Hypnosis, placebo, and performance

recovering the relational aspects of medicine

Shahram Rafieian

Howard Davis

pp. 133-150

in: Farzad Goli (ed), Biosemiotic medicine, Berlin, Springer, 2016

Abstract

Consultation between a physician and a care seeker is a frequent and essential event in health care systems and its outcome depends not only on the medical knowledge and technical skills of the doctor, but also on their ability to communicate effectively. Changes in the paradigm of medicine affect the quality of this encounter, and the dominance of biomedicine as the working paradigm of modern medicine has resulted in a change to the pattern of doctor–patient interaction (Morgan 2008). In biomedicine, the emphasis is on the human as a biological and physiological machine, and as a result, sciences such as biology, physiology, and anatomy are considered to be the "basic sciences' (Pauli et al. 2000; Greaves 2002). The model of interaction which has emerged in the biomedical approach is the paternalistic (guidance–cooperation) relationship, in which the doctor is the expert and source of knowledge who gives advice that the patient should passively accept. Although this model functions well in some situations such as emergencies and in the management of acute infectious diseases, it is insufficient in many other contexts such as the care and management of chronic diseases (Morgan 2008). In spite of many efforts to eradicate chronic health problems such as high blood pressure and diabetes, there is still a long way to go to achieve this goal (Wagner et al. 2001). In chronic health conditions, after a while, the patient becomes familiar with the basic medical and technical knowledge about their problem and clinical consultations mainly focus on issues related to long term management of the disease. As a result, it has been argued that a patient-centered approach, in which the patient's views, feelings, thoughts and needs are respected, is especially necessary in the care of chronic conditions. Such an approach improves the quality of decision making for patient care, results in adherence to treatment and in more effective ways of addressing the patient's concerns (Mead and Bower 2000). Furthermore, as will be discussed in this chapter, this relationship has a healing effect per se.