One feature of Western medicine’s social institution that serves to maintain authority/power in the hands of the physician is insulating the layperson from properly understanding what may be ailing him/her. Illich defines this process as “medical mystification” (80). It is an intellectual obscuring of sorts and stems from the physician’s special knowledge and training as it pertains to the proper functioning of the human body.
The other part of this insulation between the patient and the physician lies in the style of communication between the two. In referring to this style, or mode, of communication one must not only look at the vocabulary utilized by the physician but also at the structure of conversation between the patient and physician such as when the former enters into a hospital for medical purposes.
Physicians, nurses, and auxiliary personnel alike utilize a different vernacular from the ill layperson seeking medical attention. Throughout their careers, physicians make use of Latin extensively. Latin is used, in great part, because it is a dead language and is resistant to the linguistic volatility common to living languages, especially modern English. It is also used due to its implications about social status and worth.
Though Latin was commonly found to be written by the educated class of society, the aristocracy, it has become isolated to certain professions viewed with great esteem such as medicine and law. By decreasing the number of people who regularly use Latin, knowledge of the language reinforces an image of the elite, of those with a high degree of technical knowledge and special status. Latin is studied by physicians to be able to identify body parts as well as diagnose and treat the wide range of maladies an individual may be experiencing.
While the Latin terms physicians use often correlate to a quotidian equivalent, there is still an aura of mystery projected by prefixes such as “hemo,” “derma,” and “osteo” along with the suffixes “osis” and “itis,” to name but a few. This specialized vocabulary can often puzzle and even frighten the patient who may only vaguely aware of what is truly ailing him/her.
But Latin is not the only communicative feature that reinforces the status quo between physician and patient though. Within Western medicine there is also another kind of semantic shorthand. Nurses utilize abbreviations of complex, polysyllabic scientific and technical terms for sake of ease. As new technology is developed for medical uses, this shorthand changes. New machines and new versions of machines with new effects are utilized in both diagnosis and treatment which cause the vocabulary to adapt. The common language that medical personnel speak unites them in achieving their occupational goals which, in turn, supports the social function of Western medicine as a whole. However, this common language prevents a barrier that the majority of laypeople will not understand.
Susan Sontag speaks of this topic indirectly in her work Illness as Metaphor in which she explores the connotations attached to terms related to medicine and illness. These connotations arise when either the doctor withholds the mechanism and true nature of the illness from the patient or when the doctor simply does not comprehend the mechanism and true nature of the illness (6-7). This conceptual wiggle room gives opportunity to writers, poets, and other laypeople to develop their own ideas of what their condition may be. Cancer, previously thought to be similar, if not identical to tuberculosis, occupies a sinister synonymy “with death itself” as physicians seem unable to cure, let alone eradicate, the disease (18).
In addition to the semantic/vocabulary feature of Western medicine, there is also the nature of the patient’s consultation by the physician. Though the exact time each patient spends with his/her physician prior to being discharged or prepared for further medical examinations, there is an average in the United States of the entire physician/patient interaction taking less than twenty minutes, less than the amount of time patients are often kept in the waiting room filling out insurance paperwork and health questionnaires. Prior to this stint of an interaction, the nurses take the patient’s “vitals,” ask some preliminary questions, and carry out some other medical/administrative tasks before leaving. This is to clear the path for the physician to complete the work in an efficient and timely manner as humanly possible.
By the time the physician enters the room, he/she may ask some follow up questions and physically inspect the patient’s affected area(s), but in a significant number of cases, he/she already has a diagnosis in mind and proceeds to deliver instructions for treatment. This may be in the form of a physical activity (exercise more, avoid loud noises, etc.) or it may come as a medication, either topical or oral or otherwise. But in both types of cases, the physician speaks more than the patient and delivers imperatives, if not downright commands.
The patient is the one dependent upon the physician for help and a recovery of health. This inherently places power and authority within the hands of the physician. That the nurse completes these activities for the physician reinforces the conception of the latter as elite, as one who carries both power and authority, not just with patients but within the medical system itself. It is almost as if the physician cannot be bothered with such menial tasks, that his/her time is extremely precious and must be organized impeccably. There is also a certain detachment that increases from one level of medical personnel to the next.
But the physician does not only exercise authority over a patient, but also power in some select cases. A pertinent example comes from The Spirit Catches You and You Fall Down. In the book Fadiman relays the tale of a Hmong family caught in a head on collision of cultures, seeing as each has its own rituals, customs, and conditions of practicing medicine. To provide one example, Lia Lee, the daughter of the Hmong family in the book, is prescribed an assortment of medications that are to be taken depending on the physical symptoms she manifests at any particular moment (45-48).