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Consider that 1 the provider has been asked to help, diagnose, counsel, treat, and often to certify the patient as "sick" in a socially approved fashion; 2 the provider organizes the discussion, directing it in a fashion that will be optimally relevant to the patient's complaints and situation; 3 the provider molds patient responses and findings into recognizable, manageable patterns this allows for problem description via paradigms about illness that have been developed and accepted within the context of biomedical practice ; 4 the provider determines which portions of the material will be regarded as significant, and this decision is often made unilaterally, independent of the patient's views; and 5 the provider then describes both the diagnostic and therapeutic actions to be taken. Provider dominance may introduce an extraordinary bias, which can lead to a unilateral and ethnocentric view of "what's wrong. In addition, formal training, instruction and certification in medical methodology creates a sense of correctness, authority, and superiority in which "the doctor knows best.