Are Doctors Miracle Workers?

Interesting article on the New York Times this weekend by David Rieff on the topic of patient physician relationship. Here are a couple of thoughts. More to follow.

Trust Your Doctor?
The article by David Rieff , "Miracle Workers?" , highlights the erosion of the concept of "trust" towards one's physician. Paraphrasing George Simmel, inherent to the nature of trust is an element of faith. This faith is ‘conditional’, in the sense that it rests on the awareness that certain social and legal structures are in place to protect one's interests. One can trust because society is organized to prevent such trust from being abused. Nevertheless, trust entails a relationship between two parties that are on different levels of knowledge and power. When medicine was a humanistic science, doctors were regarded to be the exclusive keepers of their knowledge. This was essential to a patient’s trust.

The ‘exclusivity’ of a doctor’s knowledge no longer exists. Furthermore, modern clinical epistemology has moved the medical discourse from the realm of the "possible" (as I often say to my patients, the answer to any possibilistic question is always yes) to the realm of the “probable”, that is, the quantifiable world of statistics. This shift has been quite positive, allowing more sick people to be treated with more appropriate treatments. In this new paradigm, hope is rooted not in his faith but in knowledge that we are receiving the best treatment available against our disease.

Yet patients still have a longing for the days in which they could simply "trust" their doctor. This longing is partially fulfilled today by alternative medicine, whose language remains the language of the "possible" - the language of faith. Perhaps there is a fundamental human need involved, which the language of the probable and the ‘comfort of statistics’ can never fully assuage.