Physicians In Clinical Practice Research Articles

Biomedical Innovation, Uncertainty, and Doctor-Patient Interaction

JAMES R. SORENSON Boston University School of Medicine Doctor-patient exchanges in routinized medicine tend to exhibit relatively high professional control and corollary high patient dependency. This power dependency arrangement is to some extent based on bothfact andfaith; thefact that the physician has some expertise and the faith that the physician's actions will have the desired results in this specific situation. A number offactors can alter this arrangement, however. For example, biomedical innovations often produce more than routine uncertaintyfor the physician in clinical practice, resulting at times in a reduction in professional control and correspondingly an increase in the potential discretionary power of the patient. While some patients may readily accept an increase in their role as health decision-maker, many attempt to have the doctor exercise as much discretionary power in novel as in more routinized medical situations. As a result, one finds in developing areas of medicine a multiplicity of negotiated doctor-patient exchanges, some approximating traditional doctor-patient interaction and others exhibiting more of a collegial decision-making structure. One rapidly developing area of medicine, clinical genetics, is examined with particular attention given to types of doctor-patient

Juvenile Rheumatoid Arthritis, vol. VI in the series Major Problems in Clinical Pediatrics, by Earl J. Brewer, Jr., M.D. Philadelphia: W.B. Saunders Company, 1970, 231 pp., $12.50

As stated in the Preface, this is a book written for the physician in clinical practice. The sections devoted to the differential diagnosis and therapy of rheumatoid arthritis will thus be found most helpful to the average practicing pediatrician. The initial chapter described the variable patterns of the onset and course of rheumatoid arthritis, utilizing both the author's extensive experience and data from other published Series. Tables of frequency of findings are ineluded which not uncommonly point out the marked variability seen in series from different centers.

New Books

New Books

Progress in the Biological Sciences in Relation to Dermatology

This volume contains papers presented at a course given at Cambridge University to provide physicians in clinical practice an account of fundamental research of particular interest to them. The editor has selected a formidable array of topics and grouped them under the headings: the melanocyte and melanogenesis; cutaneous innervation; histochemical investigation of the skin; bacteriology and mycology; psychophysiological mechanisms; comparative medicine; immunology; inflammation; carcinogenesis; radiation of the skin; and pharmacology. A few of the writers present their subjects with little direction towards the skin and dermatology— as if the skin were an organ floating in outer space and yet to be discovered by them. An example of this is an article dealing with the mode of action of tranquilizing drugs, in which, the effect of these drugs on itching, the major dermatological symptom, is not once mentioned. One author, a well-known immunologist, starts his chapter with the statement: I wish