By [http://ezinearticles.com/?expert=Peter_Tate] Peter Tate Patients expect and often want powerful doctors; that is a doctor who has reassuring authority, who is apparently capable and whose pronouncements can reduce anxiety. One definition of medical or ‘Aesculapean’ authority divides it into three parts: Sapiential, Moral and Charismatic. These words are somewhat off putting at first meeting but bear with me. Sapiential authority This can be defined as the right to be heard based on knowledge or expertise, and means doctors must know or at least appear to know more about medicine than their patients. This can only be one part of the doctor’s authority, however, as a biochemist may know more about a particular branch of medicine, but it is to a physician that a patient turns when in need. Moral authority This is the right to significantly control and direct patients, based on doing what society expects of them as doctors. To keep their moral authority, doctors must always act with the good of the patient as their paramount concern. This is derived from the Hippocratic credo. In addition, societies generally revere doctors, meaning that their behaviour is seen as socially right as well as individually good. This is a powerful combination. Charismatic authority This is the most difficult of the three concepts, and is similar to the anthropological definition of magic. It stems from the original unity between medicine and religion. In Western culture it related to the possibility of death, and the magnitude of the issues with which the doctor deals. Many of us want doctors to be a little magical. It is true too that for many of us there is a need to supplement sapiential and moral authority with an ineffable factor, which might just hold out hope against the odds. Many doctors go out of their way to cultivate this. They develop a priestly mien, use complicated and obscure rituals, and act more like bishops than physicians. The three forms of authority are present in all doctors: though some doctors go out of their way to develop particular sapiential, moral and charismatic elements in their behaviour with patients and others. Think about some of the powerful doctors you have met and the nature of their power. Here is an example. A partially patient centred doctor has the same moral authority as her doctor centred colleague, but she may reduce some of her sapiential authority by sharing more information with her patients. This highlights a fundamental truth: Controlling information by the doctor increases their power and restricts our involvement in decisions about our health. Many doctors become very uneasy with knowledgeable inquisitive patients; such patients lessen the doctor’s control. The partially patient centred doctor will also be more likely to attempt to demystify the nature of medical diagnosis and treatment, reducing her charismatic authority and so her power to control the interview. This requires a degree of bravery in the doctor particularly when first trying such strategies. Most doctors, and perhaps especially when training, are afraid of losing control, of exposing too much of their patient’s pain and fear. They find themselves not asking the important question in case of opening an emotional Pandora’s Box and being overwhelmed. They use their power over their patient to keep the box shut and emotions at a non-threatening level. This style of behaviour can then become fixed and persist throughout a doctors career. Doctors can increase their charismatic power, should they wish, in many ways. The trappings of power are the most obvious, white coats, impressive mysterious gadgetry, attached (subservient) staff, large desks with the big chair firmly behind it. They surround themselves with grandiose looking certificates on the wall, and have computers with unintelligible displays or pointing away from us patients. They can communicate by cryptic oracle like pronouncements, shrouded in medico speak. This can then be wrapped up with dire warnings of the fearsome effects of not following the treatment properly, in order to complete the effect. Powerful rituals such as examining and prescribing are more charismatic in the absence of adequate explanations. The problem with these contrived exercises of medical authority is that the overwhelming evidence suggests they are not very effective. It quite obviously does not increase our understanding because that is not what is motivating the doctor. Doctors usually say that the reason for this style of communication is that it will make patients do what is good for them. However the sad fact seems to be that more often than not we don’t. The literature on compliance or what is now more hopefully called concordance with medical advice reflects rather badly on doctors, and us patients too if you think about it. Of course we are all just human beings, patients and surprising as it may seem, doctors too. Peter Tate qualified as a doctor at Newcastle in 1968. After spells as a P&O Surgeon and as a trainee in Kentish Town he was a family doctor for 30 years. He was an MRCGP examiner from 1981; he retired as convenor of the panel of examiners in March 2006. He is the sole author of The Doctors Communication Handbook now in its 5th edition. He is also the author of The Other Side of Medicine, a collection of essays and short stories. He has also recently published Seasickness, a novel based on his experiences as a young ships surgeon. He was a co author of The Consultation and The New Consultation OUP. He has lectured widely on communication issues. His recent medical books are available from Amazon and [http://www.radcliffe-oxford.com] http://www.radcliffe-oxford.com. Seasickness is also available from [http://www.lulu.com/petertate] http://www.lulu.com/petertate Peter has just written 3 books for patients available at: [http://thinkingaboutyourhealth.com] http://thinkingaboutyourhealth.com Article Source: [http://ezinearticles.com/?expert=Peter_Tate ] http://EzineArticles.com/?expert=Peter_Tate [http://ezinearticles.com/?Power-and-the-Doctor&id=411452 ] http://EzineArticles.com/?Power-and-the-Doctor&id=411452
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