“Ship? What Ship? I Thought I was Going to the Doctor!”: Patient-Centered Perspectives on the Health Care Team

  • David Barnard
Part of the Philosophy and Medicine book series (PHME, volume 29)


Whatever other virtues it may have, the leading metaphor of this volume is definitely not patient-centered. The image of the physician as the captain of a ship, or of illness and treatment as an ocean voyage requiring the coordination of deck-hands, mates, officers, and nautical machinery, is a bureaucrat’s image. It reflects a preoccupation with administrative structure, organizational behavior, and the rational deployment of people and technology. It does not reflect the patient’s experience of illness.


Health Care Team Insecure Attachment Attachment Figure Attachment Behavior Homeless Child 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Barnard, D.: 1985, ‘Unsung Questions of Medical Ethics’, Social Science and Medicine 21, 243–249.CrossRefGoogle Scholar
  2. 2.
    Barsky, A. J.: 1981, ‘Hidden Reasons Some Patients Visit Doctors’, Annals of Internal Medicine 94, 492–498.Google Scholar
  3. 3.
    Bloom, J. R.: 1979, ‘Team Care: Solution for Hospital Oncology Units?’ Health Care Management Review 4, 23–30.Google Scholar
  4. 4.
    Boss, M.: 1983, Existential Foundations of Medicine and Psychology, Jason Aronson, New York.Google Scholar
  5. 5.
    Bowlby, J.: 1969, Attachment and Loss: Vol. 1: Attachment, Basic Books, New York.Google Scholar
  6. 6.
    Bowlby, J.: 1973, Attachment and Loss: Vol. 2: Separation, Basic Books, New York.Google Scholar
  7. 7.
    Bowlby, J.: 1980, Attachment and Loss: Vol. 3: Loss, Basic Books, New York.Google Scholar
  8. 8.
    Buber, M.: 1958. I and Thou, 2nd ed., Scribner’s, New York.Google Scholar
  9. 9.
    Burnum, J. F.: 1973, ‘What One Internist Does in His Practice’, Annals of Internal Medicine 78, 437–444.Google Scholar
  10. 10.
    Cassell, E. J.: 1979, The Healer’s Art, Penguin, Baltimore.Google Scholar
  11. 11.
    Dingwall, R.: 1976, Aspects of Illness, Martin Robertson, London.Google Scholar
  12. 12.
    Donabedian, A.: 1983, ‘The Quality of Care in a Health Maintenance Organization: A Personal View’, Inquiry, 20, 218–222.Google Scholar
  13. 13.
    Fairbairn, W. R. D.: 1952, Psychoanalytic Studies of the Personality, Routledge and Kegan Paul, London.Google Scholar
  14. 14.
    Fletcher, R. H. et al.: 1983, ‘Patients’ Priorities for Medical Care’, Medical Care 21, 234–242.CrossRefGoogle Scholar
  15. 15.
    Frank, J.: 1973, Persuasion and Healing, Johns Hopkins University Press, Baltimore.Google Scholar
  16. 16.
    Freud, A. and Burlingham, D.: 1973, Infants without Families: Report on the Hampstead Nurseries 1939–1945, International Universities Press, New York.Google Scholar
  17. 17.
    Gold, M.: 1976, ‘A Crisis of Identity: The Case of Medical Sociology’, Journal of Health and Social Behavior 18, 160–168.CrossRefGoogle Scholar
  18. 18.
    Greenacre, P.: 1954; ‘The Role of Transference’, Journal of the American Psychoan alytic Association 2, 671–684.Google Scholar
  19. 19.
    Halstead, L.: 1976, ‘Team Care in Chronic Illness: A Critical Review of the Literature of the Past 25 Years’, Archives of Physical Medicine and Rehabilitation 57, 507–511.Google Scholar
  20. 20.
    Heschel, A. J.: 1955, God in Search of Man: A Philosophy of Judaism, Farrar, Straus, Giroux, New York.Google Scholar
  21. 21.
    Heschel, A. J.: 1965, Who is Man?, Stanford University Press, Stanford, California.Google Scholar
  22. 22.
    Janis, I.: 1958, Psychological Stress, Wiley, New York.Google Scholar
  23. 23.
    Kaffman, M.: 1972, ‘Characteristics of the Emotional Pathology of the Kibbutz Child’, American Journal of Orthopsychiatry 42, 692–709.CrossRefGoogle Scholar
  24. 24.
    Kahaha, R. J. and Bibring, G. L.: 1964, ‘Personality Types in Medical Management’, in N. Zinberg (ed.), Psychiatry and Medical Practice in a General Hospital, Interna tional Universities Press, New York, pp. 108–123.Google Scholar
  25. 25.
    Katz, J.: 1984, The Silent World of Doctor and Patient, Free Press, New York.Google Scholar
  26. 26.
    Kestenbaum, V. (ed.): 1982, The Humanity of the III: Phenomenological Perspectives, University of Tennessee Press, Knoxville.Google Scholar
  27. 27.
    Lamb, M. E. (ed.): 1982, Nontraditional Families: Parenting and Child Development, Erlbaum, Hillsdale, New Jersey.Google Scholar
  28. 28.
    Leeuw, G. van der: 1963, Religion in Essence and Manifestation, Harper and Row, New York.Google Scholar
  29. 29.
    Levy-Shiff, R.: 1983, ‘Adaptation and Competence in Early Childhood: Communally Raised Kibbutz Children versus Family Raised Children in the City’, Child Develop ment 54, 1606–1614.CrossRefGoogle Scholar
  30. 30.
    Lichstein, P.: 1982, ‘The Resident Leaves the Patient: Another Look at the Doctor-Patient Relationship’, Annals of Internal Medicine 96, 762–765.Google Scholar
  31. 31.
    Linn, M. W. et al.: 1982, ‘Satisfaction with Ambulatory Care and Compliance in Older Patients’, Medical Care 20, 606–614.CrossRefGoogle Scholar
  32. 32.
    Maccoby, E. and Feldman, S. S.: 1972, ‘Mother-attachment and Stranger Reactions in the Third Year of Life’, Monographs of the Society for Research in Child Development 37 (1, Serial No. 146).Google Scholar
  33. 33.
    McKinlay, J. B.: 1981, ‘Social Network Influences on Morbid Episodes and the Career of Help Seeking’, in L. Eisenberg and A. Kleinman (eds.), The Relevance of Social Science for Medicine, D. Reidel, Dordrecht, Holland, pp. 77–110.Google Scholar
  34. 34.
    McWhinney, I. R.: 1972, ‘Beyond Diagnosis’, New England Journal of Medicine 287, 384–387.CrossRefGoogle Scholar
  35. 35.
    Mechanic, D.: 1976, The Growth of Bureaucratic Medicine: An Inquiry into the Dynamics of Patient Behavior and the Organization of Medical Care, Wiley, New York.Google Scholar
  36. 36.
    Moore, T. W.: 1969, ‘Effects on the Children’, in S. Yudkin and A. Holmes (eds.), Working Mothers and their Children, 2nd ed., Sphere Books, London.Google Scholar
  37. 37.
    Nagi, S.: 1975, ‘Teamwork in Health Care in the U.S.: A Sociological Perspective’, Milbank Memorial Fund Quarterly, 75–91.Google Scholar
  38. 38.
    Nevo, B.: 1977, ‘Personality Difference Between Kibbutz Born and City Born Adults’, Journal of Psychology 96, 303–308.CrossRefGoogle Scholar
  39. 39.
    Otto, R.: 1923, The Idea of the Holy, Penguin, Harmondsworth.Google Scholar
  40. 40.
    Pelled, J.: 1964, ‘On the Formation of Object-Relations and Identifications of the Kibbutz Child’, Israel Annals of Psychiatry and Related Disciplines 2, 144–161.Google Scholar
  41. 41.
    Pfifferling, J.: 1981, ‘A Cultural Prescription for Medicocentrism’, in L. Eisenberg and A. Kleinman (eds.) The Relevance of Social Science for Medicine, D. Reidel, Dordrecht,Holland, pp. 197–222.Google Scholar
  42. 42.
    Reiser, S. J.: 1978, Medicine and the Reign of Technology, Cambridge University Press, New York.Google Scholar
  43. 43.
    Rogers, J. and Curtis, P.: 1980, ‘The Concept and Measurement of Continuity in Primary Care’, American Journal of Public Health 70, 122–127.Google Scholar
  44. 44.
    Sagi, A. et al.: 1985, ‘Security of Infant-Mother,-Father, and-Metapelet Attachments Among Kibbutz-Reared Israeli Children’, in I. Bretherton and E. Waters (eds.), Growing Points in Attachment Theory and Research, Society for Research in Child Development, pp. 257–275.Google Scholar
  45. 45.
    Scarr, S.: 1984, Mother Care/Other Care, Basic Books, New York.Google Scholar
  46. 46.
    Schaffer, H. R., and Emerson, P. E.: 1964, ‘The Development of Social Attachments in Infancy’, Monographs of the Society for Research in Child Development 29(3), 1–77.CrossRefGoogle Scholar
  47. 47.
    Schleiermacher, F.: 1958, On Religion: Speeches to its Cultured Despisers, Harper and Row, New York.Google Scholar
  48. 48.
    Spiro, M. E.: 1958, Children of the Kibbutz, Schocken, New York.Google Scholar
  49. 49.
    Spitz, R. A.: 1946, ‘Anaclitic Depression’, Psychoanalytic Study of the Child 2, 313–342.Google Scholar
  50. 50.
    Stein, R. E. K. and Jessop, D. J.: 1984, ‘Does Pediatric Home Care Make a Difference for Children with Chronic Illness? Findings from the Pediatric Ambulatory Care Treatment Study’, Pediatrics 73, 845–853.Google Scholar
  51. 51.
    Strauss, A. et al.: 1985, Social Organization of Medical Work, University of Chicago Press, Chicago.Google Scholar
  52. 52.
    Taylor, S. E.: 1979, ‘Hospital Patient Behavior: Helplessness, Reactance, or Con trol?’, Journal of Social Issues 35, 156–184.CrossRefGoogle Scholar
  53. 53.
    Tizard, J., and Tizard, B.: 1971, ‘The Social Development of Two-year-old Children in Residential Nurseries’, in H. R. Schaffer (ed.), The Origins of Human Social Relations, Academic Press, New York.Google Scholar
  54. 54.
    Toms, W. B.: 1977, ‘An Analysis of the Impact of the Loss of a Primary Care Physician on a Patient Population’, Journal of Family Practice 4, 115–120.Google Scholar
  55. 55.
    Winnicott, D. W.: 1958, Collected Papers: Through Paediatrics to Psychoanalysis, Tavistock, London.Google Scholar
  56. 56.
    Winnicott, D. W.: 1965, The Maturational Processes and the Facilitating Environment, International Universities Press, New York.Google Scholar
  57. 57.
    Wise, H. et al.: 1974, Making Health Teams Work, Ballinger, Cambridge.Google Scholar
  58. 58.
    Wolfenstein, M.: 1957, Disaster, Free Press, New York.Google Scholar
  59. 59.
    Zimmer, J. G., et al.: 1985, ‘A Randomized Controlled Study of a Home Health Care Team’, American Journal of Public Health 75, 134–141.CrossRefGoogle Scholar

Copyright information

© D. Reidel Publishing Company 1988

Authors and Affiliations

  • David Barnard
    • 1
  1. 1.College of MedicineThe Pennsylvania State UniversityHershey

Personalised recommendations