The papers summarised below will provoke reflection on the likely effects of empowered and empowering patients upon the professional-patient relationship.

Exploring “healthism” in the middle classes

▸ In the first paper a GP and psychiatrist explore what many health professionals see as a common, increasingly uncontainable, and personally stressful problem: the beliefs, behaviour and expectations of the articulate, health aware, and information rich middle classes. The issue is encapsulated in the phrase “healthism” which “is related to, but should not be equated with, consumerism, which is a broader term with a host of different meanings, depending on context”.

Consumerism has been described as having five faces: a vehicle for power, the ideology of conspicuous consumption, an economic ideology, a political ideology, and a social movement to protect the rights of consumers. “This last meaning comes closest to the positive connotations of consumerism as applied in health care. But the more negative notion … is probably the meaning that aligns best with healthism as an individual behaviour pattern and a potential public health problem.” The paper describes some fictitious case scenarios to illustrate “healthism” and its effects. They reflect real life problems encountered in clinical situations. For example:

Case 1: Fiona and Bruce Taylor-Brown are a childless couple in their mid 30s. Both work full time in the financial sector and have difficulty attending normal surgery hours. They are not frequent attenders, but when they do come, they always book the last appointment of the evening and usually arrive late, just as the GP is locking up. One Friday evening, Bruce attends complaining of a 2 week history of generalised weakness, light headedness, and “a burning feeling going around in the blood”. He has with him a printout from the Internet which attributes his symptoms to the presence of mercury in dental amalgam. He also has the …