Consumers on the critical list

The rise of the articulate consumer could spell trouble for the medical profession, argue Simon Williams and Michael Calnan

No television schedule is complete without its medical drama. Yet this apparent fascination with the people and practice of the profession does not translate into uncritical endorsement of modern medicine.

The public still does place considerable faith in doctors and continues to look to medicine as a solution for its ills. But at the same time it enjoys something of a love-hate relationship with it. There is evidence that a critical distance is opening up, with people becoming more ambivalent and sceptical about modern medicine. Some writers have suggested that we could be witnessing the rise of the "articulate consumer" and an increasingly litigious climate, though not on the scale of the American health care system.

Much public criticism focuses on drugs and the quality of information about them provided within the doctor-patient relationship. We found a strong "anti-drugs culture" among certain groups. Tranquillisers are heavily criticised because of the risks of addiction and their failure to tackle the root cause. This is particularly significant because medicines and drugs could serve as powerful metonyms for doctors - criticism of one implies criticism of the other.

Criticism is not confined to medicines and drugs. High-technology medicine stirs concerns because of its "unnatural" character. One respondent to our survey said of heart transplantation surgery: "It's a very peculiar feeling I get, but I don't like the idea ... it's a bit sacrilegious." Another commented about test-tube babies: "I don't altogether believe in that. I think it should be a natural function between two parties, not done artificially in a test-tube." And a third said: "Genetics is a dodgy business."

This fits in with the growing popularity of holistic therapies in contemporary western societies, a trend that may owe something to recognition of the limitations of traditional "faulty-machine" models of the body.

But at the same time high-technology medicine came in for a certain degree of respect, particularly from elderly people or those in need of its interventions, garnering praise for its "life-saving" or "life-creating" qualities.

A further complexity of our findings is that views on the merits of modern medicine often vary depending on whether it is being considered in general or personal terms. Viewed at a distance, there is considerable public scepticism. But when seen in personal or family terms, the picture is likely to be very different.

Even on the hotly contested terrain of human reproduction, there is evidence to suggest that women could in fact want more rather than less medical technology as a means of "regaining" rather than losing control of their bodies. Procedures such as in vitro fertilisation were often seen by couples undergoing treatment as a "resource" rather than a means of social oppression. This suggests that there are both gains and losses attached to these new technologies. The problem is not so much the technology as the social relations within which it is embedded.

Similarly, the growing popularity of complementary therapies does not appear to imply wholesale rejection of orthodox medicine. Rather, patterns of dual usage remain very much the norm. There is little to suggest that the public is turning its back on modern medicine. The difference is that medical technology is seen as too important to be left to the professionals alone.

Sociologists such as Anthony Giddens and Ulrich Beck have suggested that widespread lay knowledge of risky modern environments exposes the limits of so-called expertise, undermining faith and confidence in official pronouncements, including those of the medical establishment itself, concerning public safety and danger.

Because of this, the demand for public accountability and patient involvement in the development, application and risks of high-technology medicine has never been greater.

What these changes imply for medicine depends to a great extent on the response of the medical profession. The Patient's Charter, proliferating satisfaction surveys and various other public relations exercises, together with the introduction of "managed markets" could be fuelling "consumerism" in health care. Medicine could acknowledge its own limitations and the contingent nature of its knowledge base. Or it might instead shift to more defensive forms of medical practice and "damage limitation" to counter growing lay criticism and media demystification of science and technology. Issues of trust, risk and doubt loom large in the encounter between doctor and patient.

History shows that the medical profession is particularly adept at mobilising support in the face of potential challenges leaving its power base fundamentally intact. But a critical reconfiguration of professional power and dominance is under way.

Simon Williams is a sociology lecturer at Warwick University. Michael Calnan is professor in the sociology of health studies, University of Kent. They are authors of Modern Medicine: Lay Perspectives and Experiences, UCL Press, Pounds 35.00.