A Challenge to Patient and Public Involvement: The Rise of Biomedicine and the Changing Relationship between Users and Health Professionals

This paper traces from a neo-Weberian perspective the historical development of the relationship between patients and healthcare practitioners in the modern world, as exemplified by the case of Britain. In early nineteenth century ‘bedside medicine’ patients held considerable sway over diagnosis and treatment in a more pluralistic healthcare environment. This changed with the development of ‘hospital medicine’ in which the focus was on the classification of diseases by doctors in an increasingly professionalized hospital environment. The rise of ‘laboratory medicine’ linked to the strengthening of medical monopolies in the twentieth century further removed patients and the public from healthcare decision making, as underlined by the counter cultural resurgence of complementary and alternative medicine from the latter part of the twentieth century onwards based on more holistic client engagement. This paper discusses constraints on patient and public involvement (PPI) in light of such cosmological shifts in modern societies, in which the healthcare division of labour is now dominated by biomedicine. Although the ascendance of a medical profession centred on technological and scientific knowledge largely seems to preclude user engagement, this paper argues there is still scope for PPI. It is now increasingly acknowledged by health professionals that more dialogue needs to occur with patients at a micro-level and there are stronger collective user lobbies, as well as opportunities for greater consumer choice based on publicly available performance data. These trends have been fuelled by the rise in availability of information through the internet and social media – despite limited patient and public representation on health committees and the medical capture of some lay social movements in healthcare.