The Resourceful Patient

1: The rise and fall of the medical empire - the evolution of medical power

The Pulitzer Prize for 1984 was awarded to Paul Starr for his monumental study of The Social Transformation of American Medicine, sub-titled 'The Rise of a Sovereign Profession and the Making of a Vast Industry'. The book is divided into two parts: the first tracing 'the rise of medical authority' from the 18th century to 1930; the second heralding the coming of the corporation, and describing the impact that the corporation and the growing role of the State had on medical authority.

Recent discussions in the United Kingdom have focused on the need to empower patients, and the arguments sometimes appear to indicate that the medical profession has been omnipotent for ever. However, this has not been the case, and what we have seen in the last hundred years has been the rise (and, more recently, the decline) of medical power and, consequently, a decline (and then, more recently, a resurgence) in patient power.

This book is in four parts. This first part charts the waxing and waning of medical power and is set out in the following chapters.

1.1 A resourceful patient
1.2 The shifting balance of power
1.3 The four dimensions of medical decline
1.4 The decline in sapiential authority
1.5 The decline of moral authority
1.6 The decline in bureaucratic authority
1.7 The decline in charismatic authority