Transforming doctor-patient relationships

Abstract

Historians often ponder how books change history. Our Bodies, Ourselves, the enormously popular and influential work, will long be studied for igniting and sustaining a worldwide women’s health movement. It should also be studied for how it transformed doctorpatient relationships and why it is such a trusted source of health information. The book began in a small discussion group on ‘women and their bodies’ at a Boston women’s conference in 1969. It grew into a course on women and their bodies and finally into a book with global appeal. Between 1973 and 2005, the Collective published seven English language and two Spanish language editions in the USA and over 20 foreign language editions. Within five years of its first publication it was a bestseller, and by 1999 had sold over four million copies. In her history of the women’s health movement, Morgan argues that it would be difficult to exaggerate the impact of Our Bodies, Ourselves. It filled the void where there existed few popular books on women’s health. Many colleges, universities and medical schools adopted it as a text. It was unique in that it gave voice to women’s own experiences of reproductive health and body issues. Elevating and validating women’s experiential knowledge, the Collective broke new ground in medical communication. The authors urged women to demand answers and explanations and to insist on enough information to negotiate the health care system. They envisioned creating a new type of partnership between patient and doctor that bore almost no resemblance to the model that existed. In the new model, it was envisioned that doctors and patients would have different responsibilities with the latter having ultimate control. Our Bodies, Ourselves evolved through a dialogue whereby ordinary readers communicated with the Collective to get information, lodge concerns and complaints, and suggest revisions to the book. The Collective was urged to add information relevant to an ever-growing array of ‘people like me’. As they corresponded with their readers, they enhanced coverage for women with disabilities and women of colour, weathered tumultuous storms over how to address lesbian health issues, and expanded the scope and coverage of a growing array of issues. Kline’s research on letters from women to members of the Collective during the 1970s and 1980s details how critical a role readers played in the evolution of this work. Finding ways to include many voices and yet retaining control over the final product posed many challenges. Invited contributors and people who corresponded sometimes had conflicting views on what was important. Keeping the book affordable was always at odds with expanding coverage. Editorial effort increased exponentially. For the 2005 edition, editors Judy Norsigian, Heather Stephenson and Kiki Zeldes managed and coordinated the work of 102 contributors and hundreds of ‘voices’ with the help of a ‘tone and voice editor’ and a photo editor. The evolution of Our Bodies, Ourselves is visible in the front matter of each edition. For example, the preface to the 25th Anniversary Edition, written by feminist luminaries Byllye Avery, Helen Rodriguez-Trias and Gloria Steinem anchored the volume in a continuation of second wave feminism. The current edition takes a very different approach. Reaching out to a new generation of women for whom second wave feminism is history, not lived experience, the front matter includes only a brief ‘Introduction’. A short letter from the founders tells readers that the history of the book is available on the web. How has the content evolved? The 1973 edition focused heavily on women’s changing sense of self in response to the second wave of feminism. It encouraged women to change internalized sexist volume covered the anatomy and physiology of reproduction and sexuality, the social and cultural aspects of sexuality and relationships, and included a controversial chapter written by a Boston gay collective that was replaced in later editions. Short chapters on nutrition, exercise, rape, self-defence, venereal disease, birth control, abortion, deciding about having children and childbearing were followed by a limited discussion of the menopause. A well-formulated critique of the American health care system rounded out the 275-page paperback that sold for $2.98, but with substantial discounts to clinics and women’s groups. The 2005 edition, an 832-page encyclopedic version, opens with chapters on body image, eating well, drugs, exercise, complementary health practices, emotional wellbeing, environmental and occupational health, and Correspondence to: sruzek@temple.edu Sheryl Burt Ruzek PhD, Professor, Department of Public Health, 1700 N Broad Street, College of Health Professions, Temple University, Philadelphia, PA 19122, USA.