Table Of ContentIntimate Adversaries : Cultural Conflict
title:
between Doctors and Women Patients
author: Todd, Alexandra Dundas.
publisher: University of Pennsylvania Press
isbn10 | asin: 0812212770
print isbn13: 9780812212778
ebook isbn13: 9780585342085
language: English
Physician and patient, Women patients--
subject
Psychology, Interpersonal conflict.
publication date: 1989
lcc: R727.3.T63 1989eb
ddc: 610.69/6
Physician and patient, Women patients--
subject:
Psychology, Interpersonal conflict.
Page iii
Intimate Adversaries
Cultural Conflict Between Doctors and Women Patients
Alexandra Dundas Todd
Page iv
Copyright © 1989 by Alexandra Dundas Todd
All rights reserved
Printed in the United States of America
Library of Congress Cataloging-in-Publication Data
Todd, Alexandra Dundas.
Intimate adversaries.
Bibliography: p.
Includes index.
1. Physician and patient. 2. Women patientsPsychol-
ogy. 3. Interpersonal conflict. I. Title.
R727.3.T63 1989 610.69'6 88-27957
ISBN 0-8122-8152-7
ISBN 0-8122-1277-0 (pbk.)
Designed by Adrianne Onderdonk Dudden
2nd printing, 1990
Page v
For Drew
Page vii
Contents
Acknowledgments viii
Introduction 1
1 9
The Heart of Medicine
2 25
The Diseasing of Reproduction: When the Patient Is a
Woman
3 47
"The Patient Doesn't Have Anything to Say About It"
4 77
Delusions in Discourse
5 101
Good Doctors in a Bad Model
6 131
Across a Crowded Room: Some Problems, Some
Solutions
Bibliography 153
Index 163
Page viii
Acknowledgments
"The loneliness of the long-distance runner" is simultaneously the
most appropriate and inappropriate metaphor for the writing of this
book. On one hand, it brings to mind long hours spent alone, some
glorious, some excruciating, moving toward a goal at times elusive, at
times imminent. On the other hand, this book, like most books, is a
social product, the result of a multitude of contributions from friends
and colleagues.
I am enormously grateful to the following people for the interest they
brought to this project. Will Wright and Sue Fisher offered their help
and suggestions from the beginning to the end of the study. Rosemary
Taylor and Nicole Rafter encouraged me to turn the research into a
book, and I have benefited from their critical interest. Joined more
recently but with equal intensity by Stephen Fox, these friends read
drafts and provided a model for how exciting intellectual exchange
can be.
Others contributed by reading individual chapters, offering editorial
suggestions, or stimulating conversation. I would like to thank Rae
Lesser Blumberg, Kate Ermenc, Joseph Gusfield, Robert Hahn,
Evelyn Fox Keller, Jane Leserman, Bud Mehan, Joseph Rouse,
Catherine Ryan, Wendy Sanford, Marlie Wasserman, and Irving Zola.
I also want to thank all of the peoplemedical staff and women
patientswho agreed to participate in this study; Suffolk University
reference librarians Kathy Maio and Joe Middleton; secretarial staff
Cindy Morley, Annalisa Kebadjian, and Frank Pellegrino; and Patricia
Smith, editor at the University of Pennsylvania Press, who has made
the publishing process smooth and steady.
My son, Drew Todd, in his usual wonderful way, offered his
enthusiasm for and pride in my career, leading me to believe that
behind every happy, successful, single parent stands a supportive
child.
Page 1
Introduction
Time magazine, in the late 1960s, boldly asked, "Is God Dead?" This
question sent shock waves through homes and offices, creating
controversy at every level of American life. The high priests of
religion were said to be losing ground. Today, in the 1980s, when
"post-industrial prophets" (Kuhns 1971) have asserted that science is
the guiding light for modern society, a similar question might be
asked: "Is science dead?" The answer to these queries is both yes and
no. Religion is still very much with us, and a scientific view provides
much of our conceptual appreciation of the world. But in recent years
skepticism about science has grown, particularly with regard to
medical science. Doctors, the most highly visible applied scientists,
experience this skepticism perhaps most acutely. Scandals abound in
research, and medical mistakes regularly make front-page copy. We
all have our own personal stories of medical heresy. This represents a
dramatic shift.
For much of this century, Americans have placed their faith in doctors
and in the prevailing medical system. Such post World War II
breakthroughs as the development of antibiotics and Jonas Salk's
heralded polio vaccine provided credibility for modern medicine and
increased public confidence. It was believed that cures were available
for most ills and, if not, their discovery was just around the corner. In
only a matter of time human disease would be completely eradicated
through scientific research and expert medical care.
1
Growing up in the 1950s, I found these views reflected in my family.
The family doctor was called when needed and listened to with great
respect. The mention of the men who had performed assorted family
sur-
Page 2
geries brought a near reverential hush to the conversation (malpractice
cases were rare).
2 In sum, trust in doctors as the knowers and interpreters of scientific
medical truth was intact.
Since the late 1960s, this trust has eroded. Skepticism toward
authority in general has increased, and medicine is no exception.
There is an increasing awareness on the part of the general public that
a more selective eye needs to examine how doctors care for patients;
and the regard for scientific medicine, which knew no bounds, has
shown some limits. Doctors, who were thought to know all, are being
questioned. The surgeries and drug therapies that used to be viewed as
heroic and lifesaving increasingly are viewed with suspicion, needing
the reinforcement of second opinions. Women, the major consumers
of health care in this country, have been in the vanguard of these
criticisms, which reflect such complaints as the overprescription of
drugs, unnecessary surgeries, and biased medical attitudes toward
women. Blind trust in modern medicine has waned. This is not to
imply that modern medicine makes no contribution to health and life
or that the majority of Americans criticize their medical care. The cry
of dissent is a small voice slowly growing louder, not a full roar. But
there have been few large-scale miracles and many failures for doctors
in recent years. The public's expectations are high, often fueled by
media extravaganzas on high-tech discoveries, and they are all too
often dashed by daily realities. For example, although hearts can be
surgically replaced, cures for most chronic illnesses remain elusive.
Short of a cure for the common cold, at the very least, or, more
important, for AIDS or cancer, medicine's magic is in trouble.
This movement in popular opinion from total trust to growing
skepticism is mirrored in academic research. Talcott Parsons in the
