I go to a doctor, first and foremost, for information. Something has happened to me. I don't know if it's serious or what has caused it. I know nothing about it at all. Yet, I need to know in order to make decisions about my well-being, and it is this need that first brings me to the health services.
Doctors are experts in human anatomy, physiology and the science of cause and effect. They dedicate years to memorising information, learning to observe in detail and making assessments in order to finally make sometimes life and death decisions about how to address a given problem. In return, they are afforded tremendous social respect on the one hand, and legal responsibility as sole decision-makers on the other, thus carrying sufficient liability insurance as an inherent aspect of their practice.
It is taken for granted that a doctor's job is to diagnose, treat and be individually responsible for the outcome. This is the premise for the entire hierarchical system. It also, however, poses an inherent conflict for me, as I understand it to be my job - as ill-equipped as I might be - to make decisions about my own health.
When I am presented with a new situation, I find myself unable to make a decision about it. Thus, I seek out an audience with precisely the expert who can inform me - a doctor. This step, however, begins a chain of events driven by an agenda contrary to my own - to 'take' care from me, to engage in a hierarchical relationship with me and to dismiss (or neglect) my own power.
While it makes sense that I be a full and active participant in my own healing, I need information to do this; information is power. Rather than encouraging me to be fully informed and responsible, however, our system seems to treat me as a minion to be manipulated into compliance. I am a problem if I don't comply.
This has greater implications. Doctors are the gatekeepers of our society. Each one of us has a role in this world - to turn up for work and keep the economy going (regardless of how depressed it is or how much we as humans are neglected in the process). If something has happened so that I cannot report in for work - be it a physical, mental or social struggle - a doctor must confirm this inability to function. Availing of their service is often the only way to access support and meet our needs. Availing of their service, however, carries with it an assumption that we will agree to and participate in their treatment, a treatment that is limited to a culturally specific point of view.
One way to see the culture behind Western medicine is to observe their dependency on drugs. Although drugs have a place in healthcare, I believe they are over-used, unreasonably relied upon and often work against the development of real health.
Western medical treatments make sense when the body is in such crisis that it cannot be empowered to heal itself on its own quickly enough to prevent death. In such cases, immediate interventions and drugs are useful to say the least.
This, however, does not mean it makes sense for emergency responses to be commonly applied to every situation where the body's integrity is compromised. Surely the act of healing oneself has a greater impact on long-term health than the act of being healed suddenly and drastically by an outside force.
Many of us go to the doctor for ailments that cannot be classified as emergencies. I believe we go because we are scared, we do not have the skills to assess the seriousness of the situation for ourselves, because we have long since lost our ability to deal with pain and because we need both information and reassurance about our health. We go to doctors in a heightened sense of disempowerment. What we need to heal ourselves most of all is empowerment.
Our healthcare system rarely thinks of patients as part of the 'healthcare team'. While it is essential that we be 'fully informed' before any treatment is carried out, this is rooted in a legal motive - addressing the issue of consent - rather than a belief to embrace our 'full participation' or empowerment. Once consent has been given, there is no continued need for communication.
You can imagine the utter confusion for doctors when I offer an opinion for my treatment that is different from their own. I have seen their frustration as I probe for more information and alternative proposals. With no experience and only just learning about the situation, I must appear completely ill equipped to direct affairs.
And yet, I believe it is my job to be in charge of the proceedings. Like the chief executive of a company, I demand reports and consultations and ultimately call the shots. In fact, it is not my job to bring with me any medical expertise. My role on this team is not to be the expert. It is simply to be the most empowered of all.
- Shalini Sinha is an independent producer, counsellor and journalist. She is a consultant on equality issues and has lectured on Women's Studies in UCD. She co-presents Mono, RTÉ's intercultural programme.