title: From patient deference towards negotiated and precarious informality: An Eliasian analysis of English general practitioners' understandings of changing patient relations.
abstract: This article contributes to sociological debates about trends in the power and status of medical professionals, focussing on claims that deferent patient relations are giving way to a more challenging consumerism. Analysing data from a mixed methods study involving general practitioners in England, we found some support for the idea that an apparent 'golden age' of patient deference is receding. Although not necessarily expressing nostalgia for such doctor-patient relationships, most GPs described experiencing disruptive or verbally abusive interactions at least occasionally and suggested that these were becoming more common. Younger doctors tended to rate patients as less respectful than their older colleagues but were also more likely to be egalitarian in attitude. Our data suggest that GPs, especially younger ones, tend towards a more informal yet limited engagement with their patients and with the communities in which they work. These new relations might be a basis for mutual respect between professionals and patients in the consulting room, but may also generate uncertainty and misunderstanding. Such shifts are understood through an Eliasian framework as the functional-democratisation of patient-doctor relations via civilising processes, but with this shift existing alongside decivilising tendencies involving growing social distance across broader social figurations.
authors.affiliation: Department of Sociology & Centre for Social Science and Global Health, University of Amsterdam, PO Box 15508, 1001 NA Amsterdam, The Netherlands. Electronic address: p.r.brown@uva.nl.
authors.forename: Patrick
authors.initials: P
authors.lastname: Brown
authors.affiliation: Centre for Criminology and Sociology, Royal Holloway (University of London), Egham, Surrey TW20 0EX, UK. Electronic address: M.Elston@rhul.ac.uk.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Elston
authors.affiliation: Centre for Criminology and Sociology, Royal Holloway (University of London), Egham, Surrey TW20 0EX, UK. Electronic address: J.Gabe@rhul.ac.uk.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gabe
mesh_terms: D000328:Adult; D000368:Aged; D004739:England; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010819:Physician's Role / Q000523:psychology*; D010817:Physician-Patient Relations; D011364:Professional Practice / Q000592:standards / Q000639:trends*; D012922:Social Change; D012962:Sociology, Medical / Q000639:trends; D013222:State Medicine; D011795:Surveys and Questionnaires
keywords: Consumerism; Deference; Doctor-patient relationship; Elias; Medical profession; United Kingdom; Violence