THE DOCTOR-PATIENT RELATIONSHIP AND ITS HISTORICAL CONTEXT
THOMAS S. SZASZ M. D.,
WILLIAM F. KNOFF M. D., , and
MARC H. HOLLENDER M. D.1
1 The Department of Psychiatry, State University of New York, Upstate Medical Center, Syracuse, N. Y.
The doctor-patient relationship which characterizes a given situation depends on two principal categories of variables: the medical situation and the social scene. The cultural matrix impinges on the individual characteristics of both physician and patient in the form of learned orientations to disease, treatment, cure and to the doctor-patient relationship itself.
We have briefly reviewed and commented on the probable connections between the socio-historical and intellectual-scientific circumstances of 6 historical epochs and the prevalent type (s) of doctor-patient relationship.
It is our thesis that the value of a specific pattern of the doctor-patient relationship can be established only by evaluating all the relevant and pertinent variables. We would suggest, however, that awareness of the cultural relativity of the doctor-patient relationship should make us skeptical of the assumption that our current practices are "good" or the "best possible." Probably more often than not, they are neither, but simply reflect the congruence of social expectations and socially shared ethical orientations of physicians. In this connection, physicians, and perhaps psychiatrists particularly, explicitly may consider which of the following 3 alternatives they favor: 1. That they reflect the prevalent social values and expectations of their culture; 2. That they lag behind the social changes of the time and represent the values of the immediate past; or 3. That they join with those forces in society which lead to its modification (whether to "progress" or "regress"). Critical examination of the doctor-patient relationship usually predisposes to change, while non-scrutiny of human social relations favors the status quo.
