Jen’s Montgomery Response   3 comments

Montgomery asserts that “Patients see the person who is the physician but respond to the archetype; they evoke physicianly performance by the power of their need” (200). Thus the reciprocal relationship in which doctors or any professional are perceived to “perform” in accordance with their constituents’ “expectations” is made clear.

When I am less prepared than I would like to teach a class, I remind myself that at least I know more than my students do about “x.” This allows me to feel more confident (fake it until you make it!). While this can be comforting at times, I never want to rely on this dynamic. Because my credentials create certain expectations, most students are willing to abdicate their own better judgment in favor of my perceived expertise. I have to constantly fight against this apathy/passivity by empowering students and helping them to understand what they already understand; I strive to wake up their intuition and critical thinking.

Though I can clearly relate to this professional experience, I never thought of the extent to which medical doctors act under the same auspices. However, as Montgomery points out, doctors often prefer the comfort and insulation that is implicit in the “physicianly performance.” They may prefer patients who abdicate their responsibility to participate effectively in their own care because they are less trouble.

However, a teacher’s job is to insist on this participation. While students long for reassurance—you are smart; you will graduate and get a good job; etc., they have a lifetime of school and social experiences to inform their judgment about their skills and potential. All of these highly variant experiences inform their academic experience.

Patients (especially those with catastrophic illnesses), on the other hand, are usually at a loss. The experience that informs them is former/formative interactions with doctors that which is so informed by their “need” and the fulfillment of this need that magical, modern medicine prescribes, as well as our cultural conventions (our elevation of those whom we perceive as experts). This lulls patients into a false sense of security. Patients tend to believe in the science of medicine rather than the practice of medicine, as Montgomery explores throughout the text because it is reassuring.

What can we learn about the doctor/patient dynamic performance by comparing it to the teacher/student dynamic performance? In what ways might we consider the doctor both the teacher and student?

Posted August 31, 2010 by jenwojton in Uncategorized

3 responses to “Jen’s Montgomery Response

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  1. I appreciate this response because, as a teacher, I also thought about the notion of “teacher knowing all” while reading Montgomery. If I don’t know the answer to a question, I can either turn to the class and invite responses, admit it and invite them to “look into it further,” or a number of other innocuous approaches to my lack of knowledge. If I answer a question wrong, the implications are also relatively harmless. The responsibility of doctors to be “right” all the time and the implications if they are wrong (death, disability, disfigurement?) is incredible. The stress of being a doctor must be greater than that of any other profession because we think of them as superhuman. We typically rely on their diagnoses and prognoses without question. Then when something goes wrong, we sue as if medicine is foolproof.

  2. This explains why doctors pressure radiologists and other specialists to help them nail down a diagnosis.

  3. I have to agree that the societal expectations of doctors is a pressure that really effects diagnosis outcome or patient let down. For me, the impact has been with a twist in two ways:

    1.) that the doctor just doesn’t want to further investigate and is more likely to pass me along to another specialist (once I had a cardiologist who referred me to an Endocrinologist who then looked at me and said, “I think what you need is a cardiologist. Let me get you a referral.” I burst out laughing of course.) —

    2.) What I usually encounter though is an arrogance that overcomes the doctor. Not only are they expected to know it all, but they’ve actually convinced themselves they truly DO know it all. And those are the doctors least willing to listen and those are the doctors who get angry when you question their decision making. These doctors look at patients as silly fools who are incapable of thinking intelligently. And I have to wonder if this is actually more of problem due to the training of the med students. I think some learn early on to regard patients as idiots. They are zoo animals on display at the hospital zoo. They are not intelligent human beings.

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