pride in my career, leading me to believe that behind every happy, successful, single parent stands a supportive child. Page 1 Introduction Time magazine, in the late 1960s, boldly asked, "Is God Dead?" This question sent shock waves through homes and offices, creating controversy at every level of American life. The high priests of religion were said to be losing ground. Today, in the 1980s, when "post-industrial prophets" (Kuhns 1971) have asserted that science is the guiding light for modern society, a similar question might be asked: "Is science dead?" The answer to these queries is both yes and no. Religion is still very much with us, and a scientific view provides much of our conceptual appreciation of the world. But in recent years skepticism about science has grown, particularly with regard to medical science. Doctors, the most highly visible applied scientists, experience this skepticism perhaps most acutely. Scandals abound in research, and medical mistakes regularly make front-page copy. We all have our own personal stories of medical heresy. This represents a dramatic shift. For much of this century, Americans have placed their faith in doctors and in the prevailing medical system. Such post World War II breakthroughs as the development of antibiotics and Jonas Salk's heralded polio vaccine provided credibility for modern medicine and increased public confidence. It was believed that cures were available for most ills and, if not, their discovery was just around the corner. In only a matter of time human disease would be completely eradicated through scientific research and expert medical care. 1 Growing up in the 1950s, I found these views reflected in my family. The family doctor was called when needed and listened to with great respect. The mention of the men who had performed assorted family sur- Page 2 geries brought a near reverential hush to the conversation (malpractice cases were rare). 2 In sum, trust in doctors as the knowers and interpreters of scientific medical truth was intact. Since the late 1960s, this trust has eroded. Skepticism toward authority in general has increased, and medicine is no exception. There is an increasing awareness on the part of the general public that a more selective eye needs to examine how doctors care for patients; and the regard for scientific medicine, which knew no bounds, has shown some limits. Doctors, who were thought to know all, are being questioned. The surgeries and drug therapies that used to be viewed as heroic and lifesaving increasingly are viewed with suspicion, needing the reinforcement of second opinions. Women, the major consumers of health care in this country, have been in the vanguard of these criticisms, which reflect such complaints as the overprescription of drugs, unnecessary surgeries, and biased medical attitudes toward women. Blind trust in modern medicine has waned. This is not to imply that modern medicine makes no contribution to health and life or that the majority of Americans criticize their medical care. The cry of dissent is a small voice slowly growing louder, not a full roar. But there have been few large-scale miracles and many failures for doctors in recent years. The public's expectations are high, often fueled by media extravaganzas on high-tech discoveries, and they are all too often dashed by daily realities. For example, although hearts can be surgically replaced, cures for most chronic illnesses remain elusive. Short of a cure for the common cold, at the very least, or, more important, for AIDS or cancer, medicine's magic is in trouble. This movement in popular opinion from total trust to growing skepticism is mirrored in academic research. Talcott Parsons in the

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