Negotiating Identity in the Patient Role: Tales from the Romanian Medical System

In: Culture, Experience, Care: Re-Centring the Patient

Starting from Talcott Parsons’ ‘sick role’ and Michel Foucault’s ‘biopolitics,’ and on to the medicalisation of society, the patient has been theorised as a receiver of medical care in an unequal medical power structure. Although the patient is sometimes discussed as reluctant and even dismissive of the manifestations of medical authority, this power structure remains in place when discussing the doctor-patient interaction. Present day changes in the organisation of the medical system, increasingly market-oriented, have had an impact on this building block of medicine. No longer is the doctor an uncontested figure of authority, even in a place where many still see themselves at the mercy of medical practitioners. Patients do not leave their Self at the door when entering the doctor’s office; they bring with them a complex set of social and cultural knowledge on who a doctor is and should be, how a patient can gain his favours and how much one can trust a doctor’s orders. One of the main social problems in present day Romania is the malfunctioning, poorly managed, corrupt, state-funded medical system. Despite the many insufficiencies, patients and doctors generally find ways to treat the problem at hand. Informal payments – a common practice in the Romanian medical system – seem to sustain a patient’s inclination to ignore or challenge in an informal setting the medical advice received. Even when a patient follows the prescribed treatment, this is often accompanied by other treatment methods inspired by the media, family or friends. My chapter is based on ongoing in-depth interviews with medical practitioners and patients which so far reveal a complex set of negotiated identities that take the doctor-patient relation beyond a simplistic power structure.