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Waiting Rooms and the Unconscious

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Waiting Rooms and the Unconscious

Power


Although doctors tend to think of their relationships with patients in terms of care, almost everyone who has looked at these from the outside has seen them in terms of power. Many have drawn on the work of Michel Foucault, the French historian and philosopher. Foucault argued that power suffuses all human encounters, especially those involving professions and institutions. You only have to cast a critical eye on any interaction in the medical clinic to understand his basic premise. Consider, for example, the way that case notes are piled up tantalisingly on the reception desk for the doctors to come and fetch. It would be perfectly possible to give them to the patients themselves as they arrive, so they could spend time reading them and even (heaven forbid) write in them to correct errors or add personal details if they wish. In spite of this, most doctors find such an idea hard even to consider, because it challenges our innate assumptions about power relations in medical practice.

In fact, almost everything we do in the clinic sends clear signals to patients that we are the people who make and apply the rules, and they are the ones who are obliged to comply. We don't just express power in the way we behave towards patients. According to Foucault, it arises from the fundamental way that doctors see patients as bodies—what he termed 'the medical gaze'. Seen from his perspective, the way we organise our appointment systems is entirely consistent with everything else we do as doctors. It is one of a myriad of ways that we scrutinise and regulate people in order to take control of them. For much of the time, this may be partly concealed, but in waiting rooms it is there for everyone to see.

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