Traditional and new forms of patient expertise: Together with doctors or versus them?

Abstract

The article outlines and discusses two opposite perspectives of medical practitioners in relation to patients’ attempts to form lay medical expertise. The author conceptualizes these two approaches as thought styles and the corresponding communities of doctors as “thought collectives” (L. Fleck). The two thought styles are distinguished based on four characteristics: attitudes towards interaction with patients, particular ways of making sense of alternative forms of expertise, strategies for resolving conflicts with patients, and outlooks on professional knowledge and its place outside the medical community. One of the thought collectives — monopolization collective — is committed to a paternalistic model of medical care, and the corresponding style of thought does not allow noticing and acknowledging patient expertise. Patients’ attempts at joining the professional medical rationale are resisted by these medical professionals, and in situations of disagreement or conflicts doctors use a closed strategy for their resolution. Physicians from monopolization collective are skeptical about translating medical knowledge outside of practitioners. In contrast, doctors who adopt a co-construction thought style follow the logic of partnership when interacting with patients. Such a style allows medical practitioners to recognize the value in patient expertise and include it in a dialogue and disease management. When conflicts and differences of opinions arise, doctors follow open and intermediate strategies for their resolution, which implies additional efforts to build communication with patients. At the same time, there is a clear demand from this collective for the creation of high-quality popular science and educational materials for patients. High quality translation of medical knowledge is seen as a necessary means of including patients in productive co-production of expertise.