“There is Nothing Left but to Trust Anyone”: A Crisis of Trust in the Communication of a Doctor and an Onco-Patient

Abstract

The specific antithesis of the doctor and the patient ensures the functioning of the entire health care system. When one treats and advises, and the other executes recommendations that are based on scientific knowledge and personal experience — this is considered a normal medical situation. However, each case and each disease is unique, and therefore any interaction between a doctor and a patient is graded — from ideal and trouble-free to conflicting and contradictory. It is this interaction that goes "wrong", and provokes a crisis of communication between the doctor and the patient, which in turn is an important motive for the patient's refusal of conventional therapy. This crisis of communication is especially pronounced in cases where we are talking about fatal diseases, where the loss of time and the wrong decision can aggravate the situation of recovery. The article analyzes examples of such communication crises. By reconstructing the interaction between the doctor and the patient, the authors describe how patients justify refusal (or vice versa) of classical therapy, as well as what set of reactions to the actions of patients have doctors. The authors summarize all these narratives in several important thematic blocks: the specific rhetorical techniques that medical paternalistic acts are clothed in; the typologies of patients that are closely related to their requests for the format of care; and the basic normative components that form the request for a new ethic of medical care. The obtained results make a contribution to the broad field of social research of medicine, allowing to look at the normative components of the real actions of doctors and patients in the field of healthcare.