Since beliefs, interests, needs and values vary among individuals, potential for conflict or dispute exists in all areas of human endeavor, including a patient-physician relationship. Conflict- or dispute-resolution requires diligent and directed negotiation, which ideally is amicable, efficient, and sustainable, if the participants acknowledge the identity, individuality, and integrity of all parties involved. In this essay a concept ofprincipled negotiation is extrapolated to a patient-physician relationship and is exemplified by a case study. In addition, the validity of a concept oftract (...) two diplomacy is discussed, relevant from the perspective of strained or fractured primary relationships. (shrink)

Modern socio?cultural studies of medicine demonstrate the symbolic character of much of medical reality. This symbolic reality can be appreciated as mediating the traditional division of medicine into biophysical and human sciences. Comparative studies of medical systems offer a general model for medicine as a human science. These studies document that medicine, from an historical and cross?cultural perspective, is constituted as a cultural system in which symbolic meanings take an active part in disease formation, the classification and cognitive management of (...) illness, and in therapy. Medicine's symbolic reality also forms a bridge between cultural and psychophysiological phenomena; the basis for psychosomatic and socioso?matic pathology and therapy. This in turn becomes a central problem for medical theory and for a philosophical reinvestigation of medicine. (shrink)

This paper discusses one of the most famous paintings on medical themes: The Doctor by Sir Luke Fildes (Fig. 1), which exemplifies how an ideal type of doctoring is construed from reality and from the views and expectations of both the public and doctors themselves. A close reading of The Doctor elucidates three fundamental conflicts in medicine: the first is between statistical efficiency in accordance with scales of morbidity and mortality and the personal devotion that every sick child or suffering (...) individual wants to receive; the second is between the doctor-dominated market and the patient-dominated market; and the third is between influential and rich doctors (“consultants”) and practitioners of family medicine (GPs).1 Fig. 1 Sir Luke Fildes, “The Doctor”, oil on canvas, 1891. With permission from The Tate Gallery, London. (shrink)