Saturday, October 11, 2014

The informed patient

Every now and then we hear about people who look up their medical condition on the web and even tell the doctor what needs to be done. 

However, GPs could be said to mediate between patients and their own bodies and they certainly mediate between patients and the wider health machine. So patients who research their illness beforehand are trying to shortcut or at least understand part of the doctor’s mediation service. Presumably doctors don’t approve.

With the growth in information technology, this trend can be no great surprise to anyone including the medical profession, but what does it imply? If we look at the role of mediation in service industries then it could imply something of wider significance than healthcare.

As with doctors, the status of a mediator and the service they offer is often backed a certain mystique which also tends to be based on arcane knowledge. 

In times gone by this kind of mediation was almost entirely in the hands of the established church via its priests and high officials. Established churches offered the ultimate mediation service – mediation between the faithful and God - a very ancient form of social control.

A decline in religious observance seems to have coincided with a rise of a whole plethora of alternative mediation services still based, at least in part, on mystique and arcane knowledge. We call them service industries but the parallel with priestly mediation is striking. Potentially just as fragile too - in the face of information technology and the simple human desire to know.

So when patients arm themselves with knowledge before consulting their doctor, maybe we are seeing a fracture in the mystique of arcane knowledge. It’s not that the doctor has little to offer, but more interestingly, a possible crumbling of the doctor’s mystique and a recognition that his or her knowledge is accessible and not arcane.

The issue is complex because this is a subtle social and technological shift rather than a quantifiable economic trend. Even so it could have a profoundly negative impact on any service industry where the price and/or demand for mediation are sustained by an element of mystique and arcane knowledge.

Bankers we already know about, but how much of their trouble was caused by their inability or unwillingness to mediate between their customers and financial complexities? How much of an improvement would follow from a drastic simplification and demystifying of what bankers do? Has the mystique disappeared anyway?

Lawyers mediate between their clients and the law. On the surface there is nothing wrong with that, but what about the element of mystique and arcane knowledge which always seem to go with mediation?

To take an example from the entertainment industry, BrianCox offers mediation between TV viewers and the whole universe. Some folk don’t do things by halves do they? Lots of mystique and arcane knowledge behind that one.

Psychologists and psychiatrists offer mediation between a client and their own mind. Surely an example of professional chutzpah worth savouring.

Politicians offer mediation between voters and the hazards of the real world. Their credibility is crumbling to dust mostly because of their inability to mediate as claimed. 

However, their political failures could be the harbinger of wider failures. The failure of politicians to mediate as claimed, their obvious lack of arcane knowledge and the tarnished mystique of power may have implications well beyond politics.


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Paddington said...

Alternative medicines (generally the ones that don't work) were very popular even when people went to church.

Your idea of mediator is not off, though. Far too many people look for simple answers presented by authority, rather than trying to think.

Sackerson said...

AKH: another thought-provoker. I think it's to do with a decline in trust.

In medicine, we have seen doctors changing prescribing behaviour in response to drug reps' little gifts, and more recently in response to government targets and incentives.

On the other hand, we also see treatments denied, and in the cost-effectiveness assessment we suspect that cost may sometimes be overemphasised. The little boy recently removed by his parents from a Portsmouth hospital so that they could try to get advanced treatment for him elsewhere is an example, and the fact that the NHS has now agreed to pay for it only helps to confirm some people's suspicions.

I smile when I hear politicians and bankers talk about "rebuilding trust": it always suggests to me that they simply want to soften you up for another go later.

No wonder people are desperately scouring the rubbish-strewn alleyways of the Internet for alternative information.

A K Haart said...

Paddington "Far too many people look for simple answers presented by authority, rather than trying to think."

This could change of course, but the danger is that it won't and the gap between the information rich and the information poor will increase.

Sackers - yes, trust is the key but it has to be based on deep-rooted integrity. Instead of trust we have a kind of audit culture which doesn't work.