Anthropological Perspectives on Health Care Professional Training

So grad school is kicking my butt this semester, and I have not had as much time as I would like to blog! I feel sad that it has fallen by the wayside.

I'm taking a really great anthropology class this semester on health systems and medical systems. One of our first class sessions we read and discussed articles on the topic of medical provider training, and the making of the modern health care professional, from an anthropological perspective. I find this topic really interesting in its own right (especially because of Robbie Davis-Floyd's analysis of the way OB/Gyns are trained in Birth as an American Rite of Passage), but also because I know two people in medical school right now. So as I read these articles I imagine them being shaped and molded into new kinds of people.

Readings covered the education and creation of the modern health care professional, or the formation of the individual undergoing biomedical training, and aspects of training that contribute to their subjectivation. A lot of really great discussion points came out of these articles (see below for bibliography), such as the socialization of medical students, how students come to patient-blame and ignore social context, the perpetuation of inequalities, and the issue of the market-driven health care system.

Most interesting was the way health care professionals are socialized in their training, learning how to fit in as a clinician. Students learn things like "detached concern," and how to appropriately "present" patients. Unfortunately, these students often come to engage in victim-blaming, blaming the patients for their poor health rather than larger forces like power inequalities, poverty, racism, social status, etc. Because medical students are often taught how to standardize and be objective, they fail to take into account the unique, situated experiences of each individual patient. In fact, these future health care providers repeatedly come to preserve social inequality and reproduce power inequalities created by biomedicine instead of working to solve the broader political and economic issues that contribute to poor health.

Anthropological study of the way in which clinicians and physicians become modern health care professionals enables us to understand “what kinds of people are formed” through medical training. This is a topic I find particularly fascinating because of the enormous effect that health care professionals have on all our lives. I found it interesting to read the ways that clinical training affects the not only the kind of doctors these students become, but also the kinds of people they become. Moreover, these readings illuminated the important ways in which their biomedical training preserves the production the biomedical model, power differentials, and the widening health disparities in our health care system.

I would have liked to have learned more about what these researchers and authors feel would make medical training more efficient at teaching these future health care providers to recognize and address social and power inequalities, rather than perpetuating them. If medical training continues produce health care professionals who ignore the social context of each patient’s health and suffering, what is a better way to train them? These are not issues that will be easily solved. 


Articles:

Adams, V. and S. R. Kaufman 2011 Ethnography and the Making of Modern Health Professionals. Culture, Medicine and Psychiatry 35(2):313-320.

Holmes, S. M., A. C. Jenks and S. Stonington 2011 Clinical Subjectivation: Anthropologies of Contemporary Biomedical Training. Culture, Medicine and Psychiatry 35(2):105-112.

Holmes SM and Ponte M. 2011 En-case-ing the Patient: Disciplining Uncertainty in Medical Student Patient Presentations. Culture, Medicine and Psychiatry. 35(2):163-82.

Jaye, C., T. Egan, and K. Smith-Han 2010 Communities of Clinical Practice and Normalising Technologies of Self: Learning to Fit In on the Surgical Ward. Anthropology & Medicine 17 (1): 59-73.

Rivkin-Fish, M. 2011 Learning the Moral Economy of Commodified Health Care: ‘‘Community Education,’’ Failed Consumers, and the Shaping of Ethical Clinician-Citizens Cult Med Psychiatry (2011) 35:183-208.