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PART 2: Things fall apart: How the ‘healthcare consumer’ model could break down

By Katie Bo Williams

Throughout the history of modern medicine, the physician has occupied a sphere of trust and power. In 2011, Times economist Paul Krugman remarked, “There’s a reason we have TV series about heroic doctors, while we don’t have TV series about heroic middle managers.”

Up until the 1970s, that authority was systemically unquestioned. The idea that doctors prescribed and patients obeyed—sometimes blindly—is known as medical paternalism now, but at the time it seemed the obvious way to conduct the relationship.

For most physicians who trained under this paradigm, this was not necessarily an exercise in hubris, but a necessary part of compassion, Dr. Barron Lerner, a bioethicist and internist at New York University’s Langone School of Medicine, writes in a recent book about the doctor-patient relationship. Patients did not have the benefit of a medical education or experience, and fear often clouded their judgment. In the post-war era, physicians as a matter of routine withheld cancer diagnoses from patients in an effort to prevent that fear. Radiation and chemo were “just to be on the safe side.”

Patients, for their part, acquiesced to that authority: Harvard University sociologist Talcott Parsons coined the term “sick role” in 1951, which gave a name to the patient who dutifully follows physician orders, believing that because he is exempted from day-to-day obligations due to illness, it is therefore his responsibility to cooperate fully in his recovery. It wasn’t until the women’s health movement started gaining traction that patients began to push back against the physician’s sovereignty.

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