1. Dr Oonagh Corrigan Associate Professor, Sociology & Ethics of Medicine Peninsula Medical School Plymouth University. THE DOCTOR-PATIENT RELATIONSHIP & THE ‘MAGIC’ OF MEDICINE: EXPLORING THE SOCIAL AND MORAL ASPECTS OF HEALING

2. Background Thinking sociologically ‘sociological imagination’. ‘Social science as the study of biography, of history and of the problems of their intersection within social structure’ (C. Wright Mills 1952: 134) Biography Religious background. Patient. Interests clinical trials Genetic medicine Medical practice & education Emotional work of doctors Ethnography Values in medicine

3. Biomedical Model of Disease Disease is an organic condition: non-organic factors associated with the human mind are considered unimportant or are ignored. Disease is a temporary organic state that can be eradicated – cured – by medical intervention. Disease is experienced by a sick individual, who then becomes the object of treatment. Disease is treated after the symptoms appear – the application of medicine is a reactive healing process. Disease is treated in a medical environment – a surgery or a hospital – away from the site where the symptoms first appeared.

4. Power of the Biomedical Model Based on a technically powerful science that has made a massive contribution to key areas of health (for example, vaccination). The Genetic mapping of the body through the Human Genome Project. Recent technological advances…..MRI scans. Developments in neurosciences. Increasing focus on EBM Reductive –specialist knowledge ‘At one time most medical opinion inclined to the ‘reduction’ of all illness to a physiological and biological level in ….both the sense that aetiology was always to be found on that level, and only through such channels was effective therapy possible….this is certainly not the predominant medical view today’ (Parsons, 2005 {1951} The Social System p. 431)

5. The Social Model of Health and Illness Modern Western Medicine is one way of dealing with sickness and death. Social Organization. It has negative consequences. Illich and medical nemesis. Medicalization of society. Increasing commercialization of medicine. Moral (de)legitimacy

6. The Culture of Medicine: Wellcome Trust Gallery “From Cradle to Grave”

7. Emille Durkheim 1858 – 1917 ‘Biological explanations are insufficient to account for the dynamism and morality of human society. ’ Society is sui generis, it is irreducible to the individuals that compose it because society exists as an external force or pressure that acts on individuals.

8. Durkheim: ‘Social Facts’ There is a difference in kind between social facts and individual facts. They effect or create human activities, actions or agency but they are not intended. They are not the product of conscious intentions - they are the unanticipated consequence of human behaviour/agency. Social facts are constraining upon individuals for they pressure individuals to act in established, predictable ways.

9. Social Currents Social facts also include social currents, group experiences, emotions that transcend the individual and emerge only in the context of collectivity, where they force individuals to act in ways they would not have consider possible if acting individually, isolated from others.

10. Talcott Parsons Medicine in other cultures: ‘…the prominence of magic in this field is overwhelming great’ The physician occupies the place formerly occupied by the clergy and has ‘very important associations with the realm of the sacred’ (Parsons 1951)

11. The Social aspects of health and illness …Illness is a state of disturbance of the ‘normal’ functioning of the total human individual, including both the state of the organism as a biological system and his personal social adjustments. It is thus partly biologically and partly socially defined (Parsons, I951). Illness is socially deviant. Doctors fulfils societal functions by providing legitimacy for the sick person. Patient agrees to follow doctor’s advice. –The sick role. Individual recovers from illness and returns to social functioning

12. Applying scientific knowledge While the work of professionals such as engineers and lawyers involve largely purely rational and technical aspects, work of the physician differs additional expectations and emotional strains placed upon them. They must ‘…“do everything possible” to forward the complete, early and painless recovery of his patients. The general effect of the existence of large factors of known impossibility and of uncertainty in the situation with which he has had to cope is to impose strain upon him, to make it more difficult to have a “purely rational” orientation to his job’ (Parsons 1951: 450). ‘Transference’ involved ‘…the attribution of the physician of significances to the patient…that derives from the psychological needs of the patient. Inevitable tension between application of scientific expertise and emotional and social dynamic aspect in doing so.

13. Observations from the Field Problems of informed consent Issues often mistakenly understood as based on a rational choice action. –presentation of information. But patients bring expectations, hope and fears to the clinical encounter. Oncology patients (Non-Hodgkin’s Lymphoma) Patients often respond ‘miraculously’ to treatment. What makes some patients live many years longer than anticipated?

14. Health & Wellbeing? What does the social model of health and Illness contribute to our understanding of health and well-being? The biomedical model fails to address the needs of the ill patient. Increasing specialism makes it difficult to receive treatment or address the health needs of people with disparate though possible connected conditions and symptoms. The focus on EBM negates other ways of knowing and dealing with illness. Patients seeking alternative medicine, diets etc. are frequently dismissed as ‘fooled’ or foolish. The importance of understanding action and interaction in the context of social structures. The need for a narrative based research that focuses on what well-being means to individuals and how this compares to Health recommendations, outcome measures etc.