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Trusting Doctors: The Decline of Moral Authority in American Medicine

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I found this book on a library shelf. I tried to read it because I like sociology and I'm fascinated by the cultural and psycological aspects of medicine.

But somehow I just couldn't get into this book. As a former academic myself, I understand the challenge of writing for a general audience after writing for academic journals. Still, this book seemed unnecessarily dense. I was also uncomfortable with the author's style of focusing on very specific examples to make a point. For example, when the author quotes from an address to a medical school, it is hard for the readeer to tell whether it's typical or influential.

The book does have value because it raises questions that stimulate thought could lead to useful discussions in public forums. For instance, I hadn't thought about the influence of religion on medicine. Some of the anecdotes would be interesting to discuss in the context of ethics and professionalism.

But I wonder if today's lack of trust can be attributed to more mundane reasons. Just about everyone I know will consult the Internet as well as a doctor when they have a medical question. Doctors themselves (such as Atul Gawande and Jerome Groopman) write books that acknowledge the gaps in scientific medicine. These books, along with prominent newspaper accounts, reveal that medical decisions can be influenced by drug company incentives as much as by pure science.

Ultimately, Americans (and perhaps people all over the world) are replacing the question "Why we don't trust doctors" with, "Why shouldn't we bring a healthy skepticism to our encounters with the medical profession?" Imber recounts a horrific story of a doctor who actually slapped a grandmother who dared to question his authority, back in the 1930s. Although this conduct would be unlikely today, I would refer to a scene in the very recent book The Light Within, where doctors held down a dying woman to administer a useless but painful treatment.

On page 128, Imber quotes at length from Lisa Alther's review of a book about personal experience with a medical error. Alther "had to wonder where modern America got the idea that physicians should somehow be more competent than the rest of us." This quote seems to raise additional questions about the book's premise. If physicians don't have to be "more competent than the rest of us," why would we award them moral authority?

As an ordinary person, not an expert on medical sociology, I think many of us can answer Alther's question with some cynicism. If doctors keep people waiting for hours, expect patients to tolerate a degree of rudeness not accepted elsewhere, and continue to use the word "patients," they are creating expectations. Simple failure to meet these unrealistic expectations may account for erosion of trust more than the more complex rationale the author proposes.