The Elephants in the Doctor-Patient Relationship: Patient's clinical interactions and the Changing Surgical Landscape of the 1890's

The phrase 'doctor-patient relationship' obscures the profound differences between clinical interactions in hospital and in private practice. In the 1890s in private practice (whether in Britain, Australia or New Zealand) patients typically encountered doctors in their own homes, while accompanied by friends or relations. In hospital, solitary patients faced a multiplicity of nurses and doctors. At this time, surgery was already moving from homes to hospitals, thereby shifting the clinical encounter from the patient's to the doctor's territory, and the balance of power from the patient to the doctor. The fiction of one doctor interacting with one patient, ignoring the financial and administrative arrangements under which they met, served the interests of inter-doctor etiquette over 'ownership' of patients, and the emerging system of specialist referrals