[ Medical School Resources | Appendices | Discussion ]
Medical personnel encourage uncomplainingness and undemandingness in patients. In order to ensure compliance, research has found that doctors and nurses rely on procedures that attempt to reduce a patient's sense of autonomy.
The book Enemies of Patients describes how this is done:
A favored technique of diminishing the social status of the patient is treatment as a non-person... whereby the patient is greeted with what passes as civility, and said farewell to in the same fashion, with everything in between going on as if the patient weren't there as a social person at all, but only as a possession someone has left behind....' [Another researcher] found that hospital doctors did not even bother with ordinary civilities, such as introducing themselves to patients. The ideal situation... would be to have the patient's self go home while the damaged physical container is left for repair.
The worst sin towards our fellow creatures is not to hate them, but to be indifferent to them: that's the essence of inhumanity - George Bernard Shaw
In the settings I observed... the main reason for patient contact was to obtain information for medical charts. To accomplish this primary objective while restricting other demands of their heavy case loads, the interns and residents collectively developed several strategies: (1) avoiding patients and their families; (2) narrowing the focus of interaction to strictly 'medical' concerns; and (3) treating patients as non-persons - even in their presence.
They used medical terminology which was incomprehensible to most patients and often looked past them, avoiding eye contact. Patients, and, especially, family members were frequently treated as if they were invisible.
A 1998 Swedish study reported that one in four patients had experienced, "the doctor and medical student act[ing] as if I were not there."
George Orwell on Medical Students:
As usual, he neither spoke to his patient nor gave him a smile, a nod or any kind of recognition.... While he talked, very grave and upright, he would hold the wasted body beneath his two hands, sometimes giving it a gentle roll to and fro, in just the attitude of a woman handling a rolling pin.... It was a very queer feeling - queer I mean, because of their intense interest in learning their job, together with the seeming lack of any perception that the patients were human beings. It is strange to relate, but sometimes as some young student stepped forward to take his turn manipulating you, he would be actually tremulous with excitement, like a boy who has at last got his hands on some expensive piece of machinery... and not from any one of them did you get a word of conversation or a look direct in your face.
George Bernard Shaw: "That's what makes the medical student the most disgusting figure in modern civilization - no veneration, no manners."
From Enemies of Patients:
Since many sick people in hospitals have alert periods and ample time to spy out inequities, inefficiency, and malfeasance, their possible criticisms must be neutralized. The chief method for minimizing the potentiality of patients to make trouble for doctors and nurses by criticizing their work is to withhold information, so the patient cannot argue from adequate knowledge....
It has been argued that over and above what derives from professional expertise, doctors and nurses deliberately limit the communication of information to patients to prevent their work routines from constantly being interrupted with questions and to mask their shortcomings and failures from the scrutiny of clients who are living where they work. In addition to shielding doctors and nurses from the criticisms of patients, limited communication protects the professional stance of detachment and concern.
The father of medical ethics [Hippocrates] admonished physicians to perform their duties 'calmly and adroitly, concealing most things from the patient while you are attending to him.... Sometimes reprove sharply and emphatically, and sometimes comfort with solicitude and attention, revealing nothing of the patients' future or present condition.'
A letter to the editor of the Lancet, for example, argues why patients should have no right to see their medical records:
The patient wanting to read their [case-]notes indicates their lack of trust. If so, I can only see one solution: the patient seeks another medical advisor. Reading the notes does not help to achieve the rapport, mutual confidence, or trust that is essential in the healing and reassuring process of medical care....
 Mizrahi, T. "Coping with Patients." Social Problems 32(1984):156-165.
 Lynoe, N, et al. "Informed Consent in Clinical Training - Patient Experiences and Motives for Participating." Medical Education 32(1998):465-471.
 Orwell, George. "How the Poor Die." Shooting an Elephant San Diego: Harcourt Brace & Company, 1950.
 Macklin, R. Enemies of Patients New York: Oxford University Press, 1993.
 Blau, JN. Letter. "The Lancet 3 January 1987:45.