Book Reviews
Patients, Power and Politics: From Patients to Citizens
Christine Hogg
ISBN: 9-761958-78-9 1999 Sage Publications
Philip Warelow
Lecturer, School of Nursing, Deakin University, Geelong Campus, NSW
An interesting book, which takes a close look at so many of the issues that face practitioners within the health care environment. Unlike so many other texts this book chooses to look through rather than just at many of the more difficult and contemporary issues that face both the staff and users of health care services today. As the book so rightly points out there are two sides to every argument/issue and this text most certainly articulates and entertains both.
At first I felt the book was perhaps a little on the idealistic side and tended to point to issues which appeared only relevant to England and/or Great Britain. On reading further the book takes a rather broad sweep across so many issues, but what becomes apparent is that they are issues relevant to health care and patients and therefore the issues discussed are international rather than taking a particular or specific country focus.
I have always enjoyed a text that problematises issues and questions the status quo. This book by Hogg most certainly does this taking a critical perspective and questions some very pertinent issues in the process. Issues such as medical and psychiatric expansionism, the treatment of the symptoms rather than the problem, social control, the notions of consumerism versus paternalism, non orthodox therapies, the increasing financial role of drug companies, the evolvement of business like partnerships and many of the more contemporary issues making up the concerns of patients and staff within the areas of health care in the late 1990's.
The book doesn't always provide the answer but most certainly alerts the reader to many of the causative factors and the likely outcomes. I found myself not always agreeing with the particular author in reading this book but the read nonetheless proved interesting as I found I could relate to so many of the topical issues. I applaud Hogg for highlighting so many of the touchy issues within the health care arena. The notion of partnerships within health care was delicately touched upon as to the issue of complaints. Complaints within the psychiatric arena are as Hogg correctly points out, listed under symptomatology and can become part of the illness. This rather nebulous issue, like so many in psychiatry was dealt with in a rather matter of fact way (in a sense like the book itself) with the author taking no prisoners as she gave her rather candid opinion.
Medicine is a very strong and dominant enterprise, and individuals have to or choose to become part of this rather influential enterprise to seemingly exist on this earth. Medicine has a hand in our birth (birth certificate) when we are sick (certificate and prescription medications) and when we die (death certificates). Often the patient becomes very compliant and assumes a certain almost self-fulfilling role (described by Talcott Parsons as the sick role) which according to Hogg has its own particular benefits to both patient and/or doctor. The patient, in being compliant, is seen as a good patient and gets what benefits there are from a system struggling to find the necessary resources. The doctor is rewarded status wise, financially and retains his/her place in the sun. The idea of health care becoming a business, bearing in mind Hogg's arguments, with patients becoming consumers is particularly interesting having, I would argue, more problems than immediate benefits. Care under these pecuniary arrangements is problematical to everyday people and many of their providers.
Arguably shifting health care into the business arena has some appealing points such as patients being more empowered to stand up for what they see as right relational to their treatment and becoming more active in terms of litigation when they are mistreated. I have some concerns about an economic rationalist formula in health care and the sequelae of managers looking to save money at the expense of good and proper patient care. The two do not go well together. I would have liked the author to have touched upon other areas within this rather broad argument as I see and hear of so many of the more detrimental effects of these arrangements in nursing and health care circles. Clearly, the economic rationalist formula is obviously not working at the coalface or the contact point with patients.
Throughout this book Hogg cleverly interweaves her sections together and touches upon many of the strengths and weaknesses in the process which makes the book useful for many different disciplines within health care teams. The movement of people from being patients to citizens or from citizens to patients is usually a transient exercise but we are reminded by Hogg that as health care providers we should not forget that nonetheless they are still people in the process. Similarly, Hogg discusses the boundaries between health and illness constantly changing and to me this was one of the appealing features of this book. Her post structural opinion or view has a deal of merit attached in looking for what she best describes as the safe window of health somewhere near the middle.
This book, Patients, Power and Politics: From Patients to Citizens by Christine Hogg most certainly gets my vote.
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