CONFERENCE – Preparing for Physicians. The ambivalences of empowerment
Joint conference of the Collaborative Research Center 1187 Media of Cooperation and the Association for Anthropology and Medicine (AGEM)
Healing is a cooperative practice that involves multiple agents and requires negotiations of different needs and potentials. These negotiations are usually based on asymmetrical relations between healer and patient. Without specific expertise, skills, and knowledge of healing, there would be no need for consultation, and often patients are looking exactly for such an asymmetric relation to put themselves in the hands of an authority they can trust. Nevertheless, this asymmetry has often been criticized, especially in the realm of modern biomedicine and psychology, and especially in the context of chronic and rare diseases. Professional dominance (Freidson 1970) and a paternalistic imbalance in healer-patient relationships have thus led to an increasing claim for shared decision making and informed consent in order to empower the patient vis-à-vis her or his healer. The aim is to develop therapies and forms of interaction that explicitly seek to re-balance the relationship by taking into account the patients’ knowledge (as e.g. in many psychological therapies), or even trying to turn the asymmetric healer-patient relationship around and calling for full responsibility of patients themselves (e.g. in many esoteric therapies).
The Internet offers new possibilities for getting information and sharing experiences about the inefficacy or even harmfulness of popular and officially accepted therapies, on the one hand, and the efficacy of unknown and unconventional approaches, on the other, which may lead to distrust of professional or institutional authorities. Thus, patients can develop many strategies to carry out their own ideas and plans against a healer’s advice, if they disagree about the cause of the illness and the right course of treatment. Such strategies also may include simulating or neglecting specific symptoms to get a desired prescription, to avoid a specific treatment, or to get a temporary or permanent certificate of illness.
But empowerment is ambivalent. Patients are often torn between trust and suspicion, between the wish to be guided by experts and the wish to become an expert on their own, to give up or to keep responsibility for their health. Too much information can turn empowerment into confusion, and empowerment can also turn into manipulation, e.g. when pharmaceutical companies encourage patients to ask their healers for the drugs they sell (cf. Dumit 2012). Thus, empowerment is hardly straightforward. For instance, in which direction is empowerment oriented? Is it an extension of the patients’ biomedical knowledge? Or does it facilitate increasing demands from doctors, who are approached by patients who figure as consumers or customers? Does it include the right to remain a passive patient? Empowerment does not necessarily pit an autonomous patient against a dominant physician. This mélange opens up questions about the modes and means of empowerment. Who, beyond patients, has an interest in empowerment? Are Internet media engines of emancipation or sources of irritation?
After focusing on the healer’s perspectives and practices at the conference “Preparing for Patients. Learning the skills and values of healing encounters” in 2018, we now focus on the patient’s side and look for descriptions and analyses of their perspective and practices. We call for contributions that explore the ambivalences of empowerment both theoretically and empirically. We especially look for insights into the distributed nature of empowerment, the different constellations in which empowerment might be generated or reduced. Which resources are used to increase or to prevent the empowerment of patients, and which resources are used by the patients themselves? And what are the unanticipated consequences of empowerment?
Keynote: Prof. Nick Fox (University of Sheffield)
Conference language: English
AGEM JAHRESTAGUNG 31 – Preparing for Patients. Learning the skills and values of healing encounters (DE)
31st Annual Conference of the Arbeitsgemeinschaft Ethnomedizin e.V. (AGEM) in Cooperation with the Collaborative Research Center Media of Cooperation at the University of Siegen
Since the seminal studies “The Student Physician” (Merton et al. 1957) and “Boys in White” (Becker et al. 1961), there has been little in-depth research on how students of healing practices acquire such skills and how they are transmitted in learning contexts. These studies have shown how novice physicians learn to cope with the contingencies of daily work and how they learn to balance responsibility and experience. Through fine-grained ethnographic fieldwork, the researchers were able to show how such skills and attitudes are learned in the processes of becoming a competent member, by observing and imitating role models and by being sensitive to the norms and values displayed by significant others. In line with Becker et al., we assume that most of these skills are part of the tacit learning in the “hidden curriculum” (Hafferty and Franks 1994). The hidden curriculum refers to those aspects of learning contexts that do not figure prominently in official accounts, but are learned as part of becoming a member of a healing profession. Despite (or because of) their informal character, they serve as powerful orientations that slowly become taken for granted, in many cases without explicit recognition by those who teach and learn them. In the course of the conference, we want to shed light on how apprentices of healing professions are preparing and are being prepared for their encounters with patients or clients. Irrespective of the given healing cosmology, all healing knowledge is ordered in specific systems, organized in rules, schemes, and procedures that need to be adapted to the individual healing encounter. Therefore, every healing encounter is laced with fundamental uncertainties – not only with respect to treatment but also to interaction (cf. Fox 1980; Henry 2006). And all healing apprentices learn how to cope with these contingencies. The subtle transmission of a “paternalistic” model of physician-patient interaction in biomedical education might account for the long-standing asymmetry that are part of the official program of medical education, despite longstanding calls for “shared decision making” and “informed consent” (Stollberg 2008) . Consequently, “professional dominance” (Freidson 1970) is a skill that needs to be learned before it can be practiced.
Thus, we want to compare and take a closer look at the subtle modes of how students of different healing practices – biomedical as a well as all other healing traditions – are prepared and how they prepare themselves for their encounters with patients. We want to ask questions along the following lines:
CME points for physicians and psychotherapists can be obtained.
Book of Abstracts
Call for Papers