Politics, Power and Persuasion

Medicine has evolved and developed in countless ways to arrive at our current modern, version X.0 we now have. Influenced and shaped by technological advancements, social, demographical, cultural, political, and economic change through the ages, to name but a few factors off the top of my head, it still is and will continue to evolve accordingly.

As a fourth year medical student, in the age of the biopsychosocial model of medicine, I (and I think I am safe to speak for most of my colleagues from my cohort) have been made acutely aware, and rightfully so, that the one thing that remains unchanged, is the patient lying at the centre of healthcare and clinical practice.

But what I would argue, that is not explicitly taught in medical school, but what I see from my perch at the precipice of clinical practice, is that the core of healthcare is not a circle, but a triangle cornered by the three Ps of politics, power and persuasion. And not just any triangle, but the green recycling one, to show the strong interrelationship between the three, in all their various meanings, so much so that it is almost impossible to separate them (despite many an attempt to do so).

Take how the doctor-patient relationship, the key to a successful consultation, is dependant on the finely attuned, balanced shifting of power between the two parties. And then consider how the true power lies in persuasion: persuasion that you are a competent, good doctor worth trusting, that you have the patient's best interests at heart and they should therefore take your advice, that it is important that the patient complies with their medication and make the lifestyle choices advised (particularly with the increasing global burden of non-communicable disease), that it is important they come back if their condition gets worse, that they should come to see you at all in the first place. I must convince my future employer that I am better than all the other applicants for the placement on offer and then convince myself to attend work each day, to take the time to study and keep up to date with the best evidence-based practice.

At a more macro level, companies need to create the most persuasive product or service (most cost-effective, safe, quality...) on the market for NICE to recommend and/or hospitals and commissioning groups to invest in. The decision-makers in such situations must prove their competence at leadership by allocating resources, setting goals and meeting targets in light of the needs of each of their micro-environments whilst complying with the limitations and expectations of government policy. The government itself being answerable to the masses who themselves are often, wrongly or rightly, persuaded by the media.

Politics then ties everything together neatly with it, at its most fundamental level, being the art of influencing (i.e. persuading) people at an individual, organisational or governmental level. With this arguably being easier and more effective with the more power one wield, and requiring the consideration of cultural, economical, social, religious and gender factors of individuals and groups.

Of course, the above (in-exhaustive) examples of power, politics and persuasion will require and demonstrate its effect with various degrees of subtlety. But my primary goal was to establish the basis of my link between these three phrases and three others one would not commonly associate with them. Those of communication, relationships and responsibility.

The majority of people I asked regarding the title of politics, power and persuasion in healthcare when contemplating the content for this essay, in some way almost stigmatised the use of such phrases. I cannot recall a single answer akin to "a force of good!" or "a tool for bringing about positive change."

And that's where I see the future of healthcare. We live in a time when healthcare, a major concern in people's lives globally (just take a look at the results from the United Nations "my world" survey), is constantly making headlines. Unavoidable in an age where technology gives patients increasing access to information and what's available to them. But perhaps we focus too much on these external, somewhat detached parties in the political healthcare game.

I say, let's take medicine back to its roots. Lets not be afraid to use and accept the use of politics, power and persuasion in our practice and instead realise its benefits in each of our own micro-networks. Only then will be free to explore the powerful possibilities, potential and interpretation of persuasion and politics in the care of our patients.