Biomedical Engineering Reference
In-Depth Information
to the sounds of the body, and try to make an image of the functionality and
structural aspects of organs (Reiser 1978). Later on, X-ray technology gave
the medical doctor an opportunity to make photos of the inside of the body
and thus be able to actually look into the body without opening it (Kevles
1997; Pasveer 1989; Reiser 1978).
Armstrong points out that during the early twentieth century medicine
started to establish functional relationships between organs, their structures
and functions, the ill person, and even later on, lifestyle. Pathologies were no
longer just identifi ed in structural defi ciencies and pathologies of the organs
inside the body, but in the functional relationship between the patient and
his/her surroundings. Good examples of this are the relationship between
smoking and cancer, or stress and cardiac infarction. This means that it is
important for the doctor to get information from the patient not only about
symptoms, but also about lifestyle factors in order to be able to establish a
diagnosis and suggest a treatment regime.
It was not only the changes in the perception of bodies and diseases
that affected the relationship between medical doctors and patients. Forces
outside or around the medical institution have also affected the doctor-
patient relationship. Medicine is still in many ways powerful in relation to
patients. At the same time many chronically ill patients and their relatives
have become organized in various support groups or patient organizations.
In some instances there is strong support for the empowerment of patients
in order to strengthen their rights and options in relation to the medical
establishment (see for instance Gabe et al . 1994).
Many patients also have access to the Internet, which means that they can
search for information about their specifi c conditions, their treatments and
prognoses. This makes it possible to compare the information provided by
the doctor with information gathered on the Internet. In this way patients
become increasingly able to challenge and negotiate even the terms of their
own medical problems (Broom 2005; Nettleton et al . 2005; Radin 2006).
Added to this is the increase in the use of complementary and alternative
medicine (CAM) in the Western world (Eisenberg et al . 1998), which also
challenges the traditional concentration of medical knowledge in the hands
of the biomedical professionals and institutions. Furthermore, through
changes in the fi nancing and organization of the health care system, more
patients have the option of choosing their own health care providers. On
the other hand, it increases the infl uence of both private and national health
insurance over the kind of medical care offered to patients.
As a consequence the ideals and norms for communication between
doctor and patient have changed from being doctor-centred to being patient-
centred. This was partly an effect of a changing medical world-view. Earlier
communicative ideals stressed that the medical doctor should in principle be
quite critical about what the patient says and base his/her medical diagnosis
on signs rather than on the patient's account of symptoms. In order to
achieve knowledge about how the patient functions in his/her life situation
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