Literature Annotations


Furst, Lilian R.
Between Doctors and Patients: The Changing Balance of Power


Genre Treatise (287 pp.)
KeywordsArt of Medicine, Caregivers, Communication, Doctor-Patient Relationship, Empathy, History of Medicine, History of Science, Hospitalization, Literary Theory, Medical Advances, Medical Education, Medical Research, Patient Experience, Physician Experience, Power Relations, Professionalism, Society, Women in Medicine
Summary

This book, "a humanistically oriented sociocultural history of medicine" (p. x), focuses on the interactions between patient and doctor in western medicine from the nineteenth century through contemporary times. Furst, a Professor of Comparative Literature at the University of North Carolina at Chapel Hill, uses literary works to chronicle the changing patterns of medical practice, the social positions of doctors, and effects of medical education as they relate to "the doctor-patient alliance." (p. x) By "mapping cultural history in and through literature" (p. x), Furst enriches our understanding of the development of various roles and expectations of doctors and patients since approximately 1830.

The first chapter details the concept of the book and clarifies its purpose. Most histories of medicine concern famous discoveries, introductions of new technologies, and lives of renowned physicians and researchers, yet they neglect to examine patients' perspectives. Furst's mission is to reinstate patients into medical history and contemporary analysis. She chooses to focus on everyday-type of medicine, and more specifically, "to chart the evolution of the changing balance of power in the wake of the advances made in medicine in the nineteenth and twentieth centuries, drawing on literary texts as sources." (p. 17)

The other seven chapters are topic oriented and placed in general chronological order. The chapters vary in the number of sources examined. For example, Chapter 2, "Missionary to the Bedside" is a comparative analysis of Anthony Trollope's Doctor Thorne (see this database) and Elizabeth Gaskell's Wives and Daughters, and Chapter 3, "Seeing-and Hearing-is Believing" almost exclusively concerns Middlemarch by George Eliot (see this database).

Other chapters, however, include commentary on more sources. A chapter on twentieth century hospital-based practice and medical education, "Eyeing the Institution," begins with a review of various films, television shows, and novels and follows with an in-depth comparative analysis of three autobiographical accounts of medical education and training: A Year-Long Night by Robert Klitzman, A Not Entirely Benign Procedure: Four Years as a Medical Student by Perri Klass (see this database), and Becoming a Doctor by Melvin Konner.

Furst examines the effect of gender on patient and physician experiences and expectations. In Chapter 4, "A Woman's Hand," five novels about "doctresses" (a term used for women doctors in the late nineteenth century) are compared. How and why the protagonists became doctors, what sacrifices they made, how patients viewed having a woman doctor, the range of solutions to career and/or marriage choices, and the personalities of the protagonists are some of the comparisons made. These novels are placed in historical context with information about the lives and attitudes of physicians such as Elizabeth Blackwell and Mary Putnam Jacobi.

Other topics include evaluations of the nineteenth century hospital, the role of research and the laboratory (Sinclair Lewis's Arrowsmith annotated by Felice Aull, also annotated by Pamela Moore and Jack Coulehan --see this database--and A. J. Cronin's The Citadel), and the impact of contemporary changes in reimbursement and management on the power relations in medicine. A sensitivity to the effects of language on power relations is a theme throughout the book, and is more fully examined in the final chapter, "Balancing the Power." After an analysis of several books by Oliver Sacks , and his attempts to truly understand his patients' perspectives, Furst concludes, "The balance of power cannot be even, but it must at least strive to be fair." (p. 251)

Commentary

Furst's knowledge of nineteenth and twentieth century literature is extensive and impressive. The book is extremely well researched, and includes endnotes, a bibliography of primary and secondary sources, and an index. Her analyses are accessible, clear, and erudite; this text would be of value to any student and teacher of medical humanities.

As Lawrence Zaroff, M.D. states in the Foreword, the book can be used by physicians to learn not only about medical history, literature, patient perspectives, and power issues, but also to learn about themselves. This book provides a comprehensive look at one of the major tensions in modern medicine--the remarkable power to medically and surgically cure or ameliorate many illnesses that were untreatable two centuries ago, yet the difficulties in interpersonal relations that seem to go hand-in-hand with many modern medical practices and educational models.

PublisherUniv. Press of Virginia
Edition1998
Place PublishedCharlottesville, Va.
Annotated by Shafer, Audrey
Date of Entry 08/17/98
Last Revised 10/29/03