Bioethics Discussion Blog: The Charisma of the Vulnerable Human Physician: The Decline of Charismatic Authority?

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Monday, September 19, 2005

The Charisma of the Vulnerable Human Physician: The Decline of Charismatic Authority?

The Resourceful Patient is a printed but also an online book about the relationships of patients to medical care. I found chapter 1.7 "The decline in charismatic authority" quite interesting in view of my previous posting about physicians telling about themselves to their patients. I think that by being “more human” by appropriate self-disclosure perhaps the work of the physician can be more effective through empathy, better understanding by both patient and doctor of each other leading to more satisfactory compliance by the patient along with less tendency to find fault with the doctor.

The book describes charisma as “'a favour specially vouchsafed by God; a grace; a talent'.” and then proceeds to explain its course through time: how the charisma was maintained over the hundreds of years and in recent times, through secularism, the doctor replacing the priest in some communities and in the middle years of the 20th century how idealistic medical drama raised the charisma of the medical profession. Finally, there began a decline in charisma as medical drama was becoming more realistic and tended to “demythologise the healing professions.” In addition, medicine itself is demystifying itself through the clinicians “mode of dress, mode of consulting style and mode of address to patients.” Beyond that, “new healers are emerging” as the alternate and complementary medical practitioners are becoming more popular. In addition, it is also my opinion that the development of the era of consumerism, direct to consumer drug advertising and bioethics with the stressing of patient autonomy over physician paternalism that has also contributed.

Here is a brief extract from the book:

The charisma of the vulnerable human

The charisma of the remotely impressive doctor of the 20th century was powerful and had some beneficial effects for some patients, but for many the effect was demeaning. The charisma of that type of doctor derived from the reverence in which the profession was held, often augmented by the behaviour of the individual doctor. The diminution of this type of charisma may have been replaced by another type of charisma.

The word 'charisma' is now used to describe the superficial image of a public figure, closer to the adjective 'glamorous' than to the original meaning which referred to certain personal characteristics of the individual. The 21st century clinician, stripped back of the image from which 20th century charisma derived, can offer a substitute - his or her own, honest person, frailties and all. The doctor as superman has been replaced by the doctor as human being, willing to relate to another person - the patient - and the charisma of the human being who is the clinician may be as powerful as charisma derived from the false image.


What do you think is happening to the appearance of the medical profession in the eyes of the patients? ..Maurice.

2 Comments:

At Thursday, September 22, 2005 6:38:00 AM, Anonymous Niels Olson said...

Dr Bernstein,

I think the authors focused to much on the possibility of historical change in positing their two definitions of charisma.

I spent the last two and a half years on staff at the Naval Academy. My particular job brought me into contact with the top 1% and the bottom 1% of the student population. It seemed to me that some at the top had a trait in common with some at the bottom. The ones at the bottom were, almost inevitably, not only performing poorly, but despised by their chains of command. The ones at the top, you could tell the senior officers responded to their attitude with greatfulness, a feeling that this person would take care of the problem. These senior officers in turn often exhibited the same behaviors themselves so it was particularly interesting that they responded in that way to the midshipmen. I came to say "If you like it, you call it charisma, if you don't, you call it a sense of entitlement."

It seems to me easier to understand this particular trait by considering the positive and negative at the same time. Particularly since this trait is exhibited almost exclusively at opposite ends of the spectrum. Viewed as a whole, I think it is easy to see how godly favor and glamour may be the same trait in two guises.

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I also reject the notion that new healers are emerging. They're always emerging. They have always been there. Indeed, they were the motivation for the formation of the AMA and the development of state licensure laws. Some, like midwives, are better than others, like craniosacral therapists.

I do agree the consumer era and direct-to-consumer drug advertizing are new influencers.

 
At Thursday, September 22, 2005 5:30:00 PM, Blogger Maurice Bernstein, M.D. said...

And how a physician appears to a patient can be explained through the eyes of the beholder. A physician, through the eyes of a patient who is instilled with the current philosophy of "consumerism" will look at a physician one way, whereas an elderly patient who lived during the time when physician paternalism was acceptable will look at their current physician another way. To the latter, the physician has maintained charisma, to the former it may be deminished. ..Maurice.

 

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