Page 50 - Contribution To Phenomenology

PHENOMENOLOGY AND THE CLINICAL EVENT 43

(1) To be a patient is to be disadvantaged by the very condition that
brought one to the physician in the first place. Impairment compromises
in multiple ways ([22]; [26]; [41]): not only by its special ways of
capturing and focusing the person's attention, but also by the fact that
the patient cannot "do for herself' but must rely on others. To be
impaired is to experience oneself as uniquely vulnerable, exposed to the
actions of others. The patient is thus disadvantaged by the very
asymmetry of the relationship, as well as by the fact that those with
power on their side are commonly strangers, because of which the social
conditions for trust are commonly not at hand even while trust is
essential to the relationship.
From the patient's perspective, the relationship is marked by the
experience of having to rely on a host of affairs: instruments, medica-
tions, procedures, arrangements, and, most importantly, people. To
experience impairment is to find oneself in situations marked by multiple
forms of unavoidable trust—especially regarding people with respect to
whom, being strangers who possess the knowledge and skills to engage
in highly intimate contacts, trust is itself a serious and ongoing issue [46].
(2) On the other side of the asymmetrical relationship is the
physician—^who has the power, skills, knowledge, resources, and socio-
legal authority to judge what can and should be done, and to act. Here,
several things are evident.
(i) Many physicians and traditions in medicine's long history seem to
have taken this asymmetry as a rationale for construing the relation to
patients as unilateral and have thus called for solitary decision-making—a
view strongly enhanced by the 20th century marriage of medicine to the
biomedical sciences and the many discoveries consequent to that
marriage. The realities of clinical work, however, typically force the
recognition that patient encounters are reciprocal, in that patient trust and
compliance is necessary; indeed, patients often do not agree with
physicians, refuse to comply with "doctor's orders," and insist on making
their own decisions^—including the decision to treat themselves or not be

^ As Ludwig Edelstein emphasizes ([5], p. 329), healers in the skeptical,
methodist tradition were especially aware of the uniqueness of each patient and had
constantly to consider, "What about the patient who is putting himself and *his air
into the hands of the physician?" The patient had to ponder (even at times be
helped to ponder) the unavoidable trust placed in the hands of the healer, and the
healer correspondingly had to be alert to this and to do everything necessary to
make himself trustworthy.