Like the other contributors to this symposium, I owe a profound debt to Jay Katz for his intellectual rigor, his gentle but firm Socratic pedagogy, and his unparalleled generosity of time and friendship. I first met Jay during my last year of law school when, at the urging of friends, I enrolled in his seminar on informed consent. By that time, he had collected most of the materials on which he based his important book. Not surprisingly, a single semester could not contain all of that material, so many of us continued on into the second semester. During that time I learned a number of things, but largely in the abstract mode that often characterizes the law school classroom. Fortunately, I had the opportunity after my first year in medical school to work on Jay's book, The Silent World of Doctor and Patient. I am not sure that I contributed much. I have always viewed that summer as Jay's effort to create a tutorial designed to make sure I "got it." Even so, it required actually taking care of patients for the last twenty years to bring some of his lessons home.
Over the years, I have come to see the physician-patient relationship not simply as a dyad of autonomous individuals, but as one part, albeit an important and complex part, of a web of dynamic interactions that influence both parties. This perspective has important implications. The work of Barabási and others has shown that networks are fluid, self-creating, and always changing. At the same time, networks tend to respond poorly or unexpectedly to deliberate attempts to induce change. Pressure at one point can lead to a countervailing response at another. This understanding provides additional insights into people's actions and suggests both reasons for resistance as well as the possibility of support from unanticipated sources.
Clayton, Ellen Wright
"The Web of Relations: Thinking About Physicians and Patients,"
Yale Journal of Health Policy, Law, and Ethics:
2, Article 9.
Available at: http://digitalcommons.law.yale.edu/yjhple/vol6/iss2/9