Tuesday, October 14, 2008

Professionalism and Patronage and My Sinuses

Terry Johnson, in Professions and Power, remarked there were essentially two ways to resolve the inherent tension in the relationship between producer and consumer. All right he did have a third but that's not at issue here.

I had to visit a doctor which is why this came to mind. Every year I get a cold at this time of year. You can set your calendar by it. It has the exact same result each time. As I get to the end--that catarhhal stage when my sinuses awaken like the Kraken and pour forth their evil issue into the world (enough)--I always find my sinuses get infected. They just do and no matter what I do, they will. They truly have a life independent of me.

Because I'm in the middle of moving home, I'm away from my normal doctor. When I visit her, she listens sympathetically, prescribes the wide-spectrum antibiotics and I'm away and better in a week. All really quite simple.

This time I went to a walk-in clinic in Soho. This place is used to seeing every imaginable disease walk off the street. Mine doesn't even register on their scale. Even their form refers to triage--memories of "Mash" flash by.

When I saw my nurse, I told my story. She flicked through multiple screens and said, "The computer says 'No'." Well, almost: she said, "Antibiotics are contraindicated because you don't have a bacterial infection." This on the back of no tests and my prior experience.

"Go home and inhale steam," she said.

"That doesn't work anymore. I can't sleep and I can't work," I almost yelled but not quite.

She turned away from her screen and grimly looked at me. "What makes you think you know better than me?"

The killer question. I screwed myself up and announced, "It's my body and I know how it works. And it's done precisely the same thing for the last several years. One course of antibiotics will clear this up. Simple. That's how I know."

She glared at me. "Well I think it's contraindicated but I will give it to you anyway."

Oh thank bloody god for that.....

She did, but with bad grace. And when I said thank you and goodbye (without gloating), she only murmured a brief bye.

According to Johnson, in the 18th century medicine was one of those occupations where typically patients told their physicians what was wrong with them and what they expected to be done. Given the state of medical knowledge, that probably was a safe thing to do. It was a form of patronage where the client determined the resolution of this tension I referred to at the start.

The 20th century was characterized by the rise of professionalism where the producer became the dominant partner. Now of course external regulation has taken a firmer grip.

I felt rather chipper about reinvigorating some 18th century values for a change. And I can already feel my sinuses getting better. Did someone say placebo? Get out!
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2 comments:

John Flood said...

A friend emailed me with the following comment:

I wondered how this was all going to tie together, it did so beautifully in the end. An amusing RAT Prof. I shouldn't think that Doctor wouldn't want you back as a patient. If you're lucky she'll have forgotten you this time next year when your sinuses start their annual salsa.

John Flood said...

And guess bloody what? My sinuses are getting better! I knew it would work!!!