THE INFORMED CLIENT: A CASE STUDY IN THE ILLUSION OF AUTONOMY*

Abstract

Much of the sociological literature on the client-physician relationship makes two assumptions. The first is that clients are socialized to passivity in the relationship while physicians are socialized to dominance. The second is that a client is constrained from being informed about his or her own condition and from acting on that information autonomously (see, for example, Mechanic, 1978; Parsons, 1951; Suchman, 1965). Today, there is evidence of a consumer movement among health care clients which suggests that the passive patient may be a vanishing species. First, there is written material available which enables patients to assume a more active role in their own health care. Three kinds of books appear frequently in libraries and bookstores: critiques of the medical profession; blueprints for evaluating care in specific crises; and self-help manuals. The “critiques” vary in form and focus, but may have the generalized effect of spreading doubt about the efficacy of medical procedures, the precision with which doctors work, and the ethics which motivate their actions (see, for example, Kotelchuk, 1976; Millman, 1977). As an example of the “blueprint” literature, Crile’s What Women Should Know About the Breast Cancer Controversy (1973) warns women against blind acceptance of a doctor’s advice. The “self-help” manuals suggest that laypeople can and