On the remarkable persistence of asymmetry in doctor/patient interaction: a critical review.

Doctor/patient interaction has been the object of various reform efforts in Western countries since the 1960s. It has consistently been depicted as enacting relationships of dominance or oppression. Most younger medical practitioners have received interaction skills training during their professional education, intended to encourage more equal forms of consultation behaviour. However, the evidence that 'patient-centredness' has a positive impact on health outcomes is at best mixed. At the same time, empirical studies of consultations point to the remarkable persistence of asymmetry. These two factors together suggest that asymmetry may have roots that are inaccessible to training programmes in talking practices. Illustrating our argument with findings from conversation analytic studies of doctor/patient interaction, we suggest that asymmetry lies at the heart of the medical enterprise: it is founded in what doctors are there for. As such, we argue that both critical and consumerist analysts and reformers have crucially misunderstood the role and nature of medicine.