• The stethoscope and the dawn of information asymmetry

    The stethoscope entered commercial production in the middle of the 19th century. It is among the early diagnostic instruments of medicine, the use of which expanded the range of information available to the physician but not the patient, increasing the authority of the former and the dependency of the latter. From page 136 of Paul Starr’s The Social Transformation of American Medicine:

    The use of the stethoscope, as Stanley J. Reiser has observed, required the physician, at least momentarily to “isolate himself in a world of sounds, inaudible to the patient,” and encouraged him to “move away from involvement with the patient’s experiences and sensations, to a more detached relation, less with the patient but more with the sounds from the body.” These sounds the patient could neither hear nor interpret. Similarly, the other instruments that gradually assumed a place in the doctor’s bag reduced dependence on the patients’ statement of symptoms and increased the asymmetry of information.

    • Kind of similar to EHR, which can remove the doctor from the patient if not used judiciously.

    • Healers have always had special knowledge (through observation and examination as well as education). Technology is merely an extension of these “senses”. It has always been an unequal relationship.
      I think the issue has always been what information the healer chooses to share with the patient. The tendency throughout history has been for healers to hide behind this special knowledge for their benefit (to foster dependency and compliance).
      I think that technology in the form of access to personal medical records and health information has some chance of giving patients more independence to help shift the balance of power.

    • How does a flat-screen TV work, and does this asymmetry of information create “dependency” on Best Buy?

    • I know how a flat screen TV works but you are right that most people do not know and are dependent on “experts” to guide them. The fools rely on the salesmen at Best Buy; others find more reliable information. At least we do not have a “high priesthood” of TVs restricting our access to information… it’s readily available.
      (Would you also like a car analogy?)

    • ” The tendency throughout history has been for healers to hide behind this special knowledge for their benefit (to foster dependency and compliance).”

      No doubt true for some docs, but most of us make an effort to inform and explain. It just does not work very well sometimes. Most people, in my experience, just want to be told what will work best. Most are not hyperinformed internet addicts. Most patients do not know their own history that well, especially as they age. It is especially difficult to explain the nuances of treatment and statistical probabilities when people are tired or stressed out with a new cancer diagnosis. Finally, I dont think most physicians understand the finer details of the practices of other specialties. Patients will often have an even more difficult time understanding.