Trusting Doctors

Trusting Doctors: The Decline of Moral Authority in American Medicine

Copyright Date: 2008
Pages: 296
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    Trusting Doctors
    Book Description:

    For more than a century, the American medical profession insisted that doctors be rigorously trained in medical science and dedicated to professional ethics. Patients revered their doctors as representatives of a sacred vocation. Do we still trust doctors with the same conviction? InTrusting Doctors, Jonathan Imber attributes the development of patients' faith in doctors to the inspiration and influence of Protestant and Catholic clergymen during the nineteenth and early twentieth centuries. He explains that as the influence of clergymen waned, and as reliance on medical technology increased, patients' trust in doctors steadily declined.

    Trusting Doctorsdiscusses the emphasis that Protestant clergymen placed on the physician's vocation; the focus that Catholic moralists put on specific dilemmas faced in daily medical practice; and the loss of unchallenged authority experienced by doctors after World War II, when practitioners became valued for their technical competence rather than their personal integrity. Imber shows how the clergy gradually lost their impact in defining the physician's moral character, and how vocal critics of medicine contributed to a decline in patient confidence. The author argues that as modern medicine becomes defined by specialization, rapid medical advance, profit-driven industry, and ever more anxious patients, the future for a renewed trust in doctors will be confronted by even greater challenges.

    Trusting Doctorsprovides valuable insights into the religious underpinnings of the doctor-patient relationship and raises critical questions about the ultimate place of the medical profession in American life and culture.

    eISBN: 978-1-4008-2889-0
    Subjects: Health Sciences, Sociology

Table of Contents

  1. (pp. xvii-xx)

    To assert the autonomy of medicine as a sphere of life is to acknowledge the millennia of efforts on the part of physicians to delineate and come to terms with their special responsibilities in human affairs. Today many questioners, both within and from outside the profession, address what are routinely described by the mass media in the United States as the most pressing and crucial dilemmas confronting modern medicine and modern society. Among these, abortion, euthanasia, and organ transplantation rank very high in public and professional visibility. Less is heard about what medicine represents as a sphere of life and...

  2. PART ONE: Religious Foundations of Trust in Medicine
    • (pp. 3-21)

      Whether trusted or not, doctors have used the Hippocratic oath for two thousand years as the equivalent of a social contract between the medical profession and the public, administered in modern times at graduation from medical school. Even though the legacy of that contract may now seem to raise more questions than it answers about the physician’s duties, the original oath has been described as “the Medical Decalogue [equivalent to the Ten Commandments], universally accepted as such.”¹

      That original, as translated by Ludwig Edelstein in his bookThe Hippocratic Oath: Text, Translation, and Interpretation(1943), reads as follows:

      I swear...

    • (pp. 22-42)

      Unlike the Protestant heritage that coincided so effectively with emerging ideals about professional authority in the United States—and played a large part in defining those ideals—another religious tradition, sometimes entangled in public disagreements with the dominant culture, offered its own, more deliberate approaches to complex matters involving religious teachings and medical ethics. As a sociologist, I would argue that Catholic clergy and physicians represent an important case of professional exceptionalism in the history of American medicine.¹ And to this day, by virtue of religious belief rather than professional training, Catholic physicians and Catholic hospitals think and act differently...

    • (pp. 43-64)

      As we have documented, in nineteenth-century America comparisons of the three learned professions often included specific judgments about those who practiced them, judgments that focused on questions of character, and thus of trust. In an introductory address to the opening session of the Kentucky School of Medicine in 1858, Dr. George Wood Bayless (1816–1873) described the contrasting types—those who were worthy of public trust and those who were not—found within the professions of medicine, law, and the ministry:

      Medicine has her votaries, who love her science and are proud of her noble benevolence; and she has her...

    • (pp. 65-104)

      As American medicine matured and the authority of the physician rose, public health movements—now ubiquitous in American life—and the export of both medical expertise and Christian ideals to nations around the world paralleled the growth of medical research and hospitals in this country. In a sense, both of these efforts—internal and external—were, broadly conceived, missionary movements, and originally their religious and medical aspects were often linked. As they diverged, efforts at Christian proselytizing have retained the label “missionary,” while efforts to improve the health of nations on principles derived from “sanitary science,” as public health was...

  3. PART TWO: Beyond the Golden Age of Trust in Medicine
    • (pp. 107-129)

      Introducing a 1963 issue ofDaedaluson “The Professions,” Kenneth S. Lynn cheered, “Everywhere in American life, the professions are triumphant.”¹ In the following few years, this glacial confidence about professional triumphalism receded rapidly, and the decade of the 1960s is now remembered for a steep decline in public trust in all professionals.² The decline in confidence in medicine in particular had as much to do with negative publicity about medical outcomes as it did with specific complaints about individual physicians. It appears to have had very little connection with any real concerns about the remarkable progress of medical science...

    • (pp. 130-143)

      What remains of trust in doctors owes its contemporary force to two remarkable inheritances, from Protestant deliberations on character, office, and profession, on the one hand, and from Catholic deliberations on medically and morally complex cases, on the other. The criticism of the office (i.e., the Protestant inheritance by which “character” as distinct from “conduct” defines the authority of each practitioner) can be distinguished from the criticism of conduct (i.e., the Catholic inheritance by which particular actions are scrutinized and judged). Put another way, physicians are still criticized more for what they do in relation to their medical work than...

    • (pp. 144-166)

      Stephen Spender’s poem “The Funeral” goes on to speak of “straining red flags” in the hands of those who “speak of the world state” and who are no longer “haunted by the individual grief / Nor the crocodile tears of European genius.”¹ As an ode to communist revolution, Spender’s poem offers also a testament to the failure of intellectuals to understand history. But as an ode to “the time of statistics,” the poem says more today about the ubiquity of census than about particular historical or political destinies. Even though Spender may have intended an elegy to one type of...

    • (pp. 167-196)

      Trusting doctors has never been obvious or simple. Callicter (who may have lived at the time of Nero) came decisively down on the side of distrust:

      The physician, who killed me,

      Neither bled, purged, nor pilled me,

      Nor counted my pulse; but it comes to the same:

      In the height of my fever, I died of his name.¹

      In 1794 Matthew Prior described the same resultwithtreatment, thus confirming the professional, if not public, sensibility that physicians are often damned no matter what they do:

      The Remedy, Worse Than the Disease


      I sent for Radcliffe, was so ill...