5. Analyze the role of culture and power in mediating relationship quality, including that of the
health care professional and patient.

9. Recognize the infrastructural nature of hierarchy.

11. Articulate differences between the nurse's and physician's role.

Section 2 Exercise 5 Balance of power

Overview: Hierarchies in the medical system often require a sharp eye to observe and articulate. Power relationships are not necessarily conveyed by means of direct language ("I am the boss" or "you are inferior to me") but rather through infrastructural arrangement--where people sit, what their duties are, what they wear, and so forth. Power relationships are often discernible visually or kinesthetically--by seeing people and observing their motions. The two images that follow--as well as the other images in this exercise--show how visual elements provide clues to hierarchical relationships. They include a painting by William Chandler and a photograph by W. Eugene Smith. In each image, there are two participants, although in the Chandler painting, the patient is only marginally visible. Answer the discussion questions below.

William Chandler Dr. Willian Gleason, 1785 Oil Ohio Historical Society

W. Eugene Smith, Tomoko in Bath, 1972-75 Silver Gelatin Print SmithKline Beckman Corporation

1. What are the power relationships in each image?
2. Listen to the following comment by Professor McCann. You might also refer to Anne Sexton's poem, “The Touch,” discussed at the beginning of this unit. What insights do McCann's comment and Sexton's poem offer that might convey the experience of the respective patients depicted here? To what extent are the patients' basic needs met?

The clinical correlate introduces you to some basic statistical information about the doctor-patient relationship. Clinical correlate 5 What people want from their primary care physician