Biomedical Engineering Reference
In-Depth Information
will confi ne myself to three trends that may infl uence medical as well as
lay knowledge. First, the patient's view has become a more important
issue in health policy (Coulter and Fitzpatrick 2001). In North America as
well as in European countries, evidence of failure in medicine to convey
information to patients in a satisfactory way has been documented over a
long time (ibid.). This may, together with efforts throughout recent decades
in several Western countries to reorganize their health care systems towards
increased consumerism (Light 2001), have contributed to a change in the
representation of the patient. Former representations of the patient as
passive, both in health policy discourse and in health research, has gradually
lost its hegemonic position to the representation of the patient as actively
information seeking and able to take responsibility for his or her own
health (Henwood
et al
. 2003).
1
In some countries, a new kind of doctor-
patient relationship has been proposed, with implications for the process of
informed decision making (Charles
et al
. 2000, Henwood
et al
. 2003). In
this informed model, it is assumed that patients are able to 'take decisions
that refl ect both their preferences and the best scientifi c knowledge available'
(Charles
et al
. 1997: 683). The question of how people could get hold of
relevant health information independent of their doctors has thus become a
burning question in the health policy discourse in several countries.
Secondly, the general view on knowledge in modern societies is assumed
to have undergone a major shift. Theorists, such as Giddens (1990, 1991),
argue that modernity is distinguished by a new kind of refl exivity which
means that social traditions are continuously contested and revised in the
light of new knowledge. This kind of refl exivity includes a new understanding
of knowledge which Giddens describes in the following way:
Doubt, a pervasive feature of modern critical reason, permeates into
everyday life as well as philosophical consciousness, and forms a
general existential dimension of the contemporary world. Modernity
institutionalises the principle of radical doubt and insists that all
knowledge takes the form of hypotheses: claims which may very well be
true, but which are in principle always open to revision and may have at
some point to be abandoned.
(Giddens 1991: 3)
This view on knowledge is echoed in the deprofessionalization debate
when 'deprofessionalization is seen as part of a more general social trend in
the demystifi cation of expert knowledge' (Weiss and Fitzpatrick 1997).
Third, the emergence of what Castells (2001) describes as a new social
form, the network society, implies an increased public access to new tech-
nology for knowledge production, distribution and reception. For example,
the Internet, a medium of communication that came into general use as late
as around 1995, has increased the possibilities to communicate and circulate
information incredibly. For the fi rst time in history, Castells points out, it
